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PubMedDate not supplied

Cancer survival probability as a function of ego defense (adaptive) mechanisms versus depressive symptoms.

Psychological treatment studies, uncontrolled for ego defense (adaptive) styles, report conflicting survival results. The authors hypothesized that "immature" adaptive styles and frequent depression symptoms would independently predict lower survival rates. This study followed 86 consecutive, mostly late-stage, cancer outpatients for up to 5 years; their survival data were analyzed in relation to the Beck Depression Inventory and the Defense Style Questionnaire scores at study entry. Cumulative survival probability curves contrasted the extreme cases: the most (N=15) to the least (N=21) depressed, and the "immature" (N=14) to the "mature" (N=16) adaptors. Depression did not separate the groups until 30 months after diagnosis. Ego defense style separated them at 8 months; by 18 months, the "immature" survival probability had dropped to 50%, versus 87% for the "mature." At 36 months, survival probabilities were 19% and 57%, respectively. These data direct clinical attention toward ego defense mechanisms as indicators of distress and lowered survival in cancer patients. They further suggest that the maturity of adaptive mechanisms must be controlled for in behavioral-treatment trials of cancer patients.

Adaptation, Psychological↗

PubMedDate not supplied

Estimation of markov chain transition probabilities and rates from fully and partially observed data: uncertainty propagation, evidence synthesis, and model calibration.

Markov transition models are frequently used to model disease progression. The authors show how the solution to Kolmogorov's forward equations can be exploited to map between transition rates and probabilities from probability data in multistate models. They provide a uniform, Bayesian treatment of estimation and propagation of uncertainty of transition rates and probabilities when 1) observations are available on all transitions and exact time at risk in each state (fully observed data) and 2) observations are on initial state and final state after a fixed interval of time but not on the sequence of transitions (partially observed data). The authors show how underlying transition rates can be recovered from partially observed data using Markov chain Monte Carlo methods in WinBUGS, and they suggest diagnostics to investigate inconsistencies between evidence from different starting states. An illustrative example for a 3-state model is given, which shows how the methods extend to more complex Markov models using the software WBDiff to compute solutions. Finally, the authors illustrate how to statistically combine data from multiple sources, including partially observed data at several follow-up times and also how to calibrate a Markov model to be consistent with data from one specific study.

Calibration↗

PubMedDate not supplied

Physicians' estimates of the probability of myocardial infarction in emergency room patients with chest pain.

To evaluate the ability of emergency room physicians to estimate the probability of myocardial infarction in patients with acute chest pain, the authors gathered historical, physical, and electrocardiographic information from 492 patients at the time of their presentation. The physicians admitted 30% of them to intensive care: 53 of the 61 patients with infarctions (sensitivity = 87%) and 96 of the 431 without infarctions (specificity = 78%). Overall, 36% of those admitted had infarctions. The physicians' numeric estimate of the probability of infarction was a good univariate discriminator of infarction, as demonstrated by Receiver Operator Characteristics analysis, and, as indicated by their actual operating point, they seemed to maximize the accuracy of patient classification rather than sensitivity or specificity. Logistic regression analysis identified the physicians' probability estimate as the strongest multivariate predictor of infarction, considering all other clinical information available.

Adult↗

PubMedDate not supplied

Determining transition probabilities from mortality rates and autopsy findings.

The Markov process is a useful tool for modeling the natural history of disease, which is becoming increasingly important as new diagnostic tests increase the detectability of early-stage disease. The accuracy of a Markov model, however, depends on the accuracy of the estimates for the transition probabilities between different stages of disease. Because these estimates are usually based on "expert opinion" or small cohort studies, they are subject to imprecision and bias. The authors describe an alternative method of estimating transition probabilities from the stage distribution of disease observed at the time of death and age-specific mortality rates from other causes. In addition, they prove that the transition probabilities are unique given certain assumptions about how they change with age. Finally, they illustrate the method using population-based data for prostate cancer.

