A SIMEX approach for meta-analysis of diagnostic accuracy studies with attention to ROC curves

Bivariate random-effects models represent an established approach for meta-analysis of accuracy measures of a diagnostic test, which are typically given by sensitivity and specificity. A recent formulation of the classical model describes the test accuracy in terms of study-specific Receiver Operating Characteristics curves. In this way, the resulting summary curve can be thought of as an average of the study-specific Receiver Operating Characteristics curves. Within this framework, the paper shows that the standard likelihood approach for inference is prone to several issues. Small sample size can give rise to unreliable conclusions and convergence problems deeply affect the analysis. The proposed alternative is a simulation-extrapolation method, called SIMEX, developed within the measurement error literature. It suits the meta-analysis framework, as the accuracy measures provided by the studies are estimates rather than true values, and thus are prone to error. The methods are compared in a series of simulation studies, covering different scenarios of interest, including deviations from normality assumptions. SIMEX reveals a satisfactory strategy, providing more accurate inferential results if compared to the likelihood approach, while avoiding convergence failure. The approaches are applied to a meta-analysis of the accuracy of the ultrasound exam for diagnosing abdominal tuberculosis in HIV-positive subjects.

The contributing external load factors to internal load during small-sided games in professional rugby union players

Introduction

This study aimed to investigate which external load variables were associated with internal load during three small-sided games (SSG) in professional rugby union players.

Methods

Forty professional rugby union players (22 forwards, 18 backs) competing in the English Gallagher Premiership were recruited. Three different SSGs were designed: one for backs, one for forwards, and one for both backs and forwards. General linear mixed-effects models were implemented with internal load as dependent variable quantified using Stagno's training impulse, and external load as independent variables quantified using total distance, high-speed (>61% top speed) running distance, average acceleration-deceleration, PlayerLoad™, PlayerLoad™ slow (<2 m·s^-1), number of get-ups, number of first-man-to-ruck.

Results

Internal load was associated with different external load variables dependent on SSG design. When backs and forwards were included in the same SSG, internal load differed between positional groups (MLE = -121.94, SE = 29.03, t = -4.20).

Discussion

Based on the SSGs investigated, practitioners should manipulate different constraints to elicit a certain internal load in their players based on the specific SSG design. Furthermore, the potential effect of playing position on internal load should be taken into account in the process of SSG design when both backs and forwards are included.

Integration of Distinct Analysis Strategies Improves Tissue-Trait Association Identification

Integrating genome-wide association studies (GWAS) with transcriptomic data, human complex traits and diseases have been linked to relevant tissues and cell types using different methods. However, different results from these methods generated confusion while no gold standard is currently accepted, making it difficult to evaluate the discoveries. Here, applying three methods on the same data source, we estimated the sensitivity and specificity of these methods in the absence of a gold standard. We established a more specific tissue-trait association atlas by combining the information captured by different methods. Our triangulation strategy improves the performance of existing methods in establishing tissue-trait associations. The results provide better etiological and functional insights for the tissues underlying different human complex traits and diseases.

Model Selection of Nested and Non-Nested Item Response Models Using Vuong Tests

In this paper, we apply Vuong's general approach of model selection to the comparison of nested and non-nested unidimensional and multidimensional item response theory (IRT) models. Vuong's approach of model selection is useful because it allows for formal statistical tests of both nested and non-nested models. However, only the test of non-nested models has been applied in the context of IRT models to date. After summarizing the statistical theory underlying the tests, we investigate the performance of all three distinct Vuong tests in the context of IRT models using simulation studies and real data. In the non-nested case we observed that the tests can reliably distinguish between the graded response model and the generalized partial credit model. In the nested case, we observed that the tests typically perform as well as or sometimes better than the traditional likelihood ratio test. Based on these results, we argue that Vuong's approach provides a useful set of tools for researchers and practitioners to effectively compare competing nested and non-nested IRT models.

Analyzing discrete competing risks data with partially overlapping or independent data sources and nonstandard sampling schemes, with application to cancer registries

This paper demonstrates the flexibility of a general approach for the analysis of discrete time competing risks data that can accommodate complex data structures, different time scales for different causes, and nonstandard sampling schemes. The data may involve a single data source where all individuals contribute to analyses of both cause-specific hazard functions, overlapping datasets where some individuals contribute to the analysis of the cause-specific hazard function of only one cause while other individuals contribute to analyses of both cause-specific hazard functions, or separate data sources where each individual contributes to the analysis of the cause-specific hazard function of only a single cause. The approach is modularized into estimation and prediction. For the estimation step, the parameters and the variance-covariance matrix can be estimated using widely available software. The prediction step utilizes a generic program with plug-in estimates from the estimation step. The approach is illustrated with three prognostic models for stage IV male oral cancer using different data structures. The first model uses only men with stage IV oral cancer from population-based registry data. The second model strategically extends the cohort to improve the efficiency of the estimates. The third model improves the accuracy for those with a lower risk of other causes of death, by bringing in an independent data source collected under a complex sampling design with additional other-cause covariates. These analyses represent novel extensions of existing methodology, broadly applicable for the development of prognostic models capturing both the cancer and noncancer aspects of a patient's health.

