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At least 19 recordsLinked to original sources

Causal Inference for Genomic Data with Multiple Heterogeneous Outcomes.

With the evolution of single-cell RNA sequencing techniques into a standard approach in genomics, it has become possible to conduct cohort-level causal inferences based on single-cell-level measurements. However, the individual gene expression levels of interest are not directly observable; instead, only repeated proxy measurements from each individual's cells are available, providing a derived outcome to estimate the underlying outcome for each of many genes. In this paper, we propose a generic semiparametric inference framework for doubly robust estimation with multiple derived outcomes, which also encompasses the usual setting of multiple outcomes when the response of each unit is available. To reliably quantify the causal effects of heterogeneous outcomes, we specialize the analysis to standardized average treatment effects and quantile treatment effects. Through this, we demonstrate the use of the semiparametric inferential results for doubly robust estimators derived from both Von Mises expansions and estimating equations. A multiple testing procedure based on Gaussian multiplier bootstrap is tailored for doubly robust estimators to control the false discovery exceedance rate. Applications in single-cell CRISPR perturbation analysis and individual-level differential expression analysis demonstrate the utility of the proposed methods and offer insights into the usage of different estimands for causal inference in genomics.

Derived outcomes↗

A comparison of mixed-effects quantile stratification propensity adjustment strategies for longitudinal treatment effectiveness analyses of continuous outcomes.

The propensity adjustment is used to reduce bias in treatment effectiveness estimates from observational data. We show here that a mixed-effects implementation of the propensity adjustment can reduce bias in longitudinal studies of non-equivalent comparison groups. The strategy examined here involves two stages. Initially, a mixed-effects ordinal logistic regression model of propensity for treatment intensity includes variables that differentiate subjects who receive various doses of time-varying treatments. Second, a mixed-effects linear regression model compares the effectiveness of those ordinal doses on a continuous outcome over time. Here, a simulation study compares bias reduction that is achieved by implementing this propensity adjustment through various forms of stratification. The simulations demonstrate that bias decreased monotonically as the number of quantiles used for stratification increased from two to five. This was particularly pronounced with stronger effects of the confounding variables. The quartile and quintile strategies typically removed in excess of 80-90 per cent of the bias detected in unadjusted models; whereas a median-split approach removed from 20 to 45 per cent of bias. The approach is illustrated in an evaluation of the effectiveness of somatic treatments for major depression in a longitudinal, observational study of affective disorders.

Adult↗

Reduced sensitivity to hidden bias at upper quantiles in observational studies with dilated treatment effects.

When a treatment has a dilated effect, with larger effects when responses are higher, there can be much less sensitivity to bias at upper quantiles than at lower quantiles; i.e., small, plausible hidden biases might explain the ostensible effect of the treatment for many subjects, and yet only quite large hidden biases could explain the effect on a few subjects having dramatically elevated responses. An example concerning kidney function of cadmium workers is discussed in detail. In that example, the treatment effect is far from additive: It is plausibly zero at the lower quartile of responses to control, and it is large and fairly insensitive to bias at the upper quartile.

Bias↗

Reforming health care: evidence from quantile regressions for counts.

I consider the problem of estimating the effect of a health care reform on the frequency of individual doctor visits when the reform effect is potentially different in different parts of the outcome distribution. Quantile regression is a powerful method for studying such heterogeneous treatment effects. Only recently has this method been extended to situations where the dependent variable is a (non-negative integer) count. An analysis of a 1997 health care reform in Germany shows that lower quantiles, such as the first quartile, fell by substantially larger amounts than what would have been predicted based on Poisson or negative binomial models.

Adult↗

A quality-of-life-oriented endpoint for comparing therapies.