Adult↗

PubMed1989

Probability assessment approach to therapeutic drug monitoring: tobramycin.

Pharmacokinetic monitoring is an important therapeutic goal of aminoglycoside therapy. The overall goal of this study was to identify specific patient groups that would derive the maximum benefit from therapeutic drug monitoring services. These groups are patient populations with high probabilities of achieving toxic or subtherapeutic concentrations. Out of a total population of 86 stable, noncritically ill patients, 27 toxic concentrations (trough greater than 2.0 micrograms/mL) occurred in 15 patients. In comparison to patients (n = 46) with therapeutic concentrations (trough less than 2.0 micrograms/mL, peak greater than 4.0 micrograms/mL), these patients were older (64 +/- 11 vs. 54 +/- 18 years; p less than 0.02) and had a higher percentage of females (66.7 vs. 37 percent; p less than 0.05). Those patients with subtherapeutic concentrations (43 concentrations in 25 patients) had higher estimated creatinine clearance values than those with therapeutic concentrations (94 +/- 45 vs. 74 +/- 27 mL/min; p less than 0.005). Probability assessment analysis of the data showed a sevenfold increase in toxic concentrations in patients above 50 years. Females over age 50 had 2.3 times the risk of developing toxic concentrations as males over age 50. In contrast, the development of low concentrations was not predicted by age or sex. Underdosage by greater than or equal to 30 percent was a reasonable predictor (75 percent) of low peak concentrations. Furthermore, toxic concentrations did not occur in patients who were underdosed, justifying dosage increases prior to obtaining serum concentrations in these patients. The group with the highest probability of attaining therapeutic concentrations was males receiving therapeutic doses who were under age 50 (85.5 percent).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

A comparison of alternative methods to compute conditional genotype probabilities for genetic evaluation with finite locus models.

An increased availability of genotypes at marker loci has prompted the development of models that include the effect of individual genes. Selection based on these models is known as marker-assisted selection (MAS). MAS is known to be efficient especially for traits that have low heritability and non-additive gene action. BLUP methodology under non-additive gene action is not feasible for large inbred or crossbred pedigrees. It is easy to incorporate non-additive gene action in a finite locus model. Under such a model, the unobservable genotypic values can be predicted using the conditional mean of the genotypic values given the data. To compute this conditional mean, conditional genotype probabilities must be computed. In this study these probabilities were computed using iterative peeling, and three Markov chain Monte Carlo (MCMC) methods--scalar Gibbs, blocking Gibbs, and a sampler that combines the Elston Stewart algorithm with iterative peeling (ESIP). The performance of these four methods was assessed using simulated data. For pedigrees with loops, iterative peeling fails to provide accurate genotype probability estimates for some pedigree members. Also, computing time is exponentially related to the number of loci in the model. For MCMC methods, a linear relationship can be maintained by sampling genotypes one locus at a time. Out of the three MCMC methods considered, ESIP, performed the best while scalar Gibbs performed the worst.

Genotype↗

PubMed1998

Estimation of the temporal probability of human immunodeficiency virus (HIV) dementia after risk stratification for HIV-infected persons.

We developed a scheme using routinely available data to estimate the risk of human immunodeficiency virus (HIV) dementia in HIV-infected persons over time. We performed a longitudinal review of medical records from more than 100 medical facilities in 11 U.S. cities. A total of 19,462 HIV-infected persons without history of dementia enrolled in a multi-institution survey. The main outcome measure was the development of HIV dementia (1987 case definition) during the median follow-up period of 17 months (range, 1 to 72 months). Of 19,462 HIV-infected persons, HIV dementia developed in 880 persons (4.5%; 2.6% per person-year). The strongest predictors of HIV dementia were CD4+ T-lymphocyte count, anemia, and AIDS-defining infections or cancer. The 2-year probability of HIV dementia was highest for persons who had a CD4+ T-lymphocyte count of fewer than 100 cells/microL and an AIDS-defining illness or anemia or both (18.6 to 24.9%). Intermediate risk was observed in persons with CD4+ T-lymphocyte count of 100 to 199 cells/microL and an AIDS-defining illness or anemia or both or in persons with a CD4+ T-lymphocyte count of fewer than 100 cells/microL but without another risk factor (2-year probability, 10.4 to 15.2%). The 2-year probability that HIV dementia would develop was lowest (1.0%) for persons with CD4+ T-lymphocyte count of more than 200 cells/microL and no other risk factors. Risk stratification using routine clinical information provides information that may prove useful in patient care decisions.

