Reward ignorant modeling of dynamic treatment regimes

Personalized medicine optimizes patient outcome by tailoring treatments to patient‐level characteristics. This approach is formalized by dynamic treatment regimes (DTRs): decision rules that take patient information as input and output recommended treatment decisions. The DTR literature has seen the development of increasingly sophisticated causal inference techniques that attempt to address the limitations of our typically observational datasets. Often overlooked, however, is that in practice most patients may be expected to receive optimal or near‐optimal treatment, and so the outcome used as part of a typical DTR analysis may provide limited information. In light of this, we propose considering a more standard analysis: ignore the outcome and elicit an optimal DTR by modeling the observed treatment as a function of relevant covariates. This offers a far simpler analysis and, in some settings, improved optimal treatment identification. To distinguish this approach from more traditional DTR analyses, we term it reward ignorant modeling, and also introduce the concept of multimethod analysis, whereby different analysis methods are used in settings with multiple treatment decisions. We demonstrate this concept through a variety of simulation studies, and through analysis of data from the International Warfarin Pharmacogenetics Consortium, which also serve as motivation for this work.     

Demystifying optimal dynamic treatment regimes

A dynamic regime is a function that takes treatment and covariate history and baseline covariates as inputs and returns a decision to be made. Murphy (2003, Journal of the Royal Statistical Society, Series B 65, 331-366) and Robins (2004, Proceedings of the Second Seattle Symposium on Biostatistics, 189-326) have proposed models and developed semiparametric methods for making inference about the optimal regime in a multi-interval trial that provide clear advantages over traditional parametric approaches. We show that Murphy's model is a special case of Robins's and that the methods are closely related but not equivalent. Interesting features of the methods are highlighted using the Multicenter AIDS Cohort Study and through simulation.     

Variable selection in regression-based estimation of dynamic treatment regimes

Dynamic treatment regimes (DTRs) consist of a sequence of decision rules, one per stage of intervention, that aim to recommend effective treatments for individual patients according to patient information history. DTRs can be estimated from models which include interactions between treatment and a (typically small) number of covariates which are often chosen a priori. However, with increasingly large and complex data being collected, it can be difficult to know which prognostic factors might be relevant in the treatment rule. Therefore, a more data-driven approach to select these covariates might improve the estimated decision rules and simplify models to make them easier to interpret. We propose a variable selection method for DTR estimation using penalized dynamic weighted least squares. Our method has the strong heredity property, that is, an interaction term can be included in the model only if the corresponding main terms have also been selected. We show our method has both the double robustness property and the oracle property theoretically; and the newly proposed method compares favorably with other variable selection approaches in numerical studies. We further illustrate the proposed method on data from the Sequenced Treatment Alternatives to Relieve Depression study.     

Monte Carlo sensitivity analysis for unmeasured confounding in dynamic treatment regimes

Data-driven methods for personalizing treatment assignment have garnered much attention from clinicians and researchers. Dynamic treatment regimes formalize this through a sequence of decision rules that map individual patient characteristics to a recommended treatment. Observational studies are commonly used for estimating dynamic treatment regimes due to the potentially prohibitive costs of conducting sequential multiple assignment randomized trials. However, estimating a dynamic treatment regime from observational data can lead to bias in the estimated regime due to unmeasured confounding. Sensitivity analyses are useful for assessing how robust the conclusions of the study are to a potential unmeasured confounder. A Monte Carlo sensitivity analysis is a probabilistic approach that involves positing and sampling from distributions for the parameters governing the bias. We propose a method for performing a Monte Carlo sensitivity analysis of the bias due to unmeasured confounding in the estimation of dynamic treatment regimes. We demonstrate the performance of the proposed procedure with a simulation study and apply it to an observational study examining tailoring the use of antidepressant medication for reducing symptoms of depression using data from Kaiser Permanente Washington.     

