Dynamic regime marginal structural mean models for estimation of optimal dynamic treatment regimes, Part I: main content

Dynamic treatment regimes are set rules for sequential decision making based on patient covariate history. Observational studies are well suited for the investigation of the effects of dynamic treatment regimes because of the variability in treatment decisions found in them. This variability exists because different physicians make different decisions in the face of similar patient histories. In this article we describe an approach to estimate the optimal dynamic treatment regime among a set of enforceable regimes. This set is comprised by regimes defined by simple rules based on a subset of past information. The regimes in the set are indexed by a Euclidean vector. The optimal regime is the one that maximizes the expected counterfactual utility over all regimes in the set. We discuss assumptions under which it is possible to identify the optimal regime from observational longitudinal data. Murphy et al. (2001) developed efficient augmented inverse probability weighted estimators of the expected utility of one fixed regime. Our methods are based on an extension of the marginal structural mean model of Robins (1998, 1999) which incorporate the estimation ideas of Murphy et al. (2001). Our models, which we call dynamic regime marginal structural mean models, are specially suitable for estimating the optimal treatment regime in a moderately small class of enforceable regimes of interest. We consider both parametric and semiparametric dynamic regime marginal structural models. We discuss locally efficient, double-robust estimation of the model parameters and of the index of the optimal treatment regime in the set. In a companion paper in this issue of the journal we provide proofs of the main results.

Dynamic regime marginal structural mean models for estimation of optimal dynamic treatment regimes, Part II: proofs of results

In this companion article to "Dynamic Regime Marginal Structural Mean Models for Estimation of Optimal Dynamic Treatment Regimes, Part I: Main Content" [Orellana, Rotnitzky and Robins (2010), IJB, Vol. 6, Iss. 2, Art. 7] we present (i) proofs of the claims in that paper, (ii) a proposal for the computation of a confidence set for the optimal index when this lies in a finite set, and (iii) an example to aid the interpretation of the positivity assumption.

Effects of long-term head-down-tilt bed rest and different training regimes on the coagulation system of healthy men

Immobility plus preexisting chronic disease or acute trauma can activate the coagulation system, thus increasing the risk for thromboembolic events. The effects of long-term bed-rest immobility and microgravity on the coagulation system of healthy persons (e.g., during crewed Mars missions) have not yet been studied. The main objective of the second Berlin BedRest Study (BBR2-2) "Coagulation Part" was to investigate adaptations of the hemostatic system during long-term bed rest (60 days) under simulated microgravity (6° head-down-tilt [6°HDT]) and after mobilization in three different volunteer groups (randomly assigned to CTR= inactive control group; RE= resistive exercise only group; and RVE= resistive exercise with whole-body vibration group). In 24 males (aged 21-45 years), before, during, and after long-term bed rest, key parameters of coagulation were measured from venous blood samples: D-dimer (DD), thrombin-antithrombin III complex (TAT), and prothrombin fragment F1 + 2 (PT-F1 + 2). Additionally, modified rotational thrombelastometry (ROTEM (®) ) analysis was performed. Times of exploratory analyses were as follows: baseline data collection 2 days before bed rest (BDC-2); eight different days of 6°HDT bed rest (HDT1-HDT60), and two different days after reambulation (R + 3 and R + 6). We found significant changes in DD, TAT, and PT-F1 + 2 over the total time course, but no consistent effect of physical interventions (RE, RVE) on these parameters. Notably, no parameter reached levels indicative of intravascular thrombin formation. All ROTEM® parameters remained within the normal range and no pathological traces were found. Sixty days of 6°HDT bed rest are not associated with pronounced activation of the coagulation system indicative of intravascular thrombus formation in healthy volunteers independent of the training type during the bed rest.

Indigenous blood and ethical regimes in the United States and Australia since the 1960s

Blood samples collected from members of indigenous communities in the mid-20th century by scientists interested in human variation remain frozen today in institutional repositories around the world. This article focuses on two such collections-one established and maintained in the United States and the other in Australia. Through historical and ethnographic analysis, we show how scientific knowledge about the human species and ethical knowledge about human experimentation are coproduced differently in each national context over time. Through a series of vignettes, we trace the attempts of scientists and indigenous people to assemble and reassemble blood samples, ethical regimes, human biological knowledge, and personhood. In including ourselves-a U.S. historian of science and an Australian anthropologist-in the narrative, we show how humanistic and social scientific analysis contributes to ongoing efforts to maintain indigenous samples. [indigenous, biospecimens, science, genomics, postcolonial, ethics, cryopreservation].

Long-term impact of pneumococcal polysaccharide vaccination on nasopharyngeal carriage in children previously vaccinated with various pneumococcal conjugate vaccine regimes

Previously, the Fiji Pneumococcal Project (FiPP) evaluated reduced dose immunization schedules that incorporated pneumococcal protein conjugate and/or polysaccharide vaccine (PCV7 and 23vPPV, respectively). Immune hyporesponsiveness was observed in children vaccinated with 23vPPV at 12 months of age compared with children who did not receive 23vPPV.