An endpoint, time without symptoms of disease and toxicity of treatment (TWiST), is defined to provide a single measure of length and quality of survival. Time with subjective side effects of treatment and time with unpleasant symptoms of disease are subtracted from overall survival time to calculate TWiST for each patient. The purpose of this paper is to describe the construction of this endpoint, and to elaborate on its interpretation for patient care decision-making. Estimating the distribution of TWiST using actuarial methods is shown by simulation studies to be biased as a result of induced dependency between TWiST and its censoring distribution. Considering the distribution of TWiST accumulated within a specified time from start of therapy, L, allows one to reduce this bias by substituting estimated TWiST for censored values and provides a method to evaluate the "payback" period for early toxic effects. Quantile distance plots provide graphical representations for treatment comparisons. The analysis of Ludwig Trial III evaluating toxic adjuvant therapies versus a no-treatment control group for postmenopausal women with node-positive breast cancer illustrates the methodology.

Antineoplastic Agents↗

Adenosine A1 receptor antagonist improves intradialytic hypotension.

Intradialytic hypotension is a most frequent complication of hemodialysis and may contribute to cardiovascular events and high mortality. There is a hypothesis that an increase in adenosine generation during hemodialysis may cause vasodilation and a decrease in cardiac output, which results in systemic hypotension. We studied whether this can be blocked by an adenosine A1 receptor antagonist. We investigated the effects of an A1 antagonist, FK352, injection in 30 chronic hemodialysis patients with frequent intradialytic hypotension by a prospective, multicenter, double-blind placebo-controlled study for 4 weeks after 4 weeks of the observation period. Intradialytic hypotension was defined as systolic blood pressure (SBP) less than 110 mmHg, with SBP drop of more than 30 mmHg from the predialysis level. The efficacy of FK352 was primarily assessed by the reduction rate of dialysis hypotension between the FK352 and placebo groups. Incidence of emergency treatments caused by hypotension was evaluated. FK352 (50 mg, intravenous) or an equivalent placebo was injected into the dialysis circuit 1 h after starting dialysis. Blood pressure and heart rate were monitored every 30 min during dialysis. FK352 significantly improved intradialytic hypotension (P=0.046), in that the reduction rates of intradialytic hypotension in the FK352 and placebo groups were -12.8% (Q1 (first quantile), Q3 (third quantile): -27.5, -1.7), and +8.3% (Q1, Q3: -16.6, +16.7), respectively. The frequency of discontinuation of dialysis was significantly reduced by FK352. No apparent side effects were observed from treatment with FK352. In conclusion, the A1 antagonist FK352 may offer a novel therapeutic option for chronic dialysis patients associated with intradialytic hypotension.

Adenosine↗

Gaining insight from flexible models--assessment of the secondary prevention trial of CHD in the Czech male population with MI history.

OBJECTIVES: We present results from a secondary prevention trial of coronary heart disease (CHD) in the Czech male population from northern Bohemia with the history of myocardial infarction (MI) and high prevalence of metabolic syndrome. We compare several approaches to analyzing survival data from our study in terms of respective model assumptions. METHODS: While both the Cox and Weibull survival regression models assume proportionality of the hazard functions over time, in many instances this assumption appears incompatible with the data at hand. Gray's implementation of flexible models using penalized splines allows for a more realistic assessment of the covariate effects which may vary over time. RESULTS: Gray's model results revealed a steady decline in the age-adjusted intervention effect over time, which remained significant until about 2.7 years of follow-up. This was in contrast with the results obtained from the Cox and Weibull models which suggested an overall risk reduction due to intervention during the total follow-up of 6.7 years. Survival estimates based on the Cox and Gray models are shown for the two treatment groups and selected sample quantiles of the age distribution for illustration. CONCLUSIONS: Gray's time-varying coefficients model facilitated a more realistic assessment of the intervention effect. Using suitable historical controls with MI history the effect of intervention was found to gradully diminish over time.

Adult↗

[Treatment of solid tumours by intratumoral injection of immunostimulants].

