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Studies of critically ill, hospitalized patients often follow participants and characterize daily health status using an ordinal outcome variable. Statistically, longitudinal proportional odds models are a natural choice in these settings since such models can parsimoniously summarize differences across patient groups and over time. However, when one or more of the outcome states is absorbing, the proportional odds assumption for the follow-up time parameter will likely be violated, and more flexible longitudinal models are needed. Motivated by the VIOLET Study (Ginde et al), a parallel-arm, randomized clinical trial of Vitamin D3 in critically ill patients, we discuss and contrast several treatment effect estimands based on time-dependent odds ratio parameters, and we detail contemporary modeling approaches. In VIOLET, the outcome is a four-level ordinal variable where the lowest "not alive" state is absorbing and the highest "at-home" state is nearly absorbing. We discuss flexible extensions of the proportional odds model for longitudinal data that can be used for either model-based inference, where the odds ratio estimator is taken directly from the model fit, or for model-assisted inferences, where heterogeneity across cumulative log odds dichotomizations is modeled and results are summarized to obtain an overall odds ratio estimator. We focus on direct estimation of cumulative probability model (CPM) parameters using likelihood-based analysis procedures that naturally handle absorbing states. We illustrate the modeling procedures, the relative precision of model-based and model-assisted estimators, and the possible differences in the values for which the estimators are consistent through simulations and analysis of the VIOLET Study data.
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Biometría , Enfermedad Crítica , Humanos , Funciones de Verosimilitud , Estudios Longitudinales , Oportunidad RelativaRESUMEN
We propose a general class of 2-phase epidemiologic study designs for quantitative, longitudinal data that are useful when phase 1 longitudinal outcome and covariate data are available but data on the exposure (e.g., a biomarker) can only be collected on a subset of subjects during phase 2. To conduct a study using a design in the class, one first summarizes the longitudinal outcomes by fitting a simple linear regression of the response on a time-varying covariate for each subject. Sampling strata are defined by splitting the estimated regression intercept or slope distributions into distinct (low, medium, and high) regions. Stratified sampling is then conducted from strata defined by the intercepts, by the slopes, or from a mixture. In general, samples selected with extreme intercept values will yield low variances for associations of time-fixed exposures with the outcome and samples enriched with extreme slope values will yield low variances for associations of time-varying exposures with the outcome (including interactions with time-varying exposures). We describe ascertainment-corrected maximum likelihood and multiple-imputation estimation procedures that permit valid and efficient inferences. We embed all methodological developments within the framework of conducting a substudy that seeks to examine genetic associations with lung function among continuous smokers in the Lung Health Study (United States and Canada, 1986-1994).
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Diseño de Investigaciones Epidemiológicas , Modelos Estadísticos , Evaluación de Resultado en la Atención de Salud/métodos , Estudios de Casos y Controles , Humanos , Modelos Lineales , Estudios Longitudinales , MuestreoRESUMEN
In vitro cell proliferation assays are widely used in pharmacology, molecular biology, and drug discovery. Using theoretical modeling and experimentation, we show that current metrics of antiproliferative small molecule effect suffer from time-dependent bias, leading to inaccurate assessments of parameters such as drug potency and efficacy. We propose the drug-induced proliferation (DIP) rate, the slope of the line on a plot of cell population doublings versus time, as an alternative, time-independent metric.
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Proliferación Celular/efectos de los fármacos , Descubrimiento de Drogas/métodos , Modelos Teóricos , Biología Molecular/métodos , Bibliotecas de Moléculas Pequeñas/farmacología , Línea Celular Tumoral , Simulación por Computador , Relación Dosis-Respuesta a Droga , Humanos , Microscopía Fluorescente , Sensibilidad y Especificidad , Bibliotecas de Moléculas Pequeñas/química , Factores de TiempoRESUMEN
We present an integrated method that uses extended time-lapse automated imaging to quantify the dynamics of cell proliferation. Cell counts are fit with a quiescence-growth model that estimates rates of cell division, entry into quiescence and death. The model is constrained with rates extracted experimentally from the behavior of tracked single cells over time. We visualize the output of the analysis in fractional proliferation graphs, which deconvolve dynamic proliferative responses to perturbations into the relative contributions of dividing, quiescent (nondividing) and dead cells. The method reveals that the response of 'oncogene-addicted' human cancer cells to tyrosine kinase inhibitors is a composite of altered rates of division, death and entry into quiescence, a finding that challenges the notion that such cells simply die in response to oncogene-targeted therapy.
