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PubMedDate not supplied

Meta-analysis and the synthesis of evidence.

Use of meta-analytical (quantitative overview) techniques is now commonplace in a large range of medical-research contexts, with a rapid rise in its frequency of use being particularly apparent in the last decade. Many methods of meta-analysis have been proposed and used, from crude 'vote-counting' of studies showing significant or nonsignificant results, through methods for combination of effect-size estimates based on fixed- or random-effects models, to general, linear, mixed models and Bayesian methods. The history of meta-analysis and the advantages and disadvantages of various approaches to it are briefly reviewed in this paper, with reference to its application in health-services research and related fields. Broader approaches to the synthesis of evidence in these contexts using conventional multilevel modelling and hierarchical Bayesian models to address the combination of evidence from disparate types of study are then outlined.

Bayes Theorem↗

PubMed1997

Bayesian registration of models using finite element eigenmodes.

This paper is concerned with registering three-dimensional wire-frame organ models. This involves finding correspondences between points on the models of two different examples of the same organ. Such registration is widely used in the processing of medical data; for example in segmentation, or to superimpose functional information on a more detailed structural map. The algorithm described in this paper is based on matching the modes of deformation of organ shapes. Modes with lower spatial frequency characterise large scale organ features whereas small scale variations determine the high frequency modes. First, the organ sizes are normalised using a generalised version of the centroid size metric. The axes of the fundamental frequency modes are then aligned to provide initial rigid-body registration. The registration is refined by matching increasingly high frequency modes using the 'Highest confidence first' algorithm. The matches are evaluated using a Bayesian combination of local prior and likelihood functions. The prior is derived from the Gompertz metric of biological growth and ensures that physically impossible matches are not accepted. The likelihood function is a measure of the similarity between local modal deformation components. The registration algorithm has been applied by the authors in the analysis of three dimensional ultrasound data. Results are presented showing the registration of two liver models derived from 3D ultrasound.

Algorithms↗

PubMed1993

Exploring the relationship between rationality and bounded rationality in medical knowledge-based systems.

If our goal in Artificial Intelligence in Medicine (AIM) is to engineer systems health-care providers will both use and, in the process, improve their performance, we must concentrate on the development of causal theories of knowledge and problem solving. One broad direction in pursuing this goal is understanding the relationships between existing models of rationality and bounded rationality for similar tasks. Models of rationality refer to those approaches in which the optimal properties of the models are deductively provable, i.e. in which the processing is rational. Representative models of rationality used in AIM are deductive logical models, statistical models such as Bayesian inference models, and decision-analytic models. Models of bounded rationality are those which do not guarantee such optimal properties nor yield to deductive correctness proofs. These models have their roots in cognitive psychology. In this article we show how explicating the relationship between models of rationality and bounded rationality might be done in the case of abductive tasks in medicine. This is done by positioning these modeling approaches within the same framework (an abstract computational model) and interpreting in this context both computational complexity results concerning the nature of the task and empirical results studies of human problem-solving behavior.

Artificial Intelligence↗

PubMed1979

The Chatham Blood Pressure Study. An application of Bayesian growth curve models to a longitudinal study of blood pressure in children.

Recent developments in statistics have produced powerful methods that facilitate the analysis of longitudinal studies. These methods are illustrated by an analysis of a longitudinal study of blood pressure in children. The results of the study show a clear tendency for blood pressure to increase with age, and Asian children tend to have lower blood pressures than their Caucasian counterparts of the same age. There is evidence to support the hypothesis that blood pressures track.

Age Factors↗

PubMed1994

Prediction of future serum concentrations with Bayesian fitted pharmacokinetic models: results with data collected by nurses versus trained pharmacy residents.

Recording the times of dosage administration and serum sampling by trained personnel resulted in significantly greater adherence to the protocol of therapeutic drug monitoring and in significantly greater precision in the achievement of desired serum concentration goals of aminoglycoside therapy than when relatively untrained personnel recorded it as a comparatively unemphasized part of their job. This was true even when only data of peak and trough serum concentrations were used. This study demonstrates that thoughtful data collection by appropriately trained nursing, pharmacy, or other clinical personnel is an essential part of therapeutic drug monitoring and plays a significant role in the optimal individualization of drug dosage regimens for patient care.

Aged↗

PubMed2000

Bayesian information criterion for censored survival models.