Intra-lesional injections of immunostimulants--BCG or Corynebacterium parpum--induced a local cure of the McFiFj2(S) tumour and a remote therapeutic effect. When applied to rats multigrafted with the McFiFi2(S) tumour, local and distant cures were obtained in some situations. This indicates the likely intervention of a specific immune mechanism. Quantilating the pulmonary metastasis in combination with local treatment of Lewis mouse tumours showed that BCG plus C. parvum injected into the tumour and followed by surgical resection was more efficient than either of these individual or otherwise associated antitumoural procedures.

Animals↗

Reduction in thyroid volume after radioiodine therapy of Graves' hyperthyroidism: results of a prospective, randomized, multicentre study.

The reduction in thyroid size in 92 patients treated with radioiodine for Graves' thyrotoxicosis was monitored by ultrasound volumetry. The patients were randomly treated with either a standard 131I activity of 555 MBq or an activity calculated to deliver a thyroid dose of 100 Gy. Within 1 year after radioiodine treatment, a remarkable volume reduction of about 71% (median) (quantile 25% (Q 25) = 49%, Q 75 = 82%, n = 67) was observed. The bulk of this reduction (median 57%, Q 25 = 21%, Q 75 = 74%, n = 92) was found within the first 6 months. Statistical analysis reveals that the effect was clearly related to the thyroid dose actually achieved during therapy. The median reduction obtained 6 months after radioiodine application was 45% for < 100 Gy, 56% for 100-200 Gy and 67% for > 200 Gy (n = 28, 39, 25 respectively). Twelve months after radioiodine application, the effect became less evident: 53%, 68% and 75% respectively (n = 17, 29, 21). The higher median thyroid dose actually achieved by standard than by calculated activity (215 Gy vs. 116 Gy) explains the more pronounced volume reduction in the standard group than in the calculated group; 60% vs. 47% 6 months (n = 47, 45) after radioiodine treatments and 74% vs. 66% 12 months (n = 31,36) after radioiodine application. The relative reduction in thyroid size was just as marked in patients with large thyroids as in those with small glands. The goitre prevalence (thyroid volume > 20 mL in women and > 25 mL in men) was reduced from 73% to only 16% 1 year after radioiodine treatment. In patients with a thyroid volume of more than 60 mL, the median pretherapeutic thyroid volume of 102 mL was reduced to 29 mL. In conclusion, radioiodine treatment in Graves' hyperthyroidism sufficiently reduces thyroid volume in a dose-dependent manner. The findings of this study demonstrate that radioiodine is also an attractive mode of therapy for Graves' patients with substantial thyroid enlargement.

Adult↗

Optimization of follow-up timing from study of patterns of first failure after primary treatment. An example from patients with NSCLC: a study of the REACT working group of ESTRO.

BACKGROUND AND PURPOSE: The European Society for Therapeutic Radiology and Oncology was funded by the EU for a project on Recording providing Education, and Ameliorating the Consequences of Treatment (REACT). An important aim of follow-up (FU) after treatment for cancer is to detect various events associated with disease recurrence or metastatic spread or severe treatment-related complications as early as possible. Each tumour type may show a specific pattern and timing of these events related to different prognostic factors. The aim of this study was to propose a way of defining an optimal timing schedule for follow-up after treatment based on the analysis of failure patterns determined from follow-up data from prospective clinical trials. MATERIAL AND METHODS: Cox proportional hazards model was used to identify prognostic factors associated with each failure type (loco-regional recurrence (LR), distant metastasis (DM) or side effects (SE)). Competing risks methods were applied to estimate the cumulative incidence functions (CIF), adjusted on the significant prognostic factors. Equally spaced quantiles of the CIF were then used to estimate the corresponding optimised follow-up times depending on a pre-specified total number of visits. Follow-up data from the CHART bronchus clinical trial were used to analyse the pattern of time to first failure. RESULTS: A significantly higher risk of failure was observed for males (SE), stage III (DM) and conventional treatment (LR). Overall, patients treated with CHART needed 1 fewer visit in each category of patients compared to the Conventional group. For example, stage III male patients treated with CHART would need 8 visits during the first two years at 7, 11, 16, 24, 37, 52, 64 and 104 weeks rather than the 9 follow-up visits planned in the protocol. Similar patients treated with Conventional radiotherapy would need 8 visits at 3, 5, 7, 11, 15, 24, 52 and 104 weeks. CONCLUSIONS: Use of these methods would allow timing of follow-up visits to be adapted according to tumour site and prognostic factors determined previously from audit or clinical trials. Application of this approach could optimize the timing of follow-up visits by placing them closer to the times when failures are expected to occur. It does not address the wider issues of follow-up such as who should do it or what should be done for which further studies are required.