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Carcinoma de Células Escamosas/patología , Neoplasias Pulmonares/patología , Microscopía por Video/métodos , Análisis de la Célula Individual/métodos , Carcinoma de Células Escamosas/tratamiento farmacológico , Recuento de Células , Proliferación Celular , Humanos , Neoplasias Pulmonares/tratamiento farmacológico , Inhibidores de Proteínas Quinasas/farmacología , Proteínas Tirosina Quinasas/antagonistas & inhibidores , Relación Estructura-Actividad , Factores de Tiempo , Células Tumorales CultivadasRESUMEN
Polydimethylsiloxane (PDMS) is a commonly used polymer in the fabrication of microfluidic devices due to such features as transparency, gas permeability, and ease of patterning with soft lithography. The surface characteristics of PDMS can also be easily changed with oxygen or low pressure air plasma converting it from a hydrophobic to a hydrophilic state. As part of such a transformation, surface methyl groups are removed and replaced with hydroxyl groups making the exposed surface to resemble silica, a gas impermeable substance. We have utilized Platinum(II)-tetrakis(pentaflourophenyl)porphyrin immobilized within a thin (~1.5 um thick) polystyrene matrix as an oxygen sensor, Stern-Volmer relationship, and Fick's Law of simple diffusion to measure the effects of PDMS composition, treatment, and storage on oxygen diffusion through PDMS. Results indicate that freshly oxidized PDMS showed a significantly smaller diffusion coefficient, indicating that the SiO2 layer formed on the PDMS surface created an impeding barrier. This barrier disappeared after a 3-day storage in air, but remained significant for up to 3 weeks if PDMS was maintained in contact with water. Additionally, higher density PDMS formulation (5:1 ratio) showed similar diffusion characteristics as normal (10:1 ratio) formulation, but showed 60 % smaller diffusion coefficient after plasma treatment that never recovered to pre-treatment levels even after a 3-week storage in air. Understanding how plasma surface treatments contribute to oxygen diffusion will be useful in exploiting the gas permeability of PDMS to establish defined normoxic and hypoxic oxygen conditions within microfluidic bioreactor systems.
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Dimetilpolisiloxanos/química , Gases/química , Técnicas de Cultivo de Célula , Difusión , Técnicas Analíticas Microfluídicas/instrumentación , Microfluídica/métodos , Oxidación-Reducción , Oxígeno/química , Permeabilidad , Poliestirenos/química , Dióxido de Silicio/química , Propiedades de Superficie , Agua/químicaRESUMEN
Mathematical models of biomolecular networks are commonly used to study cellular processes; however, their usefulness to explain and predict dynamic behaviors is often questioned due to the unclear relationship between parameter uncertainty and network dynamics. In this work, we introduce PyDyNo (Python dynamic analysis of biochemical networks), a non-equilibrium reaction-flux based analysis to identify dominant reaction paths within a biochemical reaction network calibrated to experimental data. We first show, in a simplified apoptosis execution model, that despite the thousands of parameter vectors with equally good fits to experimental data, our framework identifies the dynamic differences between these parameter sets and outputs three dominant execution modes, which exhibit varying sensitivity to perturbations. We then apply our methodology to JAK2/STAT5 network in colony-forming unit-erythroid (CFU-E) cells and provide previously unrecognized mechanistic explanation for the survival responses of CFU-E cell population that would have been impossible to deduce with traditional protein-concentration based analyses.
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Stochastic profiling, a method to rank heterogeneity of gene expression in a cell population, shows that quantifying cell-to-cell variability has come of age and leads to biological insight.
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Técnicas Citológicas/métodos , Células Eucariotas/fisiología , Regulación de la Expresión Génica/fisiología , Procesos EstocásticosRESUMEN
The analysis of longitudinal trajectories usually focuses on evaluation of explanatory factors that are either associated with rates of change, or with overall mean levels of a continuous outcome variable. In this article, we introduce valid design and analysis methods that permit outcome dependent sampling of longitudinal data for scenarios where all outcome data currently exist, but a targeted substudy is being planned in order to collect additional key exposure information on a limited number of subjects. We propose a stratified sampling based on specific summaries of individual longitudinal trajectories, and we detail an ascertainment corrected maximum likelihood approach for estimation using the resulting biased sample of subjects. In addition, we demonstrate that the efficiency of an outcome-based sampling design relative to use of a simple random sample depends highly on the choice of outcome summary statistic used to direct sampling, and we show a natural link between the goals of the longitudinal regression model and corresponding desirable designs. Using data from the Childhood Asthma Management Program, where genetic information required retrospective ascertainment, we study a range of designs that examine lung function profiles over 4 years of follow-up for children classified according to their genotype for the IL 13 cytokine.
