An adaptive group sequential design for phase II/III clinical trials that select a single treatment from several

There is increasing interest in combining Phases II and III of clinical development into a single trial in which one of a small number of competing experimental treatments is ultimately selected and where a valid comparison is made between this treatment and the control treatment. Such a trial usually proceeds in stages, with the least promising experimental treatments dropped as soon as possible. In this paper we present a highly flexible design that uses adaptive group sequential methodology to monitor an order statistic. By using this approach, it is possible to design a trial which can have any number of stages, begins with any number of experimental treatments, and permits any number of these to continue at any stage. The test statistic used is based upon efficient scores, so the method can be easily applied to binary, ordinal, failure time, or normally distributed outcomes. The method is illustrated with an example, and simulations are conducted to investigate its type I error rate and power under a range of scenarios.

A practical comparison of group-sequential and adaptive designs

Sequential methods provide a formal framework by which clinical trial data can be monitored as they accumulate. The results from interim analyses can be used either to modify the design of the remainder of the trial or to stop the trial as soon as sufficient evidence of either the presence or absence of a treatment effect is available. The circumstances under which the trial will be stopped with a claim of superiority for the experimental treatment, must, however, be determined in advance so as to control the overall type I error rate. One approach to calculating the stopping rule is the group-sequential method. A relatively recent alternative to group-sequential approaches is the adaptive design method. This latter approach provides considerable flexibility in changes to the design of a clinical trial at an interim point. However, a criticism is that the method by which evidence from different parts of the trial is combined means that a final comparison of treatments is not based on a sufficient statistic for the treatment difference, suggesting that the method may lack power. The aim of this paper is to compare two adaptive design approaches with the group-sequential approach. We first compare the form of the stopping boundaries obtained using the different methods. We then focus on a comparison of the power of the different trials when they are designed so as to be as similar as possible. We conclude that all methods acceptably control type I error rate and power when the sample size is modified based on a variance estimate, provided no interim analysis is so small that the asymptotic properties of the test statistic no longer hold. In the latter case, the group-sequential approach is to be preferred. Provided that asymptotic assumptions hold, the adaptive design approaches control the type I error rate even if the sample size is adjusted on the basis of an estimate of the treatment effect, showing that the adaptive designs allow more modifications than the group-sequential method.

Sequentially testing for a gene-drug interaction in a genomewide analysis

Assaying a large number of genetic markers from patients in clinical trials is now possible in order to tailor drugs with respect to efficacy. The statistical methodology for analysing such massive data sets is challenging. The most popular type of statistical analysis is to use a univariate test for each genetic marker, once all the data from a clinical study have been collected. This paper presents a sequential method for conducting an omnibus test for detecting gene-drug interactions across the genome, thus allowing informed decisions at the earliest opportunity and overcoming the multiple testing problems from conducting many univariate tests. We first propose an omnibus test for a fixed sample size. This test is based on combining F-statistics that test for an interaction between treatment and the individual single nucleotide polymorphism (SNP). As SNPs tend to be correlated, we use permutations to calculate a global p-value. We extend our omnibus test to the sequential case. In order to control the type I error rate, we propose a sequential method that uses permutations to obtain the stopping boundaries. The results of a simulation study show that the sequential permutation method is more powerful than alternative sequential methods that control the type I error rate, such as the inverse-normal method. The proposed method is flexible as we do not need to assume a mode of inheritance and can also adjust for confounding factors. An application to real clinical data illustrates that the method is computationally feasible for a large number of SNPs. Copyright (c) 2007 John Wiley & Sons, Ltd.

