Tuning Parameter Selection for the Adaptive Lasso Using ERIC

Generational Differences in Moral Injury, Resilience, and Well-Being Among Nurses: Predictors of Intention to Leave Position and Profession

BACKGROUND

The COVID-19 pandemic highlighted the negative impact of moral injury on nurses' well-being. However, there is a lack of research about generational differences among nurses, particularly on newer nurses who have been identified as having a higher rate of intention to leave.

OBJECTIVE

This study examines generational differences among nurses on moral injury, well-being, resilience, and intention to leave their nursing position and profession.

METHODS

This is a secondary analysis of cross-sectional data from registered nurses in clinical practice in Ohio between July and August 2021. Data on demographics, moral injury, resilience, and well-being were collected using an online survey. Participants were categorized into 4 generational groups based on their age in 2021: Baby Boomers (57-75 years old), Generation X (42-56 years old), Generation Y (27-41 years old), and Generation Z (12-26 years old). Descriptive and inferential statistics, including logistic regression and analysis of variance, were employed for analysis.

RESULTS

Significant generational differences were found in years of clinical experience, moral injury, resilience, and well-being. Baby Boomers reported higher well-being and resilience and lower moral injury. Notably, the intention to leave the profession was more strongly associated with well-being and moral injury levels than with the years of experience or generational group.

CONCLUSIONS

The findings suggest that interventions to improve nurse retention should prioritize enhancing well-being and addressing the root causes of moral injury. Tailored strategies addressing the needs of different generations are necessary for mitigating the adverse effects of current healthcare challenges on nurse attrition.

Assessment of prescribed vs. achieved fluid balance during continuous renal replacement therapy and mortality outcome

BACKGROUND

Fluid management during continuous renal replacement therapy (CRRT) requires accuracy in the prescription of desired patient fluid balance (FBGoal) and precision in the attainable patient fluid balance (FBAchieved). Herein, we examined the association of the gap between prescribed vs. achieved patient fluid balance during CRRT (%FBGap) with hospital mortality in critically ill patients.

METHODS

Cohort study of critically ill adults with acute kidney injury (AKI) requiring CRRT and a prescription of negative fluid balance (mean patient fluid balance goal of negative ≥0.5 liters per day). Fluid management parameters included: 1) NUF (net ultrafiltration rate); 2) FBGoal; 3) FBAchieved; and 4) FBGap (% gap of fluid balance achieved vs. goal), all adjusted by patient's weight (kg) and duration of CRRT (hours).

RESULTS

Data from 653 patients (median of 102.2 patient-hours of CRRT) were analyzed. Mean (SD) age was 56.7 (14.6) years and 61.9% were male. Hospital mortality rate was 64%. Despite FBGoal was similar in patients who died vs. survived, survivors achieved greater negative fluid balance during CRRT than non-survivors: median FBAchieved -0.25 [-0.52 to -0.05] vs. 0.06 [-0.26 to 0.62] ml/kg/h, p<0.001. Median NUF was lower in patients who died vs. survived: 1.06 [0.63-1.47] vs. 1.22 [0.82-1.69] ml/kg/h, p<0.001, and median %FBGap was higher in patients who died (112.8%, 61.5 to 165.7) vs. survived (64.2%, 30.5 to 91.8), p<0.001. In multivariable models, higher %FBGap was independently associated with increased risk of hospital mortality: aOR (95% CI) 1.01 (1.01-1.02), p<0.001. NUF was not associated with hospital mortality when adjusted by %FBGap and other clinical parameters: aOR 0.96 (0.72-1.28), p = 0.771.

CONCLUSIONS

Higher %FBGap was independently associated with an increased risk of hospital mortality in critically ill adults with AKI on CRRT in whom clinicians prescribed negative fluid balance via CRRT. %FBGap represents a novel quality indicator of CRRT delivery that could assist with operationalizing fluid management interventions during CRRT.

Ranking tailoring variables for constructing individualized treatment rules: an application to schizophrenia

As with many chronic conditions, matching patients with schizophrenia to the best treatment options is difficult. Selecting antipsychotic medication is especially challenging because many of the medications can have burdensome side effects. Adjusting or tailoring medications based on patients' characteristics could improve symptoms. However, it is often not known which patient characteristics are most helpful for informing treatment selection. In this paper, we address the challenge of identifying and ranking important variables for tailoring treatment decisions. We consider a value-search approach implemented through dynamic marginal structural models to estimate an optimal individualized treatment rule. We apply our methodology to the Clinical Antipsychotics Trial of Intervention and Effectiveness (CATIE) study for schizophrenia, to evaluate if some tailoring variables have greater potential than others for selecting treatments for patients with schizophrenia (Stroup et al., 2003).

