Estimating tree-based dynamic treatment regimes using observational data with restricted treatment sequences

A dynamic treatment regime (DTR) is a sequence of decision rules that provide guidance on how to treat individuals based on their static and time-varying status. Existing observational data are often used to generate hypotheses about effective DTRs. A common challenge with observational data, however, is the need for analysts to consider “restrictions” on the treatment sequences. Such restrictions may be necessary for settings where (1) one or more treatment sequences that were offered to individuals when the data were collected are no longer considered viable in practice, (2) specific treatment sequences are no longer available, or (3) the scientific focus of the analysis concerns a specific type of treatment sequences (eg, “stepped-up” treatments). To address this challenge, we propose a restricted tree–based reinforcement learning (RT-RL) method that searches for an interpretable DTR with the maximum expected outcome, given a (set of) user-specified restriction(s), which specifies treatment options (at each stage) that ought not to be considered as part of the estimated tree-based DTR. In simulations, we evaluate the performance of RT-RL versus the standard approach of ignoring the partial data for individuals not following the (set of) restriction(s). The method is illustrated using an observational data set to estimate a two-stage stepped-up DTR for guiding the level of care placement for adolescents with substance use disorder.     

三化螟种群系统的最优管理决策

以三化螟Tryporyza invertulas(Walker)种群动态模型和水稻产量损失预测模型为基础,根据水稻插植期、品种抗性,保护利用自然天敌和杀虫剂多次使用等控制措施以及它们的各种不同组合对该虫种群动态、水稻产量损失串和净收益的影响,以净收益最大为目标函数,研究三化螟种群的最优管理决策。其中,对昆虫种群动态模拟方法作了一点改进,它综合了前人所提出的种群动态模型的优点。建立的系统模型能够提供包括农业防治、生物防治和化学防治措施在内的、对三化螟种群实施有效管理的最优决策方案。     

News from the Biological Stain Commission No. 12

Abstract

In this 12^th issue of News from the Biological Stain Commission (BSC) under the heading of Regulatory affairs, the Biological Stain Commission’s International Affairs Committee presents information from the meetings of ISO/TC 212/WG 1 Quality and competence in the medical laboratory and ISO/TC 212/WG 3 In vitro diagnostic products both held on 2 – 3 June 2010, plus information on the second plenary meeting of ISO/TC 212 Clinical laboratory testing and in vitro diagnostic test systems held on 4 June 2010. All meetings took place in Seoul, Republic of Korea. Finally, information is provided concerning the 25^th meeting of CEN/TC 140 In vitro diagnostic medical devices held on 23 June 2010 in Berlin, Germany.     

The method matters: A guide for indicator aggregation in ecological assessments

Ecological assessment requires the integration of many physical, chemical, and/or biological quality elements. The choice of the aggregation method of such partial assessments into an overall assessment can considerably affect the assessment outcome – an issue that has been controversially discussed within the scientific community for the last decade. Current practice often considers only two different aggregation methods, the weighted arithmetic mean (additive aggregation) and the one-out, all-out method (minimum aggregation). However, both have important drawbacks. Additive aggregation compensates a bad status of one quality element by a number of elements featuring good status. Minimum aggregation can lead to overly pessimistic assessment results, since only the quality element in the worst status is considered. Here, we introduce a toolbox containing current and new aggregation methods, demonstrate and discuss their properties with simple, didactical examples, and suggest in which situations best to use them. Then, we illustrate the consequences of selected aggregation schemes for ecological river assessment with the case study of the Swiss Modular Concept of stream assessment (SMC), which we apply to ten river reaches in the Mönchaltdorfer Aa catchment in Switzerland. To be able to do so, we used multi-criteria decision analysis, i.e., multi-attribute value theory, to arrange the SMC quality elements into an objectives hierarchy, and to translate their individual assessments into value functions. Our case study revealed that choosing the most appropriate aggregation method particularly matters, if objectives with significantly different qualities are aggregated. We argue that redundant objectives (i.e., quality elements), often found at the lower levels of the objectives hierarchy, should best be aggregated additively allowing for compensation to increase the statistical significance of the results. Further, we suggest that complementary sub-objectives that often occur at higher levels may be optimally aggregated with a mixture of additive and minimum aggregation. Such a mixed method will allow some compensation, but nevertheless penalize for very bad states. Since here we compare commonly used aggregation methods with some which we believe have never been discussed in an assessment context before, our study concurrently informs ecological assessment in theory and in practice.     

What is the best age to circumcise? A medical and ethical analysis

Circumcision is often claimed to be simpler, safer and more cost-effective when performed in the neonatal period as opposed to later in life, with a greater benefit-to-risk ratio. In the first part of this paper, we critically examine the evidence base for these claims, and find that it is not as robust as is commonly assumed. In the second part, we demonstrate that, even if one simply grants these claims for the sake of argument, it still does not follow that neonatal circumcision is ethically permissible absent urgent medical necessity. Based on a careful consideration of the relevant evidence, arguments and counterarguments, we conclude that medically unnecessary penile circumcision—like other medically unnecessary genital procedures, such as ‘cosmetic’ labiaplasty—should not be performed on individuals who are too young (or otherwise unable) to provide meaningful consent to the procedure.     

栽培条件对灵芝子实体的三萜组成及其活性的影响

以不同灵芝品种、不同栽培基质、不同管理方式、不同生长时期获得的灵芝子实体为原料,用95%乙醇超声提取,对提取物进行了含量测定、三萜组成分析和体外抗肿瘤实验。结果表明,不同子实体醇提物中三萜和甾醇类物质的含量在4.60-6.20mg/g之间;高效液相分析发现10种三萜化合物的种类和含量在样品间存在明显差异。所有灵芝子实体醇提物对肿瘤细胞L1210的增殖均有一定的抑制作用,开伞期的灵芝子实体醇提物抑制肿瘤增殖的活性优于其他生长时期。     

采自祁连山的冷杉侧耳生物学特性及栽培条件探索

以采自甘肃省祁连山国家级自然保护区菌物保育区的野生侧耳作为试验材料,通过形态学及系统发育分析方法将其鉴定为冷杉侧耳Pleurotus abieticola。对该菌株生物学特性及栽培条件进行初步研究,结果表明：菌丝体最适生长温度为25℃;最适pH为7.0;最适碳源为玉米粉;最适氮源为豆粉;在以棉籽壳、木屑和麸皮为栽培料时,可获得子实体。     

Higher patient doses through X-ray imaging procedures

Medical imaging using X-rays has been one of the most popular imaging modalities ever since the discovery of X-rays 125 years ago. With unquestionable benefits, concerns about radiation risks have frequently been raised. Computed tomography (CT) and fluoroscopic guided interventional procedures have the potential to impart higher radiation exposure to patients than radiographic examinations. Despite technological advances, there have been instances of increased doses per procedure mainly because of better diagnostic information in images. However, cumulative dose from multiple procedures is creating new concerns as effective doses >100 mSv are not uncommon. There is a need for action at all levels. Manufacturers must produce equipment that can provide a quality diagnostic image at substantially lesser dose and better implementation of optimization strategies by users. There is an urgent need for the industry to develop CT scanners with sub-mSv radiation dose, a goal that has been lingering. It appears that a new monochromatic X-ray source will lead to replacement of X-ray tubes all over the world in coming years and will lead to a drastic reduction in radiation doses. This innovation will impact all X-ray imaging and will help dose reduction. For interventional procedures, the likely employment of robotic systems in practice may drastically reduce radiation exposures to operators- but patient exposure will still remain an issue. Training needs always need to be emphasized and practiced.