Causal inference with marginal structural modeling for longitudinal data in laparoscopic surgery: A technical note

Causal inference prevails in the field of laparoscopic surgery.Once the causality between an intervention and outcome is established,the intervention can be applied to a target population to improve clinical outcomes.In many clinical scenarios,interventions are applied longitudinally in response to patients’conditions.Such longitudinal data comprise static variables,such as age,gender,and comorbidities;and dynamic variables,such as the treatment regime,laboratory variables,and vital signs.Some dynamic variables can act as both the confounder and mediator for the effect of an intervention on the outcome;in such cases,simple adjustment with a conventional regression model will bias the effect sizes.To address this,numerous statistical methods are being developed for causal inference;these include,but are not limited to,the structural marginal Cox regression model,dynamic treatment regime,and Cox regression model with time-varying covariates.This technical note provides a gentle introduction to such models and illustrates their use with an example in the field of laparoscopic surgery.

Structural features and exploration targets of platform margins in Sinian Dengying Formation in Deyang-Anyue Rift, Sichuan Basin, SW China

Based on the seismic, logging, drilling and other data, the distribution, structural types and mound-shoal hydrocarbon accumulation characteristics of platform margins of the Sinian Dengying Formation in the Deyang-Anyue Rift and its periphery were analyzed. Four types of platform margins are developed in the Dengying Formation, i.e., single-stage fault-controlled platform margin, multi-stage fault-controlled platform margin, gentle slope platform margin, and overlapping platform margin. In the Gaoshiti West-Weiyuan East area, single-stage fault controlled platform margins are developed in the Deng 2 Member, which trend in nearly NEE direction and are shielded by faults and mudstones, forming fault-controlled–lithologic traps. In the Lezhi-Penglai area, independent and multi-stage fault controlled platform margins are developed in the Deng 2 Member, which trend in NE direction and are controlled by synsedimentary faults;the mound-shoal complexes are aggraded and built on the hanging walls of the faults, and they are shielded by tight intertidal belts and the Lower Cambrian source rocks in multiple directions, forming fault-controlled–lithologic and other composite traps. In the Weiyuan-Ziyang area, gentle slope platform margins are developed in the Deng 2 Member, which trend in NW direction;the mound-shoal complexes are mostly thin interbeds as continuous bands and shielded by tight intertidal belts in the updip direction, forming lithologic traps. In the Gaoshiti-Moxi-Yanting area, overlapping platform margins are developed in the Deng 2 and Deng 4 members;the mound-shoal complexes are aggraded and overlaid to create platform margin buildup with a huge thickness and sealed by tight intertidal belts and the Lower Cambrian mudstones in the updip direction, forming large-scale lithologic traps on the north slope of the Central Sichuan Paleouplift. To summarize, the mound-shoal complexes on the platform margins in the Dengying Formation in the Penglai-Zhongjiang area, Moxi North-Yanting area and Weiyuan-Ziyang area are large in scale, with estimated resources of 1.58×1012 m3, and they will be the key targets for the future exploration of the Dengying Formation in the Sichuan Basin.

Types,structural evolution difference and petroleum geological significance of Cambrian-Ordovician carbonate platforms in Gucheng-Xiaotang area,Tarim Basin,NW China

Based on the latest drilling cores,thin sections,and 3D seismic data,types,features,and evolution processes of Cambrian-Ordovician carbonate platforms in the Gucheng and Xiaotang areas are studied,and favorable exploration zones in this area are also discussed.There are two types of carbonate platforms developed in the Cambrian-Ordovician in the Gucheng-Xiaotang area,namely,carbonate ramp and rimmed platforms,and the evolution process of the platform in the Gucheng area is different from that in Xiaotang area.In the Early Cambrian,the study area was a homoclinal carbonate ramp.During the Middle to Late Cambrian,it evolved into a rimmed platform,with 5 phases of mound shoals developed.In the southern area,mound shoals were in progradational arrangement and the third and fourth stages of mound shoals suffering exposure and further developed abundant karst vugs.In the northern area,the mound shoals appeared in a superposition of aggradation-weak progradation,the third,fourth,and fifth stages of mound shoals suffered exposure and dissolution,and the platform slope developed gravity flow deposits.In the Early to Middle Ordovician,the southern area gradually evolved into a distally steepened carbonate ramp,where retrogradational dolomitic shoal developed;while the northern part experienced an evolution process from a weakly rimmed platform to a distally steepened carbonate ramp,and developed two or three stages of retrogradational mound shoals.The high-frequency oscillation of sea level and local exposure and dissolution were beneficial to the formation of mound or shoal reservoirs in platform margin and ramp,and the configuration of these reservoirs with low energy slope-basin facies source rocks could form good oil-gas enrichment zones.The dolomitic shoal in the Ordovician platform ramp is the practical exploration field for increasing reserve and production in the Gucheng area.The mound shoal at the Cambrian rimmed platform margin is the key exploration object in the Xiaotang area.In addition,the Cambrian slope gravity flow deposits can be taken as the favorable exploration fields in the study area.

Pharmacological Treatment of Adult Attention-Deficit/Hyperactivity Disorder(ADHD)in a Longitudinal Observational Study:Estimated Treatment Effect Strengthened by Improved Covariate Balance

An improved method for estimation of causal effects from observational data is demonstrated. Applications in medicine have been few, and the purpose of the present study is to contribute new clinical insight by means of this new and more sophisticated analysis. Long term effect of medication for adult ADHD patients is not resolved. A model with causal parameters to represent effect of medication was formulated, which accounts for time-varying confounding and selection-bias from loss to follow-up. The popular marginal structural model (MSM) for causal inference, of Robins et al., adjusts for time-varying confounding, but suffers from lack of robustness for misspecification in the weights. Recent work by Imai and Ratkovic?[1][2] achieves robustness in the MSM, through improved covariate balance (CBMSM). The CBMSM (freely available software) was compared with a standard fit of a MSM and a naive regression model, to give a robust estimate of the true treatment effect in 250 previously non-medicated adults, treated for one year, in a specialized ADHD outpatient clinic in Norway. Covariate balance was greatly improved, resulting in a stronger treatment effect than without this improvement. In terms of treatment effect per week, early stages seemed to have the strongest influence. An estimated average reduction of 4 units on the symptom scale assessed at 12 weeks, for hypothetical medication in the 9 - 12 weeks period compared to no medication in this period, was found. The treatment effect persisted throughout the whole year, with an estimated average reduction of 0.7 units per week on symptoms assessed at one year, for hypothetical medication in the last 13 weeks of the year, compared to no medication in this period. The present findings support a strong and causal direct and indirect effect of pharmacological treatment of adults with ADHD on improvement in symptoms, and with a stronger treatment effect than has been reported.

Does ＂lnternet Plus＂ Promote New Export Space for Firms？ Evidence from China

Based on data from the Chinese Industrial Enterprises Database, this paper investigates the effect of ＂Internet Plus＂ on the trade destination mix at the enterprise level The analysis extends the classic dual margins to three dimensions： destination extensive, destination intensive and destination structural margins. The paper suggests that connecting to the internet not only raises Chinese firms＇propensity to export, but also extends the destination extensive margin. In addition, Internet Plus could create a synergistic effect for internet-enabled enterprises, that is, the development of the destination country＇s internet access benefits domestic firms＇export participation. Finally, the paper finds that lnternet Plus, rather than increasing the intensive or structural margins, leads to the transfer of exports to lower-middle-income countries and helps firms achieve competitiveness and thus increases their profit. The paper provides an explanatory mechanism and empirical evidence for firms ＇use of the internet to optimize export space.