Screening methods for linear errors-in-variables models in high dimensions

Microarray studies, in order to identify genes associated with an outcome of interest, usually produce noisy measurements for a large number of gene expression features from a small number of subjects. One common approach to analyzing such high-dimensional data is to use linear errors-in-variables models; however, current methods for fitting such models are computationally expensive. In this paper, we present two efficient screening procedures, namely corrected penalized marginal screening and corrected sure independence screening, to reduce the number of variables for final model building. Both screening procedures are based on fitting corrected marginal regression models relating the outcome to each contaminated covariate separately, which can be computed efficiently even with a large number of features. Under mild conditions, we show that these procedures achieve screening consistency and reduce the number of features substantially, even when the number of covariates grows exponentially with sample size. Additionally, if the true covariates are weakly correlated, we show that corrected penalized marginal screening can achieve full variable selection consistency. Through a simulation study and an analysis of gene expression data for bone mineral density of Norwegian women, we demonstrate that the two new screening procedures make estimation of linear errors-in-variables models computationally scalable in high dimensional settings, and improve finite sample estimation and selection performance compared with estimators that do not employ a screening stage. This article is protected by copyright. All rights reserved.

New adaptive lasso approaches for variable selection in automated pharmacovigilance signal detection

Background

Adverse effects of drugs are often identified after market introduction. Post-marketing pharmacovigilance aims to detect them as early as possible and relies on spontaneous reporting systems collecting suspicious cases. Signal detection tools have been developed to mine these large databases and counts of reports are analysed with disproportionality methods. To address disproportionality method biases, recent methods apply to individual observations taking into account all exposures for the same patient. In particular, the logistic lasso provides an efficient variable selection framework, yet the choice of the regularization parameter is a challenging issue and the lasso variable selection may give inconsistent results.

Methods

We propose a new signal detection methodology based on the adaptive lasso. We derived two new adaptive weights from (i) a lasso regression using the Bayesian Information Criterion (BIC), and (ii) the class-imbalanced subsampling lasso (CISL), an extension of stability selection. The BIC is used in the adaptive lasso stage for variable selection. We performed an extensive simulation study and an application to real data, where we compared our methods to the existing adaptive lasso, and recent detection approaches based on lasso regression or propensity scores in high dimension. For both studies, we evaluate the methods in terms of false discoveries and sensitivity.

Results

In the simulations and the application, both proposed adaptive weights show equivalent or better performances than the other competitors, with an advantage for the CISL-based adaptive weights. CISL and lasso regression using BIC are solid alternatives.

Conclusion

Our proposed adaptive lasso is an appealing methodology for signal detection in pharmacovigilance. Although we cannot rely on test theory, our approaches show a low and stable False Discovery Rate in all simulation settings. All methods evaluated in this work are implemented in the adapt4pv R package.

Supplementary Information

The online version contains supplementary material available at (10.1186/s12874-021-01450-3).

Adaptive lasso for the Cox regression with interval censored and possibly left truncated data

We propose a penalized variable selection method for the Cox proportional hazards model with interval censored data. It conducts a penalized nonparametric maximum likelihood estimation with an adaptive lasso penalty, which can be implemented through a penalized EM algorithm. The method is proven to enjoy the desirable oracle property. We also extend the method to left truncated and interval censored data. Our simulation studies show that the method possesses the oracle property in samples of modest sizes and outperforms available existing approaches in many of the operating characteristics. An application to a dental caries data set illustrates the method's utility.

Estimating average treatment effects with a double-index propensity score

We consider estimating average treatment effects (ATE) of a binary treatment in observational data when data-driven variable selection is needed to select relevant covariates from a moderately large number of available covariates X . To leverage covariates among X predictive of the outcome for efficiency gain while using regularization to fit a parametric propensity score (PS) model, we consider a dimension reduction of X based on fitting both working PS and outcome models using adaptive LASSO. A novel PS estimator, the Double-index Propensity Score (DiPS), is proposed, in which the treatment status is smoothed over the linear predictors for X from both the initial working models. The ATE is estimated by using the DiPS in a normalized inverse probability weighting estimator, which is found to maintain double robustness and also local semiparametric efficiency with a fixed number of covariates p. Under misspecification of working models, the smoothing step leads to gains in efficiency and robustness over traditional doubly robust estimators. These results are extended to the case where p diverges with sample size and working models are sparse. Simulations show the benefits of the approach in finite samples. We illustrate the method by estimating the ATE of statins on colorectal cancer risk in an electronic medical record study and the effect of smoking on C-reactive protein in the Framingham Offspring Study.