Least median of squares and iteratively re‐weighted least squares as robust linear regression methods for fluorimetric determination of α‐lipoic acid in capsules in ideal and non‐ideal cases of linearity

This study outlines two robust regression approaches, namely least median of squares (LMS) and iteratively re‐weighted least squares (IRLS) to investigate their application in instrument analysis of nutraceuticals (that is, fluorescence quenching of merbromin reagent upon lipoic acid addition). These robust regression methods were used to calculate calibration data from the fluorescence quenching reaction (?F and F‐ratio) under ideal or non‐ideal linearity conditions. For each condition, data were treated using three regression fittings: Ordinary Least Squares (OLS), LMS and IRLS. Assessment of linearity, limits of detection (LOD) and quantitation (LOQ), accuracy and precision were carefully studied for each condition. LMS and IRLS regression line fittings showed significant improvement in correlation coefficients and all regression parameters for both methods and both conditions. In the ideal linearity condition, the intercept and slope changed insignificantly, but a dramatic change was observed for the non‐ideal condition and linearity intercept. Under both linearity conditions, LOD and LOQ values after the robust regression line fitting of data were lower than those obtained before data treatment. The results obtained after statistical treatment indicated that the linearity ranges for drug determination could be expanded to lower limits of quantitation by enhancing the regression equation parameters after data treatment. Analysis results for lipoic acid in capsules, using both fluorimetric methods, treated by parametric OLS and after treatment by robust LMS and IRLS were compared for both linearity conditions.     

Empirical‐likelihood‐based criteria for model selection on marginal analysis of longitudinal data with dropout missingness

Longitudinal data are common in clinical trials and observational studies, where missing outcomes due to dropouts are always encountered. Under such context with the assumption of missing at random, the weighted generalized estimating equation (WGEE) approach is widely adopted for marginal analysis. Model selection on marginal mean regression is a crucial aspect of data analysis, and identifying an appropriate correlation structure for model fitting may also be of interest and importance. However, the existing information criteria for model selection in WGEE have limitations, such as separate criteria for the selection of marginal mean and correlation structures, unsatisfactory selection performance in small‐sample setups, and so forth. In particular, there are few studies to develop joint information criteria for selection of both marginal mean and correlation structures. In this work, by embedding empirical likelihood into the WGEE framework, we propose two innovative information criteria named a joint empirical Akaike information criterion and a joint empirical Bayesian information criterion, which can simultaneously select the variables for marginal mean regression and also correlation structure. Through extensive simulation studies, these empirical‐likelihood‐based criteria exhibit robustness, flexibility, and outperformance compared to the other criteria including the weighted quasi‐likelihood under the independence model criterion, the missing longitudinal information criterion, and the joint longitudinal information criterion. In addition, we provide a theoretical justification of our proposed criteria, and present two real data examples in practice for further illustration.     

A cure‐rate model for Q‐learning: Estimating an adaptive immunosuppressant treatment strategy for allogeneic hematopoietic cell transplant patients

Cancers treated by transplantation are often curative, but immunosuppressive drugs are required to prevent and (if needed) to treat graft‐versus‐host disease. Estimation of an optimal adaptive treatment strategy when treatment at either one of two stages of treatment may lead to a cure has not yet been considered. Using a sample of 9563 patients treated for blood and bone cancers by allogeneic hematopoietic cell transplantation drawn from the Center for Blood and Marrow Transplant Research database, we provide a case study of a novel approach to Q‐learning for survival data in the presence of a potentially curative treatment, and demonstrate the results differ substantially from an implementation of Q‐learning that fails to account for the cure‐rate.     

Convergence to Normality of the Asymptotic Quasi‐Score Function on a Linear Model

The asymptotic quasi‐likelihood method is considered for the model y_t = f_t(θ) + M_t, t = 0,1, …,T where f_tθ) is a linear predictable process of the parameter of interest θ, M_t is a martingale difference, and the nature of E(M_t² | ℱ_t–1) is unknown. This paper is concerned with the limiting distribution of the asymptotic quasi‐score function of such a model. Confidence intervals and hypothesis testing of θ is derived from the limiting distribution. Comparison is made between the estimates obtained through this method and those obtained through the least squares method.     

