Making randomised trials more efficient: report of the first meeting to discuss the Trial Forge platform

Randomised trials are at the heart of evidence-based healthcare, but the methods and infrastructure for conducting these sometimes complex studies are largely evidence free. Trial Forge (www.trialforge.org) is an initiative that aims to increase the evidence base for trial decision making and, in doing so, to improve trial efficiency.

This paper summarises a one-day workshop held in Edinburgh on 10 July 2014 to discuss Trial Forge and how to advance this initiative. We first outline the problem of inefficiency in randomised trials and go on to describe Trial Forge. We present participants' views on the processes in the life of a randomised trial that should be covered by Trial Forge.

General support existed at the workshop for the Trial Forge approach to increase the evidence base for making randomised trial decisions and for improving trial efficiency. Agreed upon key processes included choosing the right research question; logistical planning for delivery, training of staff, recruitment, and retention; data management and dissemination; and close down. The process of linking to existing initiatives where possible was considered crucial. Trial Forge will not be a guideline or a checklist but a 'go to' website for research on randomised trials methods, with a linked programme of applied methodology research, coupled to an effective evidence-dissemination process. Moreover, it will support an informal network of interested trialists who meet virtually (online) and occasionally in person to build capacity and knowledge in the design and conduct of efficient randomised trials.

Some of the resources invested in randomised trials are wasted because of limited evidence upon which to base many aspects of design, conduct, analysis, and reporting of clinical trials. Trial Forge will help to address this lack of evidence.

Received Signal Characteristics of the Indoor Off-Body Communications Channel at 5.8 GHz

In this paper we investigate the received signal characteristics of a mobile chest-worn transmitter at 5.8 GHz within a high multipath indoor environment. The off-body channel measurements considered both the co- and cross-polarized received signal for both line-of-sight (LOS) and non-LOS (NLOS) conditions. A straightforward channel model based upon the estimated path loss, a lognormal slow fading component and Ricean small-scale fading contribution is developed and used to perform simulations which allow the generation of first order received signal power characteristics.

RSSI-based environment identification for 2.45 GHz body area networks

A unique property of body area networks (BANs) is the mobility of the network as the user moves freely around. This mobility represents a significant challenge for BANs, since, in order to operate efficiently, they need to be able to adapt to the changing propagation environment. A method is presented that allows BAN nodes to classify the current operating environment in terms of multipath conditions, based on received signal strength indicator values during normal packet transmissions. A controlled set of measurements was carried out to study the effect different environments inflict on on-body link signal strength in a 2.45 GHz BAN. The analysis shows that, by using two statistical parameters, gathered over a period of one second, BAN nodes can successfully classify the operating environment for over 90% of the time.

Improving signal reliability in outdoor body-to-body communications using front and back positioned antenna diversity

It has previously been shown that human body shadowing can have a considerable impact on body-to-body communications channels in low multipath environments. Signal degradation directly attributable to shadowing when one user's body obstructs the main line of sight can be as great as 40 dB. When both people's bodies obstruct the direct line of sight path, the communications link can be lost altogether even at very short distances of a few metres. In this paper, using front and back positioned antennas, we investigate the utility of a simple selection combination diversity combining scheme with the aim of mitigating human body shadowing in outdoor body-to-body communications channels at 2.45 GHz. Early results from this work are extremely promising, indicating substantial diversity gains, as great as 29 dB, may be achieved in a number of everyday scenarios likely to be encountered in body-to-body networking. © 2012 IEEE.

Channel characterisation for indoor wearable active RFID at 868 MHz

Active radio-frequency identification systems that are used for the localisation and tracking of people will be subject to the same body centric processes that impact other forms of wearable communications. To achieve the goal of creating body worn tags with multiyear life spans, it will be necessary to gain an understanding of the channel conditions which are likely to impact the reader-tag interrogation process. In this paper we present the preliminary results of an indoor channel measurement campaign conducted at 868 MHz aimed at understanding and modelling signal characteristics for a wrist-worn tag. Using a model selection process based on the Akaike Information Criterion, the lognormal distribution was selected most often to describe the received signal amplitude. Parameter estimates are provided so that the channels investigated in this study may be readily simulated.

Localization Algorithm Performance in Ultra Low Power Active RFID Based Patient Tracking

Indoor personnel localization research has generated a range of potential techniques and algorithms. However, these typically do not account for the influence of the user's body upon the radio channel. In this paper an active RFID based patient tracking system is demonstrated and three localization algorithms are used to estimate the location of a user within a modern office building. It is shown that disregarding body effects reduces the accuracy of the algorithms' location estimates and that body shadowing effects create a systematic position error that estimates the user's location as closer to the RFID reader that the active tag has line of sight to.