We investigate the Bayesian Information Criterion (BIC) for variable selection in models for censored survival data. Kass and Wasserman (1995, Journal of the American Statistical Association 90, 928-934) showed that BIC provides a close approximation to the Bayes factor when a unit-information prior on the parameter space is used. We propose a revision of the penalty term in BIC so that it is defined in terms of the number of uncensored events instead of the number of observations. For a simple censored data model, this revision results in a better approximation to the exact Bayes factor based on a conjugate unit-information prior. In the Cox proportional hazards regression model, we propose defining BIC in terms of the maximized partial likelihood. Using the number of deaths rather than the number of individuals in the BIC penalty term corresponds to a more realistic prior on the parameter space and is shown to improve predictive performance for assessing stroke risk in the Cardiovascular Health Study.

Aged↗

PubMed1999

Oligogenic model selection using the Bayesian Information Criterion: linkage analysis of the P300 Cz event-related brain potential.

The traditional likelihood-based approach to hypothesis testing may not be an optimal strategy for evaluating oligogenic models of inheritance. Under oligogenic inheritance the number of possible multilocus models can become very large; there may be several competing linkage models having similar likelihoods; and comparisons among non-nested models can be required to determine if a given multilocus model provides a significantly better fit to observed phenotypic variation than an alternative model. We propose an efficient Bayesian approach to oligogenic model selection that makes use of existing model likelihoods, and show how model uncertainty can be incorporated into parameter estimation.

Alcoholism↗

PubMed1992

Suramin: rapid loading and weekly maintenance regimens for cancer patients.

PURPOSE: Suramin is an anticancer agent with a narrow therapeutic window and a terminal half-life of 45 to 55 days. These characteristics make it necessary to control accurately the serum concentrations of the drug. Therefore, the aim of the present study was to develop a rapid loading regimen, followed by weekly administration of suramin to maintain serum concentrations of between 150 and 300 micrograms/mL for 8 weeks. PATIENTS AND METHODS: Eligible patients were treated with five different loading regimens. Initially, weekly maintenance doses were estimated manually by the treating physician. Subsequently, computer-assisted dosing that used Bayesian pharmacokinetic modeling was used. RESULTS: Thirty-eight courses of suramin that were administered to 35 patients were studied. The optimal loading regimen consisted of a continuous infusion of 600 mg/m2 during a 24-hour period, which resulted in a mean serum concentration of 319 micrograms/mL. Potentially toxic concentrations that were observed with shorter infusions were avoided. Maintenance treatment, which used the weekly administration of suramin during a 6-hour period, seemed to be able to maintain mean suramin serum trough concentrations of 150 micrograms/mL, while preventing mean peak concentrations of more than 300 micrograms/mL. The use of Bayesian pharmacokinetics was superior to manual estimation in tailoring the optimal dose to the therapeutic window. CONCLUSIONS: Continuous infusion is the optimal way of delivering suramin during the loading phase. To maintain trough levels and peak levels within a narrower therapeutic window, suramin will have to be administered more frequently than once a week. Bayesian modeling based on individual serum levels and population pharmacokinetics allows accurate dosing to maintain suramin levels within the therapeutic window.

Adult↗

PubMed2000

Bayesian identification of a population compartmental model of C-peptide kinetics.

When models are used to measure or predict physiological variables and parameters in a given individual, the experiments needed are often complex and costly. A valuable solution for improving their cost effectiveness is represented by population models. A widely used population model in insulin secretion studies is the one proposed by Van Cauter et al. (Diabetes 41:368-377, 1992), which determines the parameters of the two compartment model of C-peptide kinetics in a given individual from the knowledge of his/her age, sex, body surface area, and health condition (i.e., normal, obese, diabetic). This population model was identified from the data of a large training set (more than 200 subjects) via a deterministic approach. This approach, while sound in terms of providing a point estimate of C-peptide kinetic parameters in a given individual, does not provide a measure of their precision. In this paper, by employing the same training set of Van Cauter et al., we show that the identification of the population model into a Bayesian framework (by using Markov chain Monte Carlo) allows, at the individual level, the estimation of point values of the C-peptide kinetic parameters together with their precision. A successful application of the methodology is illustrated in the estimation of C-peptide kinetic parameters of seven subjects (not belonging to the training set used for the identification of the population model) for which reference values were available thanks to an independent identification experiment.

Adult↗

PubMed2026

Genome-wide association studies for feed efficiency, production and feeding behavior traits in Canadian purebred Duroc pigs.