Constructing networks by filtering correlation matrices: a null model approach

Network analysis has been applied to various correlation matrix data. Thresholding on the value of the pairwise correlation is probably the most straightforward and common method to create a network from a correlation matrix. However, there have been criticisms on this thresholding approach such as an inability to filter out spurious correlations, which have led to proposals of alternative methods to overcome some of the problems. We propose a method to create networks from correlation matrices based on optimization with regularization, where we lay an edge between each pair of nodes if and only if the edge is unexpected from a null model. The proposed algorithm is advantageous in that it can be combined with different types of null models. Moreover, the algorithm can select the most plausible null model from a set of candidate null models using a model selection criterion. For three economic datasets, we find that the configuration model for correlation matrices is often preferred to standard null models. For country-level product export data, the present method better predicts main products exported from countries than sample correlation matrices do.

Variable selection for joint models with time-varying coefficients

Many clinical studies collect longitudinal and survival data concurrently. Joint models combining these two types of outcomes through shared random effects are frequently used in practical data analysis. The standard joint models assume that the coefficients for the longitudinal and survival components are time-invariant. In many applications, the assumption is overly restrictive. In this research, we extend the standard joint model to include time-varying coefficients, in both longitudinal and survival components, and we present a data-driven method for variable selection. Specifically, we use a B-spline decomposition and penalized likelihood with adaptive group LASSO to select the relevant independent variables and to distinguish the time-varying and time-invariant effects for the two model components. We use Gaussian-Legendre and Gaussian-Hermite quadratures to approximate the integrals in the absence of closed-form solutions. Simulation studies show good selection and estimation performance. Finally, we use the proposed procedure to analyze data generated by a study of primary biliary cirrhosis.

Occupational radiation exposure to the head is higher for scrub nurses than cardiologists during cardiac angiography

AIMS

This study aimed to compare the head dose of a cardiologist to scrub and scout nurses during cardiac angiography.

DESIGN

A correlational longitudinal quantitative design was used to examine the relationship between the variable of occupational dose to the medical operator when compared with the dose to the scrub and scout nurses.

METHODS

A quantitative analysis was performed on data collected during coronary angiograms (N = 612) for one cardiologist and 22 nurses performing either the scrub or scout role between May 2015 and February 2017. Analysis was based on log-transformed dose levels and reported as geometric means and associated 95% confidence intervals.

RESULTS

It was found that scrub nurses received on average 41% more head dose than the cardiologist during diagnostic procedures and 52% higher doses during interventional cases.

CONCLUSION

Nurses working in fluoroscopic cardiovascular procedures should be provided with appropriate training and protective equipment, notably lead skull caps, to minimize their occupational radiation exposure.

IMPACT

There is a notable lack of research evaluating the occupational head and eye exposure to nurses involved in fluoroscopic procedures. This study found that during diagnostic coronary angiograms, the scrub nurses received 41% more occupational head dose than the cardiologist and 52% higher head doses during interventional cases. Radial access resulted in higher doses to scrub nurses than femoral artery access. It is advisable that staff wear protective lead glasses and skull caps and use appropriately positioned ceiling mounted lead shields to minimize the risk of adverse effects of occupational exposure to ionizing radiation.

Regression analysis and variable selection for two-stage multiple-infection group testing data

Group testing, as a cost-effective strategy, has been widely used to perform large-scale screening for rare infections. Recently, the use of multiplex assays has transformed the goal of group testing from detecting a single disease to diagnosing multiple infections simultaneously. Existing research on multiple-infection group testing data either exclude individual covariate information or ignore possible retests on suspicious individuals. To incorporate both, we propose a new regression model. This new model allows us to perform a regression analysis for each infection using multiple-infection group testing data. Furthermore, we introduce an efficient variable selection method to reveal truly relevant risk factors for each disease. Our methodology also allows for the estimation of the assay sensitivity and specificity when they are unknown. We examine the finite sample performance of our method through extensive simulation studies and apply it to a chlamydia and gonorrhea screening data set to illustrate its practical usefulness.