Profile-likelihood Confidence Intervals in Item Response Theory Models

Confidence intervals (CIs) are fundamental inferential devices which quantify the sampling variability of parameter estimates. In item response theory, CIs have been primarily obtained from large-sample Wald-type approaches based on standard error estimates, derived from the observed or expected information matrix, after parameters have been estimated via maximum likelihood. An alternative approach to constructing CIs is to quantify sampling variability directly from the likelihood function with a technique known as profile-likelihood confidence intervals (PL CIs). In this article, we introduce PL CIs for item response theory models, compare PL CIs to classical large-sample Wald-type CIs, and demonstrate important distinctions among these CIs. CIs are then constructed for parameters directly estimated in the specified model and for transformed parameters which are often obtained post-estimation. Monte Carlo simulation results suggest that PL CIs perform consistently better than Wald-type CIs for both non-transformed and transformed parameters.

Pattern of mutation rates in the germline of Drosophila melanogaster males from a large-scale mutation screening experiment

The sperm or eggs of sexual organisms go through a series of cell divisions from the fertilized egg; mutations can occur at each division. Mutations in the lineage of cells leading to the sperm or eggs are of particular importance because many such mutations may be shared by somatic tissues and also may be inherited, thus having a lasting consequence. For decades, little has been known about the pattern of the mutation rates along the germline development. Recently it was shown from a small portion of data that resulted from a large-scale mutation screening experiment that the rates of recessive lethal or nearly lethal mutations differ dramatically during the germline development of Drosophila melanogaster males. In this paper the full data set from the experiment and its analysis are reported by taking advantage of a recent methodologic advance. By analyzing the mutation patterns with different levels of recessive lethality, earlier published conclusions based on partial data are found to remain valid. Furthermore, it is found that for most nearly lethal mutations, the mutation rate at the first cell division is even greater than previous thought compared with those at other divisions. There is also some evidence that the mutation rate at the second division decreases rapidly but is still appreciably greater than those for the rest of the cleavage stage. The mutation rate at spermatogenesis is greater than late cleavage and stem-cell stages, but there is no evidence that rates are different among the five cell divisions of the spermatogenesis. We also found that a modestly biased sampling, leading to slightly more primordial germ cells after the eighth division than those reported in the literature, provides the best fit to the data. These findings provide conceptual and numerical basis for exploring the consequences of differential mutation rates during individual development.

On random sample size, ignorability, ancillarity, completeness, separability, and degeneracy: sequential trials, random sample sizes, and missing data

The vast majority of settings for which frequentist statistical properties are derived assume a fixed, a priori known sample size. Familiar properties then follow, such as, for example, the consistency, asymptotic normality, and efficiency of the sample average for the mean parameter, under a wide range of conditions. We are concerned here with the alternative situation in which the sample size is itself a random variable which may depend on the data being collected. Further, the rule governing this may be deterministic or probabilistic. There are many important practical examples of such settings, including missing data, sequential trials, and informative cluster size. It is well known that special issues can arise when evaluating the properties of statistical procedures under such sampling schemes, and much has been written about specific areas (Grambsch P. Sequential sampling based on the observed Fisher information to guarantee the accuracy of the maximum likelihood estimator. Ann Stat 1983; 11: 68-77; Barndorff-Nielsen O and Cox DR. The effect of sampling rules on likelihood statistics. Int Stat Rev 1984; 52: 309-326). Our aim is to place these various related examples into a single framework derived from the joint modeling of the outcomes and sampling process and so derive generic results that in turn provide insight, and in some cases practical consequences, for different settings. It is shown that, even in the simplest case of estimating a mean, some of the results appear counterintuitive. In many examples, the sample average may exhibit small sample bias and, even when it is unbiased, may not be optimal. Indeed, there may be no minimum variance unbiased estimator for the mean. Such results follow directly from key attributes such as non-ancillarity of the sample size and incompleteness of the minimal sufficient statistic of the sample size and sample sum. Although our results have direct and obvious implications for estimation following group sequential trials, there are also ramifications for a range of other settings, such as random cluster sizes, censored time-to-event data, and the joint modeling of longitudinal and time-to-event data. Here, we use the simplest group sequential setting to develop and explicate the main results. Some implications for random sample sizes and missing data are also considered. Consequences for other related settings will be considered elsewhere.

Practical Marginalized Multilevel Models

Clustered data analysis is characterized by the need to describe both systematic variation in a mean model and cluster-dependent random variation in an association model. Marginalized multilevel models embrace the robustness and interpretations of a marginal mean model, while retaining the likelihood inference capabilities and flexible dependence structures of a conditional association model. Although there has been increasing recognition of the attractiveness of marginalized multilevel models, there has been a gap in their practical application arising from a lack of readily available estimation procedures. We extend the marginalized multilevel model to allow for nonlinear functions in both the mean and association aspects. We then formulate marginal models through conditional specifications to facilitate estimation with mixed model computational solutions already in place. We illustrate the MMM and approximate MMM approaches on a cerebrovascular deficiency crossover trial using SAS and an epidemiological study on race and visual impairment using R. Datasets, SAS and R code are included as supplemental materials.