Detecting the node-density artifact in phylogeny reconstruction

The node-density effect is an artifact of phylogeny reconstruction that can cause branch lengths to be underestimated in areas of the tree with fewer taxa. Webster, Payne, and Pagel (2003, Science 301:478) introduced a statistical procedure (the "delta" test) to detect this artifact, and here we report the results of computer simulations that examine the test's performance. In a sample of 50,000 random data sets, we find that the delta test detects the artifact in 94.4% of cases in which it is present. When the artifact is not present (n = 10,000 simulated data sets) the test showed a type I error rate of approximately 1.69%, incorrectly reporting the artifact in 169 data sets. Three measures of tree shape or "balance" failed to predict the size of the node-density effect. This may reflect the relative homogeneity of our randomly generated topologies, but emphasizes that nearly any topology can suffer from the artifact, the effect not being confined only to highly unevenly sampled or otherwise imbalanced trees. The ability to screen phylogenies for the node-density artifact is important for phylogenetic inference and for researchers using phylogenetic trees to infer evolutionary processes, including their use in molecular clock dating. [Delta test; molecular clock; molecular evolution; node-density effect; phylogenetic reconstruction; speciation; simulation.]

Face verification using Gabor wavelets and AdaBoost

This paper presents a new face verification algorithm based on Gabor wavelets and AdaBoost. In the algorithm, faces are represented by Gabor wavelet features generated by Gabor wavelet transform. Gabor wavelets with 5 scales and 8 orientations are chosen to form a family of Gabor wavelets. By convolving face images with these 40 Gabor wavelets, the original images are transformed into magnitude response images of Gabor wavelet features. The AdaBoost algorithm selects a small set of significant features from the pool of the Gabor wavelet features. Each feature is the basis for a weak classifier which is trained with face images taken from the XM2VTS database. The feature with the lowest classification error is selected in each iteration of the AdaBoost operation. We also address issues regarding computational costs in feature selection with AdaBoost. A support vector machine (SVM) is trained with examples of 20 features, and the results have shown a low false positive rate and a low classification error rate in face verification.

Improvement of classification accuracy for stochastic discrimination - Multi-class classification

In this paper, an improved stochastic discrimination (SD) is introduced to reduce the error rate of the standard SD in the context of multi-class classification problem. The learning procedure of the improved SD consists of two stages. In the first stage, a standard SD, but with shorter learning period is carried out to identify an important space where all the misclassified samples are located. In the second stage, the standard SD is modified by (i) restricting sampling in the important space; and (ii) introducing a new discriminant function for samples in the important space. It is shown by mathematical derivation that the new discriminant function has the same mean, but smaller variance than that of standard SD for samples in the important space. It is also analyzed that the smaller the variance of the discriminant function, the lower the error rate of the classifier. Consequently, the proposed improved SD improves standard SD by its capability of achieving higher classification accuracy. Illustrative examples axe provided to demonstrate the effectiveness of the proposed improved SD.

On improvement of classification accuracy for stochastic discrimination

Stochastic discrimination (SD) depends on a discriminant function for classification. In this paper, an improved SD is introduced to reduce the error rate of the standard SD in the context of a two-class classification problem. The learning procedure of the improved SD consists of two stages. Initially a standard SD, but with shorter learning period is carried out to identify an important space where all the misclassified samples are located. Then the standard SD is modified by 1) restricting sampling in the important space, and 2) introducing a new discriminant function for samples in the important space. It is shown by mathematical derivation that the new discriminant function has the same mean, but with a smaller variance than that of the standard SD for samples in the important space. It is also analyzed that the smaller the variance of the discriminant function, the lower the error rate of the classifier. Consequently, the proposed improved SD improves standard SD by its capability of achieving higher classification accuracy. Illustrative examples are provided to demonstrate the effectiveness of the proposed improved SD.

A forward constrained selection algorithm for probabilistic neural network

A new probabilistic neural network (PNN) learning algorithm based on forward constrained selection (PNN-FCS) is proposed. An incremental learning scheme is adopted such that at each step, new neurons, one for each class, are selected from the training samples arid the weights of the neurons are estimated so as to minimize the overall misclassification error rate. In this manner, only the most significant training samples are used as the neurons. It is shown by simulation that the resultant networks of PNN-FCS have good classification performance compared to other types of classifiers, but much smaller model sizes than conventional PNN.