AIDS Dementia Complex↗

PubMedDate not supplied

Methods for solving nonlinear equations used in evaluating emergency vehicle busy probabilities.

In this paper we present two iterative methods for solving a model to evaluate busy probabilities for Emergency Medical Service (EMS) vehicles. The model considers location dependent service times and is an alternative to the mean service calibration method; a procedure, used with the Hypercube Model, to accommodate travel times and location-dependent service times. We use monotonicity arguments to prove that one iterative method always converges to a solution. A large computational experiment suggests that both methods work satisfactorily in EMS systems with low ambulance busy probabilities and the method that always converges to a solution performs significantly better in EMS systems with high busy probabilities.

Algorithms↗

PubMed1995

Issues associated with the design of a national probability sample for human exposure assessment.

Data obtained from national probability sample surveys provide important information on the prevalence of various health conditions and distributions of physical and biochemical characteristics of the U.S. population. The sample design of a survey specifies how sampling from a designated population over a stated period is to be accomplished. A survey's analytical objectives and interests--in particular subpopulations--affect the sample design strategy. Selected subdomains of the population often must be oversampled so that estimates can be made with acceptable precision. This article addresses sample design considerations for a national probability sample for human tissue monitoring and specimen banking. Among the sampling issues addressed are the oversampling of special populations e.g., minority groups and at-risk groups such as low income or elderly persons; geographic coverage; and sample size considerations. The sample design for a major health survey, the Third National Health and Nutrition Examination Survey (NHANES III), is used to illustrate a complex, multistage probability sample design and to highlight some of the sampling issues discussed in this article.

Data Collection↗

PubMed2002

Probability-based construction of reference ranges for ratios of log-gaussian analytes: an example from automated leukocyte counts.

Reference ranges (RRs) are frequently used for interpreting laboratory values in clinical trials, assessing abnormality of laboratory results, and combining results from different laboratories. When a clinical laboratory measure must be derived from other tests, eg, the WBC differential percentage from the WBC count and WBC differential absolute count, a derivation of the RR may also be required. A naive method for determining RRs calculates the upper and lower limits of the derived test from the upper and lower limits of the measured values using the same algebraic formula used for the derived measure. This naive method and any others that do not use probability-based transformations do not maintain the distributional characteristics of the RRs. RRs derived in such a manner are deemed uninterpretable because they do not contain a specific proportion of the distribution. We propose a probability-based approach for the interconversion of RRs for ratios of 2 log-gaussian analytes. The proposed method gives a simple algebraic formula for calculating the RRs of the derived measures while preserving the probability relationships. The nonparametric method and a parametric method that takes the log transformation, estimates an RR, and then exponentiates are provided as comparators. An example that compares the commonly used naive method and the proposed method is provided on automated leukocyte count data. This provides evidence that the proposed method maintains the distributional characteristics of the transformed RR measures while the naive method does not.

Adolescent↗

PubMed2005

The proximity heuristic in judgments of accident probabilities.