This study aimed to identify potential genetic variants and candidate genes associated with feed efficiency (FE), production, and feeding behavior traits in Canadian purebred Duroc pigs. Genome-wide association studies (GWAS) were conducted using 8,861 individuals and an imputed Affymetrix PigGen Canada 50K panel v2.0 using a linear mixed model (LMM) and a Bayesian B model. This analysis used an adjusted P-value threshold (ranging from 6.6 × 10-5 to 1.3 × 10-4) using a false-discovery rate to determine significance. The number of significant SNPs identified for each trait was as follows: average daily gain (ADG, 48), daily feed intake (DFI, 85), feed conversion ratio (FCR, 101), residual feed intake (RFI, 37), residual gain (RG, 64), residual intake and gain (RIG, 55), backfat thickness (BF, 100), loin depth (LD, 6), Kleiber's ratio (KR, 0), total time spent eating per day (TPD, 7), and number of visits to the feeder per day (NVD, 6). Several traits (BF, DFI, FCR, RFI, RG, and RIG) showed strong overlapping signals on chromosomes 7 and 10 with 24 shared significant SNPs, indicating potential shared genetic mechanisms. These traits also had 71 overlapping candidate genes, such as PACSIN1, PTCH1, ADIPOR1, and ITPR3, associated with glucose, lipid, and cholesterol metabolism. Well-known candidate genes in literature associated with growth and fatness such as MC4R and CDH20 were also identified to be associated with ADG, BF, FCR, and DFI in this study. Gene ontology enrichment analysis revealed that a set of the candidate genes were involved in the gonadotropin-releasing hormone (GnRH) and the platelet-derived growth factor (PDGF) signaling pathways. Overall, this study contributed to understanding the genetic architecture and provided a biological foundation for improving FE, production, and feeding behavior traits in Canadian Duroc pigs, facilitating the selection of more efficient pigs.

Sus scrofa↗

PubMed1997

Linear Bayesian inference for accelerated Weibull model.

In this paper, we present a Bayesian approach for inference from accelerated life tests when the underlying life model is Weibull. Our approach is based on the General Linear Models framework of West, Harrison and Migon (1985). We discuss inference for the model and show that computable results can be obtained using linear Bayesian methods. We illustrate the usefulness of our approach by applying it to some actual data from accelerated life tests.

Bayes Theorem↗

PubMed1998

A semiparametric Bayesian approach to the random effects model.

In longitudinal random effects models, the random effects are typically assumed to have a normal distribution in both Bayesian and classical models. We provide a Bayesian model that allows the random effects to have a nonparametric prior distribution. We propose a Dirichlet process prior for the distribution of the random effects; computation is made possible by the Gibbs sampler. An example using marker data from an AIDS study is given to illustrate the methodology.

Acquired Immunodeficiency Syndrome↗

PubMed1997

A Bayesian analysis of regression models with continuous errors with application to longitudinal studies.

We employ a regression model with errors that follow a continuous autoregressive process to analyse longitudinal studies. In this way, unequally spaced observations do not present a problem in the analysis. We employ a Bayesian approach, where our inferences are based on a direct resampling process that generates values from the posterior distribution of the parameters of the model. We illustrate these Bayesian inferences with an analysis of a longitudinal study that involves the regression of foetal head circumference on menstrual age. Using these same data, we contrast the Bayesian approach with a maximum likelihood technique.

Bayes Theorem↗

PubMed1991

A Monte Carlo method for Bayesian inference in frailty models.

Many analyses in epidemiological and prognostic studies and in studies of event history data require methods that allow for unobserved covariates or "frailties." Clayton and Cuzick (1985, Journal of the Royal Statistical Society, Series A 148, 82-117) proposed a generalization of the proportional hazards model that implemented such random effects, but the proof of the asymptotic properties of the method remains elusive, and practical experience suggests that the likelihoods may be markedly nonquadratic. This paper sets out a Bayesian representation of the model in the spirit of Kalbfleisch (1978, Journal of the Royal Statistical Society, Series B 40, 214-221) and discusses inference using Monte Carlo methods.

Algorithms↗

PubMedDate not supplied

Modelling categorical covariates in Bayesian disease mapping by partition structures.

We consider the problem of mapping the risk from a disease using a series of regional counts of observed and expected cases, and information on potential risk factors. To analyse this problem from a Bayesian viewpoint, we propose a methodology which extends a spatial partition model by including categorical covariate information. Such an extension allows detection of clusters in the residual variation, reflecting further, possibly unobserved, covariates. The methodology is implemented by means of reversible jump Markov chain Monte Carlo sampling. An application is presented in order to illustrate and compare our proposed extensions with a purely spatial partition model. Here we analyse a well-known data set on lip cancer incidence in Scotland.