Generation and Characterization of ALX-0171, a Potent Novel Therapeutic Nanobody for the Treatment of Respiratory Syncytial Virus Infection

Respiratory Syncytial Virus (RSV) is an important causative agent of lower respiratory tract infections in infants and elderly. Its fusion (F) protein is critical for virus infection. It is targeted by several investigational antivirals and by palivizumab, a humanised monoclonal antibody used prophylactically in infants considered at high risk of severe RSV disease. ALX-0171 is a trimeric Nanobody that binds the antigenic site II of RSV F-protein with subnanomolar affinity. ALX-0171 demonstrated superior in vitro neutralisation compared to palivizumab against prototypic RSV A and B strains. Moreover, ALX-0171 completely blocked replication below limit of detection in 87% of the viruses tested versus 18% for palivizumab at a fixed concentration. Importantly, ALX-0171 was highly effective in reducing both nasal and lung RSV titers when delivered prophylactically or therapeutically directly to the lungs of cotton rats. ALX-0171 represents a potent novel antiviral compound with significant potential to treat RSV-mediated disease.

Sustained intraocular VEGF neutralization results in retinal neurodegeneration in the Ins2Akita diabetic mouse

Current therapies that target vascular endothelial growth factor (VEGF) have become a mainstream therapy for the management of diabetic macular oedema. The treatment involves monthly repeated intravitreal injections of VEGF inhibitors. VEGF is an important growth factor for many retinal cells, including different types of neurons. In this study, we investigated the adverse effect of multiple intravitreal anti-VEGF injections (200 ng/μl/eye anti-mouse VEGF164, once every 2 weeks totalling 5-6 injections) to retinal neurons in Ins2(Akita) diabetic mice. Funduscopic examination revealed the development of cotton wool spot-like lesions in anti-VEGF treated Ins2(Akita) mice after 5 injections. Histological investigation showed focal swellings of retinal nerve fibres with neurofilament disruption. Furthermore, anti-VEGF-treated Ins2(Akita) mice exhibited impaired electroretinographic responses, characterized by reduced scotopic a- and b-wave and oscillatory potentials. Immunofluorescent staining revealed impairment of photoreceptors, disruptions of synaptic structures and loss of amacrine and retinal ganglion cells in anti-VEGF treated Ins2(Akita) mice. Anti-VEGF-treated WT mice also presented mild amacrine and ganglion cell death, but no overt abnormalities in photoreceptors and synaptic structures. At the vascular level, exacerbated albumin leakage was observed in anti-VEGF injected diabetic mice. Our results suggest that sustained intraocular VEGF neutralization induces retinal neurodegeneration and vascular damage in the diabetic eye.

Channel Measurements of Device-to-Device Communications at 2.45 GHz

In the future, device-to-device communications will become a fundamental part of cellular communications. Interoperability between handsets will be facilitated using frequencies located in a number of bands including those found in the Industrial, Scientific and Medical (ISM) band at 2.45 GHz. In this paper, we present the results of channel measurements made between two hypothetical cellular handsets operating at 2.45 GHz in an outdoor environment. We consider a range of typical usage scenarios such as both user equipment being held at the head while imitating a voice call, placed in user's pocket for both stationary and dynamic links. A range of parameter estimates obtained using the shadowed κ-μ fading model are also presented.

A Statistical Characterization of Shadowed Fading in Indoor Off-Body Communications Channels At 5.8 GHz

This paper investigates the characteristics of the shadowed fading observed in off-body communications channels at 5.8 GHz using the κ-μ / gamma composite fading model. Realistic measurements have been conducted considering four individual scenarios namely line of sight (LOS) and non-LOS (NLOS) walking, rotation and random movements within an indoor laboratory environment. It is shown that the κ-μ / gamma composite fading model provides a better fit to the fading observed in off-body communications channels compared to the conventional Nakagami-m and Rician fading models.

Signal Reliability Improvement Using Selection Combining Based Macro-Diversity for Off-Body Communications At 868 MHz

This paper investigates the potential improvement in signal reliability for outdoor short-range off-body communications channels at 868 MHz using the macro-diversity offered by multiple co-located base stations. In this study, ten identical hypothetical base stations were positioned equidistantly around the perimeter of a rectangle of length 6.67 m and width 3.3 m. A body worn node was placed on the central chest region of an adult male. Five scenarios, each considering different user trajectories, were then analyzed to test the efficacy of using macro-diversity when the desired link is subject to shadowing caused by the human body. A number of selection combining based macro-diversity configurations consisting of four and then ten base stations were considered. It was found that using a macro-diversity system consisting of four base stations (or equivalently signal branches), a maximum diversity gain of 22.5 dB could be obtained while implementing a 10-base station setup this figure could be improved to 25.2 dB.

Fading Characteristics of Body–to–Body Channels Subject to Vehicular Traffic Conditions at 2.45 GHz

In this paper we investigate the small-scale fading characteristics of body-to-body communications channels in an urban environment at 2.45 GHz. The experiments considered body-to-body channels between devices positioned on two persons on either side of a busy road. The Ricean-K factors estimated from the measurements suggest that a significant dominant component existed in the majority of the channels.