In daily life, probabilities are often assessed informally through the perceived distance to a target event. Accident probabilities are believed to be high when a disastrous outcome appears to be close. This proximity heuristic can lead to exaggerated p(death) estimates in risky situations (Experiment 2), and sometimes higher probabilities for death after near-accidents than after actual accidents (Experiment 3 and 4). Near-accidents are also believed to be equally good, or better, predictors of future disasters than actual accidents, despite being less serious and more frequent (Experiment 5). The proximity heuristic influences the way people talk about their own and other people's chances (Experiment 1), and how they prepare to avoid (or, if necessary, to produce) a disastrous outcome (Experiment 6).

Accidents, Traffic↗

PubMed2004

Conditional probability methods for haplotyping in pedigrees.

Efficient haplotyping in pedigrees is important for the fine mapping of quantitative trait locus (QTL) or complex disease genes. To reconstruct haplotypes efficiently for a large pedigree with a large number of linked loci, two algorithms based on conditional probabilities and likelihood computations are presented. The first algorithm (the conditional probability method) produces a single, approximately optimal haplotype configuration, with computing time increasing linearly in the number of linked loci and the pedigree size. The other algorithm (the conditional enumeration method) identifies a set of haplotype configurations with high probabilities conditional on the observed genotype data for a pedigree. Its computing time increases less than exponentially with the size of a subset of the set of person-loci with unordered genotypes and linearly with its complement. The size of the subset is controlled by a threshold parameter. The set of identified haplotype configurations can be used to estimate the identity-by-descent (IBD) matrix at a map position for a pedigree. The algorithms have been tested on published and simulated data sets. The new haplotyping methods are much faster and provide more information than several existing stochastic and rule-based methods. The accuracies of the new methods are equivalent to or better than those of these existing methods.

Animals↗

PubMed2006

Haplotype probabilities for multiple-strain recombinant inbred lines.

Recombinant inbred lines (RIL) derived from multiple inbred strains can serve as a powerful resource for the genetic dissection of complex traits. The use of such multiple-strain RIL requires a detailed knowledge of the haplotype structure in such lines. Broman (2005) derived the two- and three-point haplotype probabilities for 2(n)-way RIL; the former required hefty computation to infer the symbolic results, and the latter were strictly numerical. We describe a simpler approach for the calculation of these probabilities, which allowed us to derive the symbolic form of the three-point haplotype probabilities. We also extend the two-point results for the case of additional generations of intermating, including the case of 2(n)-way intermated recombinant inbred populations (IRIP).

Animals↗

PubMed2004

On the Metropolis-Hastings acceptance probability to add or drop a quantitative trait locus in Markov chain Monte Carlo-based Bayesian analyses.

The Metropolis-Hastings algorithm used in analyses that estimate the number of QTL segregating in a mapping population requires the calculation of an acceptance probability to add or drop a QTL from the model. Expressions for this acceptance probability need to recognize that sets of QTL are unordered such that the number of equivalent sets increases with the factorial of the QTL number. Here, we show how accounting for this fact affects the acceptance probability and review expressions found in the literature.

Algorithms↗

PubMed1997

Lower probability of patient survival with continuous peritoneal dialysis in the United States compared with Canada. Canada-USA (CANUSA) Peritoneal Dialysis Study Group.