Bayes Theorem↗

PubMed1998

Classification of non-stationary neural signals.

Although a number of methods have been proposed for classification of individual action potentials embedded in multi-unit activity, they have been challenged by non-stationarity. The waveform shapes of action potentials can change rapidly over time as a result of shifts in membrane conductances during extended burst firing sequences and more slowly over time due to electrode drift. These changes are typically non-Gaussian. We present an algorithm for waveform identification that makes no assumptions on the distribution of these shapes other than the change in waveform shape for a particular neuron should not be discontinuous. We apply this algorithm to the resolution of multi-unit neural signals recorded in the cat visual cortex and we compare this approach to a spike sorting method that is based on the Bayesian likelihood of a spike fitting a particular model (Lewicki, M. Bayesian modeling and classification of neural signals. Neural Comput 1994;6(5):1005-1030.

Action Potentials↗

PubMed1992

Advanced computer programs for drug dosing that combine pharmacokinetic and symbolic modeling of patients.

In this paper, we describe our design for advanced drug dosing programs that "reason" using a combination of Bayesian pharmacokinetic modeling and symbolic modeling of patient status and drug response. Our design is similar to the design of the Digitalis Therapy Advisor program, but extends this previous work by incorporating a Bayesian pharmacokinetic model, performing a "meta-level" analysis of drug concentrations to identify sampling errors and changes in pharmacokinetics, and including the results of this analysis in reasoning for dosing and therapeutic monitoring recommendations. The design has been implemented in a program for aminoglycoside antibiotics called Aminoglycoside Therapy Manager. The program is user-friendly and runs on low-cost general-purpose hardware. The initial validation study showed that the program was as accurate in predicting future drug concentrations as an expert using commercial Bayesian forecasting software and that its dosing recommendations were similar to those of an expert.

Aminoglycosides↗

PubMed1999

Pharmacokinetic variability of nimodipine disposition after single and multiple oral dosing to hypertensive renal failure patients: parametric and nonparametric population analysis.

OBJECTIVES: To explore the contribution of renal failure to nimodipine overall pharmacokinetic variability after single and multiple oral dosing and to develop a population pharmacokinetic model by means of the nonparametric expectation maximization (NPEM2) algorithm based on sampled individual drug concentrations close to the estimated patients' C(SS)avs (NPEM2-C(SS)av). PATIENTS, MATERIALS AND METHODS: 24 hypertensive patients with normal and reduced renal function, without clinical and laboratory data for hepatic dysfunction, were enrolled in the study and their nimodipine plasma levels were analyzed by means of a parametric and nonparametric population pharmacokinetic modeling using a maximum a posteriori Bayesian (MAPB) estimator in an iterative two-stage Bayesian population modeling program and NPEM2-algorithm. RESULTS: Comparison of parameter dispersion revealed higher variability of nimodipine disposition after the first dose than at steady-state except for apparent volume of distribution at steady-state, V(SS)/F, whose variability increased from 98% to 223%. The most variable was mean residence time, MRT, whose coefficient of variation (CV) was 288% after the first dose and decreased by more than 2 times at steady-state, followed by terminal elimination half-life, t(1/2el), with CV = 171% after the first dosing and decreasing by more than 3 times at steady-state. Concerning the impact of renal failure on disposition parameters variability, patients with slightly to moderately reduced renal function, creatinine clearances between 51 to 80 and 25 to 50 ml/min, resp., stated higher variation than patients with more definitively altered renal function. The validation of NPEM2-C(SS)av population model was performed by using a set of 272 individual plasma drug concentrations, including trough levels as well as concentrations belonging to mono-exponential elimination phases after single and multiple dosing. Bayesian forecasting, using 4 trough levels per patient as Bayesian priors, revealed highly significant correlation between observed and population model predicted drug concentrations (r = 0.526, p < 0.0001). The predictive performance of NPEM2-C(SS)av population model was characterized by low bias (mean error = -0.48 microg/l, 95% CI = -0.99-0.04 microg/l), and good precision (root mean squared error = 4.32 microg/l, 95% CI = -2.53-11.17 microg/l). CONCLUSIONS: As predicted for high hepatic clearance drugs [Rowland 1985], nimodipine parameters variability decreased after reaching steady-state. NPEM2-C(SS)av population model demonstrated high accuracy and precision in predicting drug levels from terminal exponential phase including trough levels at steady-state.

Administration, Oral↗