Modeling and estimating a threshold effect: An application to improving cardiac surgery practices.

Estimating thresholds when a threshold effect exists has important applications in biomedical research. However, models/methods commonly used in the biomedical literature may lead to a biased estimate. For patients undergoing coronary artery bypass grafting (CABG), it is thought that exposure to low oxygen delivery (DO2) contributes to an increased risk of avoidable acute kidney injury. This research is motivated by estimating the threshold of nadir DO2 for CABG patients to help develop an evidence-based guideline for improving cardiac surgery practices. We review several models (sudden-jump model, broken-stick model, and the constrained broken-stick model) that can be adopted to estimate the threshold and discuss modeling assumptions, scientific plausibility, and implications in estimating the threshold. Under each model, various estimation methods are studied and compared. In particular, under a constrained broken-stick model, a modified two-step Newton-Raphson algorithm is introduced. Through comprehensive simulation studies and an application to data on CABG patients from the University of Michigan, we show that the constrained broken-stick model is flexible, more robust, and able to incorporate scientific knowledge to improve efficiency. The two-step Newton-Raphson algorithm has good computational performances relative to existing methods.

Estimation in optimal treatment regimes based on mean residual lifetimes with right-censored data.

An optimal individualized treatment regime (ITR) is a decision rule in allocating the best treatment to each patient and, hence, maximizing overall benefits. In this paper, we propose a novel framework based on nonparametric inverse probability weighting (IPW) and augmented inverse probability weighting (AIPW) estimators of the value function when the data are subject to right censoring. In contrast to most existing approaches that are designed to maximize the expected survival time under a binary treatment framework, the proposed method targets maximizing the mean residual lifetime of patients. Specifically, the proposed IPW method searches the optimal ITR by maximizing an estimator for the overall population outcome directly, without specifying the regression model for the conditional mean residual lifetime, whereas the AIPW method integrates the model information of the mean residual lifetime to improve the robustness. Furthermore, to overcome the computational difficulty in a nonsmooth value estimator, smoothed IPW and AIPW estimators are constructed. In theory, we establish the asymptotic properties of the proposed method under suitable regularity conditions. The empirical performances of the proposed IPW and AIPW estimators are evaluated using simulation studies and are further illustrated with an application to the real-world data set from the Acquired Immunodeficiency Syndrome Clinical Trial Group Protocol 175 (ACTG175).

Robust method for optimal treatment decision making based on survival data.

Identifying the optimal treatment decision rule, where the best treatment for an individual varies according to his/her characteristics, is of great importance when treatment effect heterogeneity exists. We develop methods for estimating the optimal treatment decision rule based on data with survival time as the primary endpoint. Our methods are based on a flexible semiparametric accelerated failure time model, where only the treatment contrast (ie, the difference in means between treatments) is parameterized and all other aspects are unspecified. An individual's treatment contrast is firstly estimated robustly by an augmented inverse probability weighted estimator (AIPWE). Then the optimal decision rule is estimated by minimizing the loss between the treatment contrast and the AIPWE contrast. Two loss functions with different strategies to account for censoring are proposed. The proposed loss functions distinguish from existing ones in that they are based on treatment contrasts, which completely determine the optimal treatment rule. Our methods can further incorporate a penalty term to select variables that are only important for treatment decision making, while taking advantage of all covariates predictive of outcomes to improve performance. Comprehensive simulation studies have been conducted to evaluate performances of the proposed methods relative to existing methods. The proposed methods are illustrated with an application to the ACTG 175 clinical trial on HIV-infected patients.

C-learning: A new classification framework to estimate optimal dynamic treatment regimes.

A dynamic treatment regime is a sequence of decision rules, each corresponding to a decision point, that determine that next treatment based on each individual's own available characteristics and treatment history up to that point. We show that identifying the optimal dynamic treatment regime can be recast as a sequential optimization problem and propose a direct sequential optimization method to estimate the optimal treatment regimes. In particular, at each decision point, the optimization is equivalent to sequentially minimizing a weighted expected misclassification error. Based on this classification perspective, we propose a powerful and flexible C-learning algorithm to learn the optimal dynamic treatment regimes backward sequentially from the last stage until the first stage. C-learning is a direct optimization method that directly targets optimizing decision rules by exploiting powerful optimization/classification techniques and it allows incorporation of patient's characteristics and treatment history to improve performance, hence enjoying advantages of both the traditional outcome regression-based methods (Q- and A-learning) and the more recent direct optimization methods. The superior performance and flexibility of the proposed methods are illustrated through extensive simulation studies.

HiView: an integrative genome browser to leverage Hi-C results for the interpretation of GWAS variants.