Carcinoma, Non-Small-Cell Lung↗

Stratification and weighting via the propensity score in estimation of causal treatment effects: a comparative study.

Estimation of treatment effects with causal interpretation from observational data is complicated because exposure to treatment may be confounded with subject characteristics. The propensity score, the probability of treatment exposure conditional on covariates, is the basis for two approaches to adjusting for confounding: methods based on stratification of observations by quantiles of estimated propensity scores and methods based on weighting observations by the inverse of estimated propensity scores. We review popular versions of these approaches and related methods offering improved precision, describe theoretical properties and highlight their implications for practice, and present extensive comparisons of performance that provide guidance for practical use.

Computer Simulation↗

Estimating earnings losses due to mental illness: a quantile regression approach.

BACKGROUND: The ability of workers to remain productive and sustain earnings when afflicted with mental illness depends importantly on access to appropriate treatment and on flexibility and support from employers. In the United States there is substantial variation in access to health care and sick leave and other employment flexibilities across the earnings distribution. Consequently, a worker's ability to work and how much his/her earnings are impeded likely depend upon his/her position in the earnings distribution. Because of this, focusing on average earnings losses may provide insufficient information on the impact of mental illness in the labor market. AIMS: In this paper, we examine the effects of mental illness on earnings by recognizing that effects could vary across the distribution of earnings. METHODS: Using data from the National Comorbidity Survey, we employ a quantile regression estimator to identify the effects at key points in the earnings distribution. RESULTS: We find that earnings effects vary importantly across the distribution. While average effects are often not large, mental illness more commonly imposes earnings losses at the lower tail of the distribution, especially for women. In only one case do we find an illness to have negative effects across the distribution. IMPLICATIONS: Mental illness can have larger negative impacts on economic outcomes than previously estimated, even if those effects are not uniform. Consequently, researchers and policy makers alike should not be placated by findings that mean earnings effects are relatively small. Such estimates miss important features of how and where mental illness is associated with real economic losses for the ill.

Adult↗

Bayesian estimation of cost-effectiveness ratios from clinical trials.

Estimation of the incremental cost-effectiveness ratio (ICER) is difficult for several reasons: treatments that decrease both cost and effectiveness and treatments that increase both cost and effectiveness can yield identical values of the ICER; the ICER is a discontinuous function of the mean difference in effectiveness; and the standard estimate of the ICER is a ratio. To address these difficulties, we have developed a Bayesian methodology that involves computing posterior probabilities for the four quadrants and separate interval estimates of ICER for the quadrants of interest. We compute these quantities by simulating draws from the posterior distribution of the cost and effectiveness parameters and tabulating the appropriate posterior probabilities and quantiles. We demonstrate the method by re-analysing three previously published clinical trials.

Bayes Theorem↗

The revised Anxious Thoughts and Tendencies (AT&T) scale: a general measure of anxiety-prone cognitive style.