Adaptive elastic net for group testing

For disease screening, group (pooled) testing can be a cost-saving alternative to one-at-a-time testing, with savings realized through assaying pooled biospecimen (eg, urine, blood, saliva). In many group testing settings, practitioners are faced with the task of conducting disease surveillance. That is, it is often of interest to relate individuals' true disease statuses to covariate information via binary regression. Several authors have developed regression methods for group testing data, which is challenging due to the effects of imperfect testing. That is, all testing outcomes (on pools and individuals) are subject to misclassification, and individuals' true statuses are never observed. To further complicate matters, individuals may be involved in several testing outcomes. For analyzing such data, we provide a novel regression methodology which generalizes and extends the aforementioned regression techniques and which incorporates regularization. Specifically, for model fitting and variable selection, we propose an adaptive elastic net estimator under the logistic regression model which can be used to analyze data from any group testing strategy. We provide an efficient algorithm for computing the estimator along with guidance on tuning parameter selection. Moreover, we establish the asymptotic properties of the proposed estimator and show that it possesses "oracle" properties. We evaluate the performance of the estimator through Monte Carlo studies and illustrate the methodology on a chlamydia data set from the State Hygienic Laboratory in Iowa City.

Assessing Tuning Parameter Selection Variability in Penalized Regression

Penalized regression methods that perform simultaneous model selection and estimation are ubiquitous in statistical modeling. The use of such methods is often unavoidable as manual inspection of all possible models quickly becomes intractable when there are more than a handful of predictors. However, automated methods usually fail to incorporate domain-knowledge, exploratory analyses, or other factors that might guide a more interactive model-building approach. A hybrid approach is to use penalized regression to identify a set of candidate models and then to use interactive model-building to examine this candidate set more closely. To identify a set of candidate models, we derive point and interval estimators of the probability that each model along a solution path will minimize a given model selection criterion, for example, Akaike information criterion, Bayesian information criterion (AIC, BIC), etc., conditional on the observed solution path. Then models with a high probability of selection are considered for further examination. Thus, the proposed methodology attempts to strike a balance between algorithmic modeling approaches that are computationally efficient but fail to incorporate expert knowledge, and interactive modeling approaches that are labor intensive but informed by experience, intuition, and domain knowledge. Supplementary materials for this article are available online.

Order selection and sparsity in latent variable models via the ordered factor LASSO

Generalized linear latent variable models (GLLVMs) offer a general framework for flexibly analyzing data involving multiple responses. When fitting such models, two of the major challenges are selecting the order, that is, the number of factors, and an appropriate structure for the loading matrix, typically a sparse structure. Motivated by the application of GLLVMs to study marine species assemblages in the Southern Ocean, we propose the Ordered Factor LASSO or OFAL penalty for order selection and achieving sparsity in GLLVMs. The OFAL penalty is the first penalty developed specifically for order selection in latent variable models, and achieves this by using a hierarchically structured group LASSO type penalty to shrink entire columns of the loading matrix to zero, while ensuring that non-zero loadings are concentrated on the lower-order factors. Simultaneously, individual element sparsity is achieved through the use of an adaptive LASSO. In conjunction with using an information criterion which promotes aggressive shrinkage, simulation shows that the OFAL penalty performs strongly compared with standard methods and penalties for order selection, achieving sparsity, and prediction in GLLVMs. Applying the OFAL penalty to the Southern Ocean marine species dataset suggests the available environmental predictors explain roughly half of the total covariation between species, thus leading to a smaller number of latent variables and increased sparsity in the loading matrix compared to a model without any covariates.

Penalized variable selection in competing risks regression

Penalized variable selection methods have been extensively studied for standard time-to-event data. Such methods cannot be directly applied when subjects are at risk of multiple mutually exclusive events, known as competing risks. The proportional subdistribution hazard (PSH) model proposed by Fine and Gray (J Am Stat Assoc 94:496-509, 1999) has become a popular semi-parametric model for time-to-event data with competing risks. It allows for direct assessment of covariate effects on the cumulative incidence function. In this paper, we propose a general penalized variable selection strategy that simultaneously handles variable selection and parameter estimation in the PSH model. We rigorously establish the asymptotic properties of the proposed penalized estimators and modify the coordinate descent algorithm for implementation. Simulation studies are conducted to demonstrate the good performance of the proposed method. Data from deceased donor kidney transplants from the United Network of Organ Sharing illustrate the utility of the proposed method.