abstract: In investigating mediating processes, researchers usually use randomized experiments and linear regression or structural equation modeling to determine if the treatment affects the hypothesized mediator and if the mediator affects the targeted outcome. However, randomizing the treatment will not yield accurate causal path estimates unless certain assumptions are satisfied. Since randomization of the mediator may not be plausible for most studies (i.e., the mediator status is not randomly assigned, but self-selected by participants), both the direct and indirect effects may be biased by confounding variables. The purpose of this dissertation is (1) to investigate the extent to which traditional mediation methods are affected by confounding variables and (2) to assess the statistical performance of several modern methods to address confounding variable effects in mediation analysis. This dissertation first reviewed the theoretical foundations of causal inference in statistical mediation analysis, modern statistical analysis for causal inference, and then described different methods to estimate causal direct and indirect effects in the presence of two post-treatment confounders. A large simulation study was designed to evaluate the extent to which ordinary regression and modern causal inference methods are able to obtain correct estimates of the direct and indirect effects when confounding variables that are present in the population are not included in the analysis. Five methods were compared in terms of bias, relative bias, mean square error, statistical power, Type I error rates, and confidence interval coverage to test how robust the methods are to the violation of the no unmeasured confounders assumption and confounder effect sizes. The methods explored were linear regression with adjustment, inverse propensity weighting, inverse propensity weighting with truncated weights, sequential g-estimation, and a doubly robust sequential g-estimation. Results showed that in estimating the direct and indirect effects, in general, sequential g-estimation performed the best in terms of bias, Type I error rates, power, and coverage across different confounder effect, direct effect, and sample sizes when all confounders were included in the estimation. When one of the two confounders were omitted from the estimation process, in general, none of the methods had acceptable relative bias in the simulation study. Omitting one of the confounders from estimation corresponded to the common case in mediation studies where no measure of a confounder is available but a confounder may affect the analysis. Failing to measure potential post-treatment confounder variables in a mediation model leads to biased estimates regardless of the analysis method used and emphasizes the importance of sensitivity analysis for causal mediation analysis. / Dissertation/Thesis / Ph.D. Psychology 2013

Les levures du genre Candida figurent parmi les pathogènes majeurs isolés chez les patients en soins intensifs et sont responsables d'infections systémiques : les candidoses invasives. Le retard et le manque de fiabilité du diagnostic sont susceptibles d'aggraver l'état du patient et d'augmenter le risque de décès à court terme. Pour respecter les objectifs de traitement, les experts recommandent de traiter le plus précocement possible les patients à haut risque de candidose invasive. Cette attitude permet de proposer un traitement précoce aux malades atteints, mais peut entraîner un traitement inutile et coûteux et favoriser l'émergence de souches de moindre sensibilité aux antifongiques utilisés.Ce travail applique des méthodes statistiques modernes à des données observationnelles longitudinales. Il étudie l'impact des traitements antifongiques systémiques sur la répartition des quatre principales espèces de Candida dans les différents prélèvements de patients en réanimation médicale, sur leur sensibilité à ces antifongiques, sur le diagnostic des candidémies ainsi que sur le pronostic des patients. Les analyses de séries de données temporelles à l'aide de modèles ARIMA (moyenne mobile autorégressive intégrée) ont confirmé l'impact négatif de l'utilisation des antifongiques sur la sensibilité des principales espèces de Candida ainsi que la modification de leur répartition sur une période de dix ans. L'utilisation de modèles hiérarchiques sur données répétées a montré que le traitement influence négativement la détection des levures et augmente le délai de positivité des hémocultures dans le diagnostic des candidémies. Enfin, l'utilisation des méthodes d'inférence causale a montré qu'un traitement antifongique préventif n'a pas d'impact sur le pronostic des patients non neutropéniques, non transplantés et qu'il est possible de commencer une désescalade précoce du traitement antifongique entre le premier et le cinquième jour après son initiation sans aggraver le pronostic. / Candida species are among the main pathogens isolated from patients in intensive care units (ICUs) and are responsible for a serious systemic infection: invasive candidiasis. A late and unreliable diagnosis of invasive candidiasis aggravates the patient's status and increases the risk of short-term death. The current guidelines recommend an early treatment of patients with high risks of invasive candidiasis, even in absence of documented fungal infection. However, increased antifungal drug consumption is correlated with increased costs and the emergence of drug resistance whereas there is yet no consensus about the benefits of the probabilistic antifungal treatment.The present work used modern statistical methods on longitudinal observational data. It investigated the impact of systemic antifungal treatment (SAT) on the distribution of the four Candida species most frequently isolated from ICU patients', their susceptibilities to SATs, the diagnosis of candidemia, and the prognosis of ICU patients. The use of autoregressive integrated moving average (ARIMA) models for time series confirmed the negative impact of SAT use on the susceptibilities of the four Candida species and on their relative distribution over a ten-year period. Hierarchical models for repeated measures showed that SAT has a negative impact on the diagnosis of candidemia: it decreases the rate of positive blood cultures and increases the time to positivity of these cultures. Finally, the use of causal inference models showed that early SAT has no impact on non-neutropenic, non-transplanted patient prognosis and that SAT de-escalation within 5 days after its initiation in critically ill patients is safe and does not influence the prognosis.