BACKGROUND: The AT&T was developed from a perspective which proposes that panic disorder with agoraphobia arises from interaction between a specific biological predisposition, expressed in spontaneous panic attacks, and a general anxiety-prone cognitive style. Many items of the original AT&T, a putative measure of the cognitive component, were complex and ambiguous; and normative data were not available. METHOD: In this research, the items were simplified and clarified. A community sample of northern New Mexico Hispanics and geographically matched non-Hispanic whites was identified from an earlier epidemiological study. The sample included 151 Anglos and 168 Hispanics; 98 respondents aged 18-34, 75 aged 35-49, 69 aged 50-64, and 77 aged 65 or more; and 111 men and 208 women. RESULTS: Factor analysis produced one major factor with high loadings from the 15 negatively worded items, that accounted for about 41% of the total variation in the 15 items. The mean major factor score for Anglos was 1.65 with a standard deviation of 0.48, and for Hispanics was 1.76+/-0.52. F = 4.17, df = 1/311, P < 0.05, and effect size d = 0.22. There were no significant age or gender effects. Item analysis of the major factor produced item/total correlations from 0.49 to 0.68 and a Cronbach's alpha of 0.91. In a separate clinical sample of 30 patients with panic disorder, the test-retest correlation of the major factor at baseline and after 8 weeks of treatment was 0.75. In the community sample, the correlations of the major factor with anxiety-related clusters of the SCL-90 were: Somatization, 0.36; Anxiety, 0.53: and Phobia, 0.44. CONCLUSIONS AND RECOMMENDATIONS: We recommend that the AT&T be reduced to the 15 items of its major factor, and we supply quantiles and moments based on the full community sample of 319 as a standard of comparison. Further research with the AT&T in clinical samples of patients with anxiety disorders is ongoing.

Adolescent↗

CD4 cell counts in adults with newly diagnosed HIV infection: results of surveillance in England and Wales, 1990-1998. CD4 Surveillance Scheme Advisory Group.

OBJECTIVES: To describe the distribution and changes in CD4 cell counts (both initial and subsequent) in HIV-infected persons over time and determine the factors influencing these counts. DESIGN: Reports were requested from laboratories measuring CD4 cell counts in England and Wales. Initial counts were analysed and median counts were followed over time. METHODS: Time trends and the relationship between initial CD4 cell count and age, sex, and HIV risk category were studied using quantile regression methods or chi-square tests. RESULTS: Between 1990 and 1998, 9553 adults were newly diagnosed with HIV infection and had a CD4 cell count within 6 months of HIV diagnosis. Over 50% of initial CD4 cell counts in each major risk category were below 350 cells/mm3. Older age (P < 0.001), male sex (P < 0.013) and heterosexual risk (P < 0.001) were independently associated with lower initial CD4 cell counts. For heterosexually infected adults, the median initial CD4 cell count was significantly negatively associated with the year of diagnosis (P = 0.03) and the median age increased through the time period examined (P < 0.001), whereas for men who have sex with men (MSM), there was no significant change in these values over time. For each year cohort of newly diagnosed individuals, the median CD4 cell count in subsequent years decreased until 1996 and then increased thereafter, consistent with a treatment effect. CONCLUSION: Across all major risk groups, a large proportion of HIV-infected adults are being diagnosed late in the course of HIV disease. For the heterosexually infected, the data suggest an ageing cohort effect, whereas for MSM the data are consistent with continuing transmission.

Adult↗

Simple adjustments for randomized trials with nonrandomly missing or censored outcomes arising from informative covariates.

In randomized trials with missing or censored outcomes, standard maximum likelihood estimates of the effect of intervention on outcome are based on the assumption that the missing-data mechanism is ignorable. This assumption is violated if there is an unobserved baseline covariate that is informative, namely a baseline covariate associated with both outcome and the probability that the outcome is missing or censored. Incorporating informative covariates in the analysis has the desirable result of ameliorating the violation of this assumption. Although this idea of including informative covariates is recognized in the statistics literature, it is not appreciated in the literature on randomized trials. Moreover, to our knowledge, there has been no discussion on how to incorporate informative covariates into a general likelihood-based analysis with partially missing outcomes to estimate the quantities of interest. Our contribution is a simple likelihood-based approach for using informative covariates to estimate the effect of intervention on a partially missing outcome in a randomized trial. The first step is to create a propensity-to-be-missing score for each randomization group and divide the scores into a small number of strata based on quantiles. The second step is to compute stratum-specific estimates of outcome derived from a likelihood-analysis conditional on the informative covariates, so that the missing-data mechanism is ignorable. The third step is to average the stratum-specific estimates and compute the estimated effect of intervention on outcome. We discuss the computations for univariate, survival, and longitudinal outcomes, and present an application involving a randomized study of dual versus triple combinations of HIV-1 reverse transcriptase inhibitors.