BACKGROUND: Genome-wide association studies (GWAS) have identified thousands of genetic variants associated with complex traits and diseases. However, most of them are located in the non-protein coding regions, and therefore it is challenging to hypothesize the functions of these non-coding GWAS variants. Recent large efforts such as the ENCODE and Roadmap Epigenomics projects have predicted a large number of regulatory elements. However, the target genes of these regulatory elements remain largely unknown. Chromatin conformation capture based technologies such as Hi-C can directly measure the chromatin interactions and have generated an increasingly comprehensive catalog of the interactome between the distal regulatory elements and their potential target genes. Leveraging such information revealed by Hi-C holds the promise of elucidating the functions of genetic variants in human diseases. RESULTS: In this work, we present HiView, the first integrative genome browser to leverage Hi-C results for the interpretation of GWAS variants. HiView is able to display Hi-C data and statistical evidence for chromatin interactions in genomic regions surrounding any given GWAS variant, enabling straightforward visualization and interpretation. CONCLUSIONS: We believe that as the first GWAS variants-centered Hi-C genome browser, HiView is a useful tool guiding post-GWAS functional genomics studies. HiView is freely accessible at: http://www.unc.edu/~yunmli/HiView .

Likelihood-based complex trait association testing for arbitrary depth sequencing data.

UNLABELLED: In next generation sequencing (NGS)-based genetic studies, researchers typically perform genotype calling first and then apply standard genotype-based methods for association testing. However, such a two-step approach ignores genotype calling uncertainty in the association testing step and may incur power loss and/or inflated type-I error. In the recent literature, a few robust and efficient likelihood based methods including both likelihood ratio test (LRT) and score test have been proposed to carry out association testing without intermediate genotype calling. These methods take genotype calling uncertainty into account by directly incorporating genotype likelihood function (GLF) of NGS data into association analysis. However, existing LRT methods are computationally demanding or do not allow covariate adjustment; while existing score tests are not applicable to markers with low minor allele frequency (MAF). We provide an LRT allowing flexible covariate adjustment, develop a statistically more powerful score test and propose a combination strategy (UNC combo) to leverage the advantages of both tests. We have carried out extensive simulations to evaluate the performance of our proposed LRT and score test. Simulations and real data analysis demonstrate the advantages of our proposed combination strategy: it offers a satisfactory trade-off in terms of computational efficiency, applicability (accommodating both common variants and variants with low MAF) and statistical power, particularly for the analysis of quantitative trait where the power gain can be up to ∼60% when the causal variant is of low frequency (MAF < 0.01). AVAILABILITY AND IMPLEMENTATION: UNC combo and the associated R files, including documentation, examples, are available at http://www.unc.edu/∼yunmli/UNCcombo/ CONTACT: yunli@med.unc.edu SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

Robust estimation of optimal dynamic treatment regimes for sequential treatment decisions.

A dynamic treatment regime is a list of sequential decision rules for assigning treatment based on a patient's history. Q- and A-learning are two main approaches for estimating the optimal regime, i.e., that yielding the most beneficial outcome in the patient population, using data from a clinical trial or observational study. Q-learning requires postulated regression models for the outcome, while A-learning involves models for that part of the outcome regression representing treatment contrasts and for treatment assignment. We propose an alternative to Q- and A-learning that maximizes a doubly robust augmented inverse probability weighted estimator for population mean outcome over a restricted class of regimes. Simulations demonstrate the method's performance and robustness to model misspecification, which is a key concern.

A robust method for estimating optimal treatment regimes.

A treatment regime is a rule that assigns a treatment, among a set of possible treatments, to a patient as a function of his/her observed characteristics, hence "personalizing" treatment to the patient. The goal is to identify the optimal treatment regime that, if followed by the entire population of patients, would lead to the best outcome on average. Given data from a clinical trial or observational study, for a single treatment decision, the optimal regime can be found by assuming a regression model for the expected outcome conditional on treatment and covariates, where, for a given set of covariates, the optimal treatment is the one that yields the most favorable expected outcome. However, treatment assignment via such a regime is suspect if the regression model is incorrectly specified. Recognizing that, even if misspecified, such a regression model defines a class of regimes, we instead consider finding the optimal regime within such a class by finding the regime that optimizes an estimator of overall population mean outcome. To take into account possible confounding in an observational study and to increase precision, we use a doubly robust augmented inverse probability weighted estimator for this purpose. Simulations and application to data from a breast cancer clinical trial demonstrate the performance of the method.

Estimating Optimal Treatment Regimes from a Classification Perspective.

A treatment regime maps observed patient characteristics to a recommended treatment. Recent technological advances have increased the quality, accessibility, and volume of patient-level data; consequently, there is a growing need for powerful and flexible estimators of an optimal treatment regime that can be used with either observational or randomized clinical trial data. We propose a novel and general framework that transforms the problem of estimating an optimal treatment regime into a classification problem wherein the optimal classifier corresponds to the optimal treatment regime. We show that commonly employed parametric and semi-parametric regression estimators, as well as recently proposed robust estimators of an optimal treatment regime can be represented as special cases within our framework. Furthermore, our approach allows any classification procedure that can accommodate case weights to be used without modification to estimate an optimal treatment regime. This introduces a wealth of new and powerful learning algorithms for use in estimating treatment regimes. We illustrate our approach using data from a breast cancer clinical trial.