Dentre as possíveis propostas encontradas na literatura estatística para analisar dados oriundos de estudos com observações correlacionadas, estão os modelos condicionais e os modelos marginais. Diversas técnicas têm sido propostas para a análise de diagnóstico nesses modelos. O objetivo deste trabalho é apresentar algumas das técnicas de diagnóstico disponíveis para os dois tipos de modelos e avaliá-las por meio de estudos de simulação. As técnicas apresentadas também foram aplicadas em um conjunto de dados reais. / Conditional and marginal models are among the possibilities in statistical literature to analyze data from studies with correlated observations. Several techniques have been proposed for diagnostic analysis in these models. The objective of this work is to present some of the diagnostic techniques available for both modeling approaches and to evaluate them by simulation studies. The presented techniques were also applied in a real dataset.

Made available in DSpace on 2016-06-02T20:06:02Z (GMT). No. of bitstreams: 1 2447.pdf: 2730026 bytes, checksum: 0c7b575bbfeb3fed2fc6c929b9785516 (MD5) Previous issue date: 2009-03-05 / Financiadora de Estudos e Projetos / The objective of this work is to present techniques of regression analysis for longitudinal data when the response variable is binary. Initially, there is a review of generalized linear models, marginal models, transition models, mixed models, and logistic regression methods of estimation, which will be necessary for the development of work. In addition to the methods of estimation, some structures of correlation will be studied in an attempt to capture the intra-individual serial dependence over time. These methods were applied in two situations, one where the response variable is continuous and normal distribution, and another when the response variable has the Bernoulli distribution. It was also sought to explore and present techniques for selection of models and diagnostics for the two cases. Finally, an application of the above methodology will be presented using a set of real data. / O objetivo deste trabalho é apresentar técnicas de análise de regressão para dados longitudinais quando a variável resposta é binária. Inicialmente, é feita uma revisão sobre modelos lineares generalizados, modelos marginais, modelos de transição, modelos mistos, regressão logística e métodos de estimação, pois serão necessários para o desenvolvimento do trabalho. Além dos métodos de estimação, algumas estruturas de correlação serão estudadas, na tentativa de captar a dependência serial intra-indivíduo ao longo do tempo. Estes métodos foram aplicados em duas situações; uma quando a variável resposta é contínua, e se assume ter distribuição normal, e a outra quando a variável resposta assume ter distribuição de Bernoulli. Também se procurou pesquisar e apresentar técnicas de seleção de modelos e de diagnósticos para os dois casos. Ao final, uma aplicação com a metodologia pesquisada será apresentada utilizando um conjunto de dados reais.

Dentre as possíveis propostas encontradas na literatura estatística para analisar dados oriundos de estudos com observações correlacionadas, estão os modelos condicionais e os modelos marginais. Diversas técnicas têm sido propostas para a análise de diagnóstico nesses modelos. O objetivo deste trabalho é apresentar algumas das técnicas de diagnóstico disponíveis para os dois tipos de modelos e avaliá-las por meio de estudos de simulação. As técnicas apresentadas também foram aplicadas em um conjunto de dados reais. / Conditional and marginal models are among the possibilities in statistical literature to analyze data from studies with correlated observations. Several techniques have been proposed for diagnostic analysis in these models. The objective of this work is to present some of the diagnostic techniques available for both modeling approaches and to evaluate them by simulation studies. The presented techniques were also applied in a real dataset.