Component processes of early reading, spelling, and narrative writing skills in Turkish: a longitudinal study

The study examined: (a) the role of phonological, grammatical, and rapid automatized naming (RAN) skills in reading and spelling development; and (b) the component processes of early narrative writing skills. Fifty-seven Turkish-speaking children were followed from Grade 1 to Grade 2. RAN was the most powerful longitudinal predictor of reading speed and its effect was evident even when previous reading skills were taken into account. Broadly, the phonological and grammatical skills made reliable contributions to spelling performance but their effects were completely mediated by previous spelling skills. Different aspects of the narrative writing skills were related to different processing skills. While handwriting speed predicted writing fluency, spelling accuracy predicted spelling error rate. Vocabulary and working memory were the only reliable longitudinal predictors of the quality of composition content. The overall model, however, failed to explain any reliable variance in the structural quality of the compositions

Improvement of the GenTHREADER method for genomic fold recognition

Motivation: In order to enhance genome annotation, the fully automatic fold recognition method GenTHREADER has been improved and benchmarked. The previous version of GenTHREADER consisted of a simple neural network which was trained to combine sequence alignment score, length information and energy potentials derived from threading into a single score representing the relationship between two proteins, as designated by CATH. The improved version incorporates PSI-BLAST searches, which have been jumpstarted with structural alignment profiles from FSSP, and now also makes use of PSIPRED predicted secondary structure and bi-directional scoring in order to calculate the final alignment score. Pairwise potentials and solvation potentials are calculated from the given sequence alignment which are then used as inputs to a multi-layer, feed-forward neural network, along with the alignment score, alignment length and sequence length. The neural network has also been expanded to accommodate the secondary structure element alignment (SSEA) score as an extra input and it is now trained to learn the FSSP Z-score as a measurement of similarity between two proteins. Results: The improvements made to GenTHREADER increase the number of remote homologues that can be detected with a low error rate, implying higher reliability of score, whilst also increasing the quality of the models produced. We find that up to five times as many true positives can be detected with low error rate per query. Total MaxSub score is doubled at low false positive rates using the improved method.

Prediction of Staphylococcus aureus antimicrobial resistance by whole-genome sequencing

Whole-genome sequencing (WGS) could potentially provide a single platform for extracting all the information required to predict an organism’s phenotype. However, its ability to provide accurate predictions has not yet been demonstrated in large independent studies of specific organisms. In this study, we aimed to develop a genotypic prediction method for antimicrobial susceptibilities. The whole genomes of 501 unrelated Staphylococcus aureus isolates were sequenced, and the assembled genomes were interrogated using BLASTn for a panel of known resistance determinants (chromosomal mutations and genes carried on plasmids). Results were compared with phenotypic susceptibility testing for 12 commonly used antimicrobial agents (penicillin, methicillin, erythromycin, clindamycin, tetracycline, ciprofloxacin, vancomycin, trimethoprim, gentamicin, fusidic acid, rifampin, and mupirocin) performed by the routine clinical laboratory. We investigated discrepancies by repeat susceptibility testing and manual inspection of the sequences and used this information to optimize the resistance determinant panel and BLASTn algorithm. We then tested performance of the optimized tool in an independent validation set of 491 unrelated isolates, with phenotypic results obtained in duplicate by automated broth dilution (BD Phoenix) and disc diffusion. In the validation set, the overall sensitivity and specificity of the genomic prediction method were 0.97 (95% confidence interval [95% CI], 0.95 to 0.98) and 0.99 (95% CI, 0.99 to 1), respectively, compared to standard susceptibility testing methods. The very major error rate was 0.5%, and the major error rate was 0.7%. WGS was as sensitive and specific as routine antimicrobial susceptibility testing methods. WGS is a promising alternative to culture methods for resistance prediction in S. aureus and ultimately other major bacterial pathogens.

Energy-efficient resource allocation in OFDM systems with distributed antennas

In this paper, we develop an energy-efficient resource-allocation scheme with proportional fairness for downlink multiuser orthogonal frequency-division multiplexing (OFDM) systems with distributed antennas. Our aim is to maximize energy efficiency (EE) under the constraints of the overall transmit power of each remote access unit (RAU), proportional fairness data rates, and bit error rates (BERs). Because of the nonconvex nature of the optimization problem, obtaining the optimal solution is extremely computationally complex. Therefore, we develop a low-complexity suboptimal algorithm, which separates subcarrier allocation and power allocation. For the low-complexity algorithm, we first allocate subcarriers by assuming equal power distribution. Then, by exploiting the properties of fractional programming, we transform the nonconvex optimization problem in fractional form into an equivalent optimization problem in subtractive form, which includes a tractable solution. Next, an optimal energy-efficient power-allocation algorithm is developed to maximize EE while maintaining proportional fairness. Through computer simulation, we demonstrate the effectiveness of the proposed low-complexity algorithm and illustrate the fundamental trade off between energy and spectral-efficient transmission designs.

Latent learning in end stage renal disease (ESRD)

Cognitive functions such as attention and memory are known to be impaired in End Stage Renal Disease (ESRD), but the sites of the neural changes underlying these impairments are uncertain. Patients and controls took part in a latent learning task, which had previously shown a dissociation between patients with Parkinson’s disease and those with medial temporal damage. ESRD patients (n=24) and age and education-matched controls (n=24) were randomly assigned to either an exposed or unexposed condition. In Phase 1 of the task, participants learned that a cue (word) on the back of a schematic head predicted that the subsequently seen face would be smiling. For the exposed (but not unexposed) condition, an additional (irrelevant) colour cue was shown during presentation. In Phase 2, a different association, between colour and facial expression, was learned. Instructions were the same for each phase: participants had to predict whether the subsequently viewed face was going to be happy or sad. No difference in error rate between the groups was found in Phase 1, suggesting that patients and controls learned at a similar rate. However, in Phase 2, a significant interaction was found between group and condition, with exposed controls performing significantly worse than unexposed (therefore demonstrating learned irrelevance). In contrast, exposed patients made a similar number of errors to unexposed in Phase 2. The pattern of results in ESRD was different from that previously found in Parkinson’s disease, suggesting a different neural origin.

Flexible selection of a single treatment incorporating short-term endpoint information in a phase II/III clinical trial

Seamless phase II/III clinical trials in which an experimental treatment is selected at an interim analysis have been the focus of much recent research interest. Many of the methods proposed are based on the group sequential approach. This paper considers designs of this type in which the treatment selection can be based on short-term endpoint information for more patients than have primary endpoint data available. We show that in such a case, the familywise type I error rate may be inflated if previously proposed group sequential methods are used and the treatment selection rule is not specified in advance. A method is proposed to avoid this inflation by considering the treatment selection that maximises the conditional error given the data available at the interim analysis. A simulation study is reported that illustrates the type I error rate inflation and compares the power of the new approach with two other methods: a combination testing approach and a group sequential method that does not use the short-term endpoint data, both of which also strongly control the type I error rate. The new method is also illustrated through application to a study in Alzheimer's disease. © 2015 The Authors. Statistics in Medicine Published by John Wiley & Sons Ltd.

Soft-bit and numerical precision requirements on multiband full-rate ultra-wideband (UWB) receivers

This paper discusses the architectural design, implementation and associated simulated peformance results of a possible receiver solution fir a multiband Ultra-Wideband (UWB) receiver. The paper concentrates on the tradeoff between the soft-bit width and numerical precision requirements for the receiver versus performance. The required numerical precision results obtained in this paper can be used by baseband designers of cost effective UWB systems using Systein-on-Chip (SoC), FPGA and ASIC technology solutions biased toward the competitive consumer electronics market(1).