Acquired Immunodeficiency Syndrome↗

Factors influencing the outcome of ICSI in patients with obstructive and non-obstructive azoospermia: a comparative study.

BACKGROUND: Factors influencing success of sperm retrieval in azoospermic patients and outcome of ICSI were evaluated. METHODS AND RESULTS: Uni- and multifactorial analysis were performed using logistic and stepwise analysis, following surgical sperm retrieval by percutaneous epididymal sperm aspiration (55 cycles) or testicular sperm extraction (142 cycles) in 52 and 123 patients with obstructive azoospermia (OA) and non-obstructive azoospermia (NOA) respectively. ICSI cycles using fresh or cryopreserved-thawed sperm were included. Sperm were retrieved to allow ICSI in 100 and 41% of OA and NOA patients, with no significant correlation with patients' age or FSH level. Occurrence of pregnancy was significantly correlated with female age (90th quantile: 38 years), number of oocytes retrieved (10th quantile: five oocytes) and number of oocytes injected (10th quantile: four oocytes). Sperm origin (epididymal versus testicular), status (fresh or thawed), male partner's age, and serum FSH had no significant effect upon implantation rate, pregnancy rate per embryo transfer or spontaneous miscarriage rate. CONCLUSIONS: In OA patients ICSI should be planned in conjunction with surgical sperm retrieval. In contrast, the lack of efficient non-invasive parameters to predict sperm retrieval in NOA suggests that elective surgical sperm retrieval may be offered to these patients prior to ovarian stimulation of their partners, especially when donor back-up is not an alternative. Female factors such as age and ovarian reserve have significant impact upon clinical success rates.

Adult↗

Effect of strategic gastrointestinal nematode control on fertility and mortality of N'Dama cattle in The Gambia.

A large-scale longitudinal study was undertaken to investigate the effects of a strategic treatment of gastrointestinal nematodes on the mortality and fertility of N'Dama cattle under village conditions. Initially, 1046 animals from 26 private N'Dama cattle herds, were monitored from October 1989 to December 1994. Each herd was stratified by age and the animals were randomly allocated to two groups with a similar average age. One group received a single anthelmintic treatment of fenbendazole (Panacur, 7.5 mg/kg BW, Hoechst Veterinä AG) in October 1989, whereas the other group remained untreated. In July 1990, the herds were subdivided into two different treatment schemes. In the herds of scheme 1, the treated animals (Treatment group I) were treated once (in August), whereas in the herds of scheme 2, the treated animals (Treatment group II) were treated twice (in July and September). The same treatment schedule was used in the subsequent rainy seasons until December 1994. One group in every herd of both schemes served as control (Treatment group 0) and received no anthelmintic treatment throughout the study. The average annual cumulative incidence mortality between 0-1 year was more than two times higher in treated animals compared to their controls (21% against 7.5%). No differences were found in older age categories. Survival analysis confirmed differences in mortality from 0-1 year, but were not significant in proportional hazard models. The 25% quantiles of age at first calving was used to quantify differences between twice treated animals (50.2 months) and its controls (58.3 months) which represents a decrease of 8 months in twice treated animals. Annual calving rates of twice treated animals were 52.2% compared to 43.6% in the control group (P < 0.001), which is an increase of 8.6% to the control rate. Possible causes of increased mortality in 0-1 year old treated calves are discussed. We can conclude that in the present epidemiological situation and the given parasite spectrum, gastro-intestinal nematodes mainly affect host fertility. Strategic control of gastro-intestinal nematodes is thus recommended for young heifers up to their age of first calving provided the overall financial analysis of the intervention is beneficial.

Abortion, Veterinary↗