Information‐theoretic model selection affects home‐range estimation and habitat preference inference: a case study of male Reeves’s Pheasants Syrmaticus reevesii

Reeves’s Pheasant Syrmaticus reevesii is a vulnerable forest bird inhabiting broadleaved habitats dominated by oaks Quercus spp. in central China. Identifying home‐ranges and habitat associations is important for understanding the biology of this species and developing effective management and conservation plans. We used information‐theoretic criteria to evaluate the relative performance of four parametric (exponential power, one‐mode bivariate normal, two‐mode bivariate normal and two‐mode bivariate circle) and two non‐parametric models (adaptive and fixed kernel) for estimating home‐ranges and habitat associations of Reeves’s Pheasants. For parametric models, Akaike’s information criterion (AIC_c) and the likelihood cross‐validation criterion (CVC) were relatively consistent in ranking the bivariate exponential power model the least acceptable, whereas the two‐mode bivariate models performed better. The CVC suggested that kernel models, particularly the adaptive kernel, performed best among all six models evaluated. The average core area and 95% contour area based on the model with greatest support were 6.1 and 54.9 ha, respectively, and were larger than those estimated from other models. The discrepancy in estimates between models with highest and the lowest support decreased as the contour size increased; however, home‐range shapes differed between models. Minimum convex polygons that removed 5% of extreme data points (MCP95) were roughly half the size of home‐ranges based on kernel models. Estimates of home‐range and model evaluation were not affected by sample size (> 50 observations for each bird). Inference about habitat preference based on composition analysis and home‐range overlap varied between models. That with strongest support suggested that Reeves’s Pheasants selected mature fir and mixed forest, avoided farmland, and had mean among‐individual home‐range overlaps of 20%. We recommend non‐parametric methods, particularly the adaptive kernel method, for estimating home‐ranges and core areas for species with complex multi‐polar habitat preferences in heterogeneous environments with large habitat patches. However, we caution against the traditional convenience of using a single model to estimate home‐ranges and recommend exploration of multiple models for describing and understanding the ecological processes underlying space use and habitat associations.     

Quantile regression improves models of lake eutrophication with implications for ecosystem‐specific management

相似文献   

Risk Factor Adjustment in Marginal Structural Model Estimation of Optimal Treatment Regimes

Marginal structural models (MSMs) are an increasingly popular tool, particularly in epidemiological applications, to handle the problem of time‐varying confounding by intermediate variables when studying the effect of sequences of exposures. Considerable attention has been devoted to the optimal choice of treatment model for propensity score‐based methods and, more recently, to variable selection in the treatment model for inverse weighting in MSMs. However, little attention has been paid to the modeling of the outcome of interest, particularly with respect to the best use of purely predictive, non‐confounding variables in MSMs. Four modeling approaches are investigated in the context of both static treatment sequences and optimal dynamic treatment rules with the goal of estimating a marginal effect with the least error, both in terms of bias and variability.     

Inverse‐probability‐of‐treatment weighted estimation of causal parameters in the presence of error‐contaminated and time‐dependent confounders

Inverse‐probability‐of‐treatment weighted (IPTW) estimation has been widely used to consistently estimate the causal parameters in marginal structural models, with time‐dependent confounding effects adjusted for. Just like other causal inference methods, the validity of IPTW estimation typically requires the crucial condition that all variables are precisely measured. However, this condition, is often violated in practice due to various reasons. It has been well documented that ignoring measurement error often leads to biased inference results. In this paper, we consider the IPTW estimation of the causal parameters in marginal structural models in the presence of error‐contaminated and time‐dependent confounders. We explore several methods to correct for the effects of measurement error on the estimation of causal parameters. Numerical studies are reported to assess the finite sample performance of the proposed methods.     

Regulation of dynamic polarity switching in bacteria by a Ras‐like G‐protein and its cognate GAP

The rod‐shaped cells of the bacterium Myxococcus xanthus move uni‐directionally and occasionally undergo reversals during which the leading/lagging polarity axis is inverted. Cellular reversals depend on pole‐to‐pole relocation of motility proteins that localize to the cell poles between reversals. We show that MglA is a Ras‐like G‐protein and acts as a nucleotide‐dependent molecular switch to regulate motility and that MglB represents a novel GTPase‐activating protein (GAP) family and is the cognate GAP of MglA. Between reversals, MglA/GTP is restricted to the leading and MglB to the lagging pole defining the leading/lagging polarity axis. For reversals, the Frz chemosensory system induces the relocation of MglA/GTP to the lagging pole causing an inversion of the leading/lagging polarity axis. MglA/GTP stimulates motility by establishing correct polarity of motility proteins between reversals and reversals by inducing their pole‐to‐pole relocation. Thus, the function of Ras‐like G‐proteins and their GAPs in regulating cell polarity is found not only in eukaryotes, but also conserved in bacteria.