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Biometría/métodos , Asma/tratamiento farmacológico , Asma/fisiopatología , Niño , Interpretación Estadística de Datos , Volumen Espiratorio Forzado , Humanos , Funciones de Verosimilitud , Modelos Lineales , Estudios Longitudinales , Modelos EstadísticosRESUMEN
Cells grown in culture act as a model system for analyzing the effects of anticancer compounds, which may affect cell behavior in a cell cycle position-dependent manner. Cell synchronization techniques have been generally employed to minimize the variation in cell cycle position. However, synchronization techniques are cumbersome and imprecise and the agents used to synchronize the cells potentially have other unknown effects on the cells. An alternative approach is to determine the age structure in the population and account for the cell cycle positional effects post hoc. Here we provide a formalism to use quantifiable lifespans from live cell microscopy experiments to parameterize an age-structured model of cell population response.
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Antineoplásicos/farmacología , Ciclo Celular/efectos de los fármacos , Senescencia Celular/efectos de los fármacos , Modelos Biológicos , Neoplasias/metabolismo , Antineoplásicos/uso terapéutico , Humanos , Neoplasias/tratamiento farmacológico , Neoplasias/patologíaRESUMEN
We discuss a decision-theoretic approach to building a panel-based, preemptive genotyping program. The method is based on findings that a large percentage of patients are prescribed medications that are known to have pharmacogenetic associations, and over time, a substantial proportion are prescribed additional such medication. Preemptive genotyping facilitates genotype-guided therapy at the time medications are prescribed; panel-based testing allows providers to reuse previously collected genetic data when a new indication arises. Because it is cost-prohibitive to conduct panel-based genotyping on all patients, we describe a three-step approach to identify patients with the highest anticipated benefit. First, we construct prediction models to estimate the risk of being prescribed one of the target medications using readily available clinical data. Second, we use literature-based estimates of adverse event rates, variant allele frequencies, secular death rates, and costs to construct a discrete event simulation that estimates the expected benefit of having an individual's genetic data in the electronic health record after an indication has occurred. Finally, we combine medication prescription risk with expected benefit of genotyping once a medication is indicated to calculate the expected benefit of preemptive genotyping. For each patient-clinic visit, we calculate this expected benefit across a range of medications and select patients with the highest expected benefit overall. We build a proof of concept implementation using a cohort of patients from a single academic medical center observed from July 2010 through December 2012. We then apply the results of our modeling strategy to show the extent to which we can improve clinical and economic outcomes in a cohort observed from January 2013 through December 2015.
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Substudies of the Childhood Asthma Management Program (CAMP Research Group, 1999, 2000) seek to identify patient characteristics associated with asthma symptoms and lung function. To determine if genetic measures are associated with trajectories of lung function as measured by forced vital capacity (FVC), children in the primary cohort study retrospectively had candidate loci evaluated. Given participant burden and constraints on financial resources, it is often desirable to target a sub-sample for ascertainment of costly measures. Methods that can leverage the longitudinal outcome on the full cohort to selectively measure informative individuals have been promising, but have been restricted in their use to analysis of the targeted sub-sample. In this paper we detail two multiple imputation analysis strategies that exploit outcome and partially observed covariate data on the non-sampled subjects, and we characterize alternative design and analysis combinations that could be used for future studies of pulmonary function and other outcomes. Candidate predictor (e.g. IL10 cytokine polymorphisms) associations obtained from targeted sampling designs can be estimated with very high efficiency compared to standard designs. Further, even though multiple imputation can dramatically improve estimation efficiency for covariates available on all subjects (e.g., gender and baseline age), only modest efficiency gains were observed in parameters associated with predictors that are exclusive to the targeted sample. Our results suggest that future studies of longitudinal trajectories can be efficiently conducted by use of outcome-dependent designs and associated full cohort analysis.
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Mapping quantitative cell traits (QCT) to underlying molecular defects is a central challenge in cancer research because heterogeneity at all biological scales, from genes to cells to populations, is recognized as the main driver of cancer progression and treatment resistance. A major roadblock to a multiscale framework linking cell to signaling to genetic cancer heterogeneity is the dearth of large-scale, single-cell data on QCT-such as proliferation, death sensitivity, motility, metabolism, and other hallmarks of cancer. High-volume single-cell data can be used to represent cell-to-cell genetic and nongenetic QCT variability in cancer cell populations as averages, distributions, and statistical subpopulations. By matching the abundance of available data on cancer genetic and molecular variability, QCT data should enable quantitative mapping of phenotype to genotype in cancer. This challenge is being met by high-content automated microscopy (HCAM), based on the convergence of several technologies including computerized microscopy, image processing, computation, and heterogeneity science. In this chapter, we describe an HCAM workflow that can be set up in a medium size interdisciplinary laboratory, and its application to produce high-throughput QCT data for cancer cell motility and proliferation. This type of data is ideally suited to populate cell-scale computational and mathematical models of cancer progression for quantitatively and predictively evaluating cancer drug discovery and treatment.