In a prospective cohort study of 680 incident continuous peritoneal dialysis (PD) patients in North America, dialysis in the United States compared with Canada was associated with a relative risk (RR) of death of 1.93 (95% confidence interval [CI], 1.14 to 3.28). The 2-yr survival probability was 79.7% in Canada and 63.2% in the United States. This difference was not explained by race, age, gender, functional status, insulin-dependent diabetes mellitus, history of cardiovascular disease (CVD), nutritional status, or adequacy of dialysis. Other potential explanatory variables were further evaluated. These included severity of CVD, residual renal function, race, differential transfer to hemodialysis or transplantation, patient compliance, modality selection bias, and incidence of endstage renal disease requiring dialysis. Cardiovascular morbidity and peritonitis probabilities were compared. The CVD severity index was not different between countries; the RR risk associated with dialysis in the United States remained high at 1.87 (95% CI, 1.09 to 3.19). Residual renal function at initiation of dialysis was not different between countries. The 2-yr survival for Caucasians was 77% in Canada and 55% in the United States. There was no difference in the probability of transfer to hemodialysis or transplantation. The RR of a nonfatal cardiovascular event in the United States compared with Canada was 1.80 (95% CI, 1.21 to 2.67). There was no difference in time to first peritonitis. The observed to predicted creatinine ratio, as an estimate of compliance, was 1.13 in Canada and 1.00 in the United States. The prevalence of PD in the study centers was 48% in Canada and 22% in the United States. The incidence of new dialysis patients in 1992 was 100/million population in Canada compared with 211/ million in the United States. The survival difference is not explained by age, gender, insulin-dependent diabetes mellitus, nutritional status, or adequacy of dialysis. Neither is it explained by race, severity of CVD, transfer to hemodialysis, transplantation, or an estimate of compliance. The lower proportion of patients receiving PD in the United States may represent a selection bias of uncertain direction. The higher acceptance rate for dialysis in the United States may explain, in part, the greater cardiovascular morbidity and the decreased survival observed.

Adult↗

PubMed1991

Subjective probability and delay.

Human subjects indicated their preference between a hypothetical $1,000 reward available with various probabilities or delays and a certain reward of variable amount available immediately. The function relating the amount of the certain-immediate reward subjectively equivalent to the delayed $1,000 reward had the same general shape (hyperbolic) as the function found by Mazur (1987) to describe pigeons' delay discounting. The function relating the certain-immediate amount of money subjectively equivalent to the probabilistic $1,000 reward was also hyperbolic, provided that the stated probability was transformed to odds against winning. In a second experiment, when human subjects chose between a delayed $1,000 reward and a probabilistic $1,000 reward, delay was proportional to the same odds-against transformation of the probability to which it was subjectively equivalent.

Adult↗

PubMed2005

Comparisons of continuous and discrete methods for combining probability values associated with matched-pairs t-test data.

Fisher's well-known continuous method for combining independent probability values from continuous distributions is compared with an exact discrete analog of Fisher's continuous method for combining independent probability values from discrete distributions using matched-pairs t-test data. Fisher's continuous method is shown to be inadequate for combining probability values from many discrete distributions, given the continuity assumption when discrete distributions are considered. Although Fisher's continuous method does not detect a well-documented effect among distributions, the exact discrete analog method clearly detects the effect.

Algorithms↗

PubMed1992

Female traits, ovary and follicle characteristics, and the conditional probability of normal oocyte development after superovulation of beef cows.

The proportion of transferable beef embryos obtained after superovulation, follicle aspiration, and in vitro maturation and fertilization has been small. To seek possible explanations, cows on different planes of nutrition were treated with exogenous gonadotropin and oocytes were isolated from their ovaries. The record for each oocyte included characteristics of the follicle, ovary, and cow from which it was obtained and the response to in vitro maturation, fertilization, and development. The sample was used to obtain estimates of the relationships among the variables. The logistic function with the probability of normal development as the dependent variable was the basic equation of the statistical model. When an explanatory variable was itself a result of the biological system, an equation explaining variation therein was added to the model. Had equations representing endogenous regressors not been added to the model a simple, single equation would have represented oocyte development response; given an oocyte at aspiration only one variable, cumulus quantity, was found to condition the probability of normal development directly. However, the complete model included four additional equations: 1) the probability that an oocyte was recovered at aspiration was conditional on the plane of nutritional treatment and progesterone concentration in follicular fluid; 2) cumulus quantity was conditional on the presence on a corpus luteum, follicle size, and progesterone concentration; 3) progesterone concentration was dependent on plane of nutrition; and 4) corpus luteum was conditional on plane of nutrition. The estimated model provided some insight into the complexity of oocyte development response and the role nutrition may play.

Animal Nutritional Physiological Phenomena↗