Here we assess the long-term impact of 23vPPV vaccination on nasopharyngeal carriage rates and densities of Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus and Moraxella catarrhalis. Nasopharyngeal swabs (n = 194) were obtained from healthy children who participated in FiPP (now aged 5–7 years). S. pneumoniae were isolated and identified by standard culture-based methods, and serotyped using latex agglutination and the Quellung reaction. Carriage rates and densities of S. pneumoniae, H. influenzae, S. aureus and M. catarrhalis were determined using real-time quantitative PCR.

There were no differences in the rate or density of S. pneumoniae, H. influenzae or M. catarrhalis carriage by PCV7 dose or 23vPPV vaccination in the vaccinated participants overall. However, differences were observed between the two main ethnic groups: Fijian children of Indian descent (Indo-Fijian) were less likely to carry S. pneumoniae, H. influenzae and M. catarrhalis, and there was evidence of a higher carriage rate of S. aureus compared with indigenous Fijian (iTaukei) children. Polysaccharide vaccination appeared to have effects that varied between ethnic groups, with 23vPPV vaccination associated with a higher carriage rate of S. aureus in iTaukei children, while there was a lower carriage rate of S. pneumoniae associated with 23vPPV vaccination in Indo-Fijian children.

Overall, polysaccharide vaccination had no long-term impact on pneumococcal carriage, but may have impacted on S. aureus carriage and have varying effects in ethnic groups, suggesting current WHO vaccine schedule recommendations against the use of 23vPPV in children under two years of age are appropriate.

Changing dominance of key plant species across a Mediterranean climate region: implications for fuel types and future fire regimes

Herbaceous and woody plants represent different fuel types in flammable ecosystems, due to contrasting patterns of growth and flammability in response to productivity (moisture availability). However, other factors, such as soil type, fire regimes and competitive interactions may also influence the relative composition of herbaceous and woody plants within a community. The Mediterranean climate region of south eastern Australia is transitional between two contrasting fuel systems; herbaceous dominated in the dry north, versus woody plant dominated shrublands in the relatively moist south. Across the rainfall gradient of the region, there are confounded changes in dominant soil types and fire frequency. We used model-subset selection using Akaike's Information Criterion to examine potential driving mechanisms of community compositional change from herbaceous (e.g. Triodia scariosa, Austrostipa sp.) to woody plants (e.g. Beyeria opaca, Leptospermum coriaceum, Acacia ligulata) by measuring relative cover across combinations of rainfall, time since the last fire (TSF) and soil type. We examined the relative influence of environmental versus competitive interactions on determining the cover of perennial hummock grass, T. scariosa, and co-occurring woody shrubs. Rainfall and soil types, rather than competition, were the over-arching determinants of the relative cover of grasses and shrubs. Given the sensitivity to rainfall, our results indicate there is strong potential for the nature of fuel, flammability and fire regimes to be altered in the future via climate change in this region.

Dominant drivers of seedling establishment in a fire-dependent obligate seeder: climate or fire regimes?

Climate change is causing fire regime shifts in ecosystems worldwide. Plant species with regeneration strategies strongly linked to a fire regime, such as obligate seeders, may be particularly threatened by these changes. It is unclear whether changes in fire regimes or the direct effects of climate change will be the dominant threats to obligate seeders in future. We investigated the relative importance of fire-related variables (fire return interval andfire severity) and environmental factors (climate and topography) on seedling establishment in the world's tallest angiosperm, an obligate seeder, Eucalyptus regnans. Throughout its range, this species dominates the wet montane forests of south-eastern Australia and plays a keystone role in forest structure. Following major wildfires, we investigated seedling establishment in E. regnanswithin 1 year of fire as this is a critical stage in the regeneration niche of obligate seeders. Seedling presence and abundance were strongly related to the occurrence of fire but not to variation in fire severity (moderate vs. high severity). Seedling abundance increased with increasing fire return interval (range 26-300 years). First-year seedling establishment was also strongly associated with low temperatures and with high elevations, high precipitation and persistent soil water availability. Our results show that both climate and fire regimes are strong drivers of E. regnans seedling establishment. The predicted warming and drying of the climate might reduce the regeneration potential for some obligate seeders in future and these threats are likely to be compounded by changes in fire regimes, particularly increases in fire frequency.

Exchange rate regimes and fiscal discipline: the role of trade openness

This study revisits the relationship between exchange rate regime (ERR) choice and fiscal discipline focusing on the role of trade openness. The conventional theoretical view is that fixed regimes bring about more fiscal discipline, while the recent literature argues that flexible regimes are more disciplinary. Empirical studies have provided mixed evidence. Using a panel dataset for a large number of developing and developed countries, as well as pooled panel OLS and instrumental variables (IV) estimation techniques, we find support for both views. We document that a fixed ERR is disciplinary at low levels of trade openness, while a flexible regime produces a greater fiscal discipline above a certain level of trade openness. Moreover, this relationship applies to only developing countries. These findings remain robust across different measures of fiscal outcomes, a number of controls, across different sub-samples, and are supported by both annual and five-year averaged panel data.