Bayesian spatial+: A joint model perspective

A common phenomenon in spatial regression models is spatial confounding. This phenomenon occurs when spatially indexed covariates modeling the mean of the response are correlated with a spatial effect included in the model. spatial+ Dupont et al. (2022) is a popular approach to reducing spatial confounding. spatial+ is a two-stage frequentist approach that explicitly models the spatial structure in the confounded covariate, removes it, and uses the corresponding residuals in the second stage. In a frequentist setting, there is no uncertainty propagation from the first stage estimation determining the residuals since only point estimates are used. Inference can also be cumbersome in a frequentist setting, and some of the gaps in the original approach can easily be remedied in a Bayesian framework. First, a Bayesian joint model can easily achieve uncertainty propagation from the first to the second stage of the model. In a Bayesian framework, we also have the tools to infer the model's parameters directly. Notably, another advantage of using a Bayesian framework we thoroughly explore is the ability to use prior information to impose restrictions on the spatial effects rather than applying them directly to their posterior. We build a joint prior for the smoothness of all spatial effects that simultaneously shrinks towards a high smoothness of the response and imposes that the spatial effect in the response is a smoother of the confounded covariates' spatial effect. This prevents the response from operating at a smaller scale than the covariate and can help to avoid situations where there is insufficient variation in the residuals resulting from the first stage model. We evaluate the performance of the Bayesian spatial+ via both simulated and real datasets

Bayesian nonparametric generative modeling of large multivariate non-Gaussian spatial fields

Multivariate spatial fields are of interest in many applications, including climate model emulation. Not only can the marginal spatial fields be subject to nonstationarity, but the dependence structure among the marginal fields and between the fields might also differ substantially. Extending a recently proposed Bayesian approach to describe the distribution of a nonstationary univariate spatial field using a triangular transport map, we cast the inference problem for a multivariate spatial field for a small number of replicates into a series of independent Gaussian process (GP) regression tasks with Gaussian errors. Due to the potential nonlinearity in the conditional means, the joint distribution modeled can be non-Gaussian. The resulting nonparametric Bayesian methodology scales well to high-dimensional spatial fields. It is especially useful when only a few training samples are available, because it employs regularization priors and quantifies uncertainty. Inference is conducted in an empirical Bayes setting by a highly scalable stochastic gradient approach. The implementation benefits from mini-batching and could be accelerated with parallel computing. We illustrate the extended transport-map model by studying hydrological variables from non-Gaussian climate-model output

Liesel: A Probabilistic Programming Framework for Developing Semi-Parametric Regression Models and Custom Bayesian Inference Algorithms

Liesel is a probabilistic programming framework focusing on but not limited to semi-parametric regression. It comprises a graph-based model building library, a Markov chain Monte Carlo (MCMC) library with support for modular inference algorithms combining multiple kernels (both implemented in Python), and an R interface (RLiesel) for the configuration of semi-parametric regression models. Each component can be used independently of the others, e.g. the MCMC library also works with third-party model implementations. Our goal with Liesel is to facilitate a new research workflow in computational statistics: In a first step, the researcher develops a model graph with pre-implemented and well-tested building blocks as a base model, e.g. using RLiesel. Then, the graph can be manipulated to incorporate new research ideas, before the MCMC library can be used to run and analyze a default or user-defined MCMC procedure. The researcher has the option to combine powerful MCMC algorithms such as the No U-Turn Sampler (NUTS) with self-written kernels. Various tools for chain post-processing and diagnostics are also provided. Considering all its components, Liesel enables efficient and reliable statistical research on complex models and estimation algorithms. It depends on JAX as a numerical computing library. This way, it can benefit from the latest machine learning technology such as automatic differentiation, just-in-time (JIT) compilation, and the use of high-performance computing devices such as tensor processing units (TPUs)

Safety of hospital discharge before return of bowel function after elective colorectal surgery

Background: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function. Methods: A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien–Dindo classification system. Results: A total of 3288 patients were included in the analysis, of whom 301 (9·2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4–7) and 7 (6–8) days respectively (P < 0·001). There were no significant differences in rates of readmission between these groups (6·6 versus 8·0 per cent; P = 0·499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0·90, 95 per cent c.i. 0·55 to 1·46; P = 0·659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34·7 versus 39·5 per cent; major 3·3 versus 3·4 per cent; P = 0·110). Conclusion: Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients

Safety of hospital discharge before return of bowel function after elective colorectal surgery

Background Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function. Methods A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien-Dindo classification system. Results A total of 3288 patients were included in the analysis, of whom 301 (9 center dot 2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4-7) and 7 (6-8) days respectively (P < 0 center dot 001). There were no significant differences in rates of readmission between these groups (6 center dot 6 versus 8 center dot 0 per cent; P = 0 center dot 499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0 center dot 90, 95 per cent c.i. 0 center dot 55 to 1 center dot 46; P = 0 center dot 659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34 center dot 7 versus 39 center dot 5 per cent; major 3 center dot 3 versus 3 center dot 4 per cent; P = 0 center dot 110). Conclusion Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients

Safety and efficacy of non-steroidal anti-inflammatory drugs to reduce ileus after colorectal surgery

Background: Ileus is common after elective colorectal surgery, and is associated with increased adverse events and prolonged hospital stay. The aim was to assess the role of non-steroidal anti-inflammatory drugs (NSAIDs) for reducing ileus after surgery. Methods: A prospective multicentre cohort study was delivered by an international, student- and trainee-led collaborative group. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The primary outcome was time to gastrointestinal recovery, measured using a composite measure of bowel function and tolerance to oral intake. The impact of NSAIDs was explored using Cox regression analyses, including the results of a centre-specific survey of compliance to enhanced recovery principles. Secondary safety outcomes included anastomotic leak rate and acute kidney injury. Results: A total of 4164 patients were included, with a median age of 68 (i.q.r. 57\u201375) years (54\ub79 per cent men). Some 1153 (27\ub77 per cent) received NSAIDs on postoperative days 1\u20133, of whom 1061 (92\ub70 per cent) received non-selective cyclo-oxygenase inhibitors. After adjustment for baseline differences, the mean time to gastrointestinal recovery did not differ significantly between patients who received NSAIDs and those who did not (4\ub76 versus 4\ub78 days; hazard ratio 1\ub704, 95 per cent c.i. 0\ub796 to 1\ub712; P = 0\ub7360). There were no significant differences in anastomotic leak rate (5\ub74 versus 4\ub76 per cent; P = 0\ub7349) or acute kidney injury (14\ub73 versus 13\ub78 per cent; P = 0\ub7666) between the groups. Significantly fewer patients receiving NSAIDs required strong opioid analgesia (35\ub73 versus 56\ub77 per cent; P < 0\ub7001). Conclusion: NSAIDs did not reduce the time for gastrointestinal recovery after colorectal surgery, but they were safe and associated with reduced postoperative opioid requirement

Safety of hospital discharge before return of bowel function after elective colorectal surgery

Background: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function.Methods: A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien-Dindo classification system.Results: A total of 3288 patients were included in the analysis, of whom 301 (9.2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4-7) and 7 (6-8) days respectively (P < 0.001). There were no significant differences in rates of readmission between these groups (6.6 versus 8.0 per cent; P = 0.499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0.90, 95 per cent c.i. 0.55 to 1.46; P = 0.659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34.7 versus 39.5 per cent; major 3.3 versus 3.4 per cent; P = 0.110).Conclusion: Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients