A comparison of methods for constructing confidence intervals after phase II/III clinical trials

Recently, in order to accelerate drug development, trials that use adaptive seamless designs such as phase II/III clinical trials have been proposed. Phase II/III clinical trials combine traditional phases II and III into a single trial that is conducted in two stages. Using stage 1 data, an interim analysis is performed to answer phase II objectives and after collection of stage 2 data, a final confirmatory analysis is performed to answer phase III objectives. In this paper we consider phase II/III clinical trials in which, at stage 1, several experimental treatments are compared to a control and the apparently most effective experimental treatment is selected to continue to stage 2. Although these trials are attractive because the confirmatory analysis includes phase II data from stage 1, the inference methods used for trials that compare a single experimental treatment to a control and do not have an interim analysis are no longer appropriate. Several methods for analysing phase II/III clinical trials have been developed. These methods are recent and so there is little literature on extensive comparisons of their characteristics. In this paper we review and compare the various methods available for constructing confidence intervals after phase II/III clinical trials.

Point estimates and confidence regions for sequential trials involving selection

A number of authors have proposed clinical trial designs involving the comparison of several experimental treatments with a control treatment in two or more stages. At the end of the first stage, the most promising experimental treatment is selected, and all other experimental treatments are dropped from the trial. Provided it is good enough, the selected experimental treatment is then compared with the control treatment in one or more subsequent stages. The analysis of data from such a trial is problematic because of the treatment selection and the possibility of stopping at interim analyses. These aspects lead to bias in the maximum-likelihood estimate of the advantage of the selected experimental treatment over the control and to inaccurate coverage for the associated confidence interval. In this paper, we evaluate the bias of the maximum-likelihood estimate and propose a bias-adjusted estimate. We also propose an approach to the construction of a confidence region for the vector of advantages of the experimental treatments over the control based on an ordering of the sample space. These regions are shown to have accurate coverage, although they are also shown to be necessarily unbounded. Confidence intervals for the advantage of the selected treatment are obtained from the confidence regions and are shown to have more accurate coverage than the standard confidence interval based upon the maximum-likelihood estimate and its asymptotic standard error.

Development of a methodology to investigate the importance of chemical speciation on the bioavailability of contaminants to Eisenia andrei

The uptake of metals by earthworms occurs predominantly via the soil pore water, or via an uptake route which is related to the soil pore water metal concentration. However, it has been suggested that the speciation of the metal is also important. A novel technique is described which exposes Eisenia andrei Bouche to contaminant bearing solutions in which the chemical factors affecting its speciation may be individually and systematically manipulated. In a preliminary experiment, the LC50 for copper nitrate was 0.046 mg l(-1) (95 % confidence intervals: 0.03 and 0.07 mg l(-1)). There was a significant positive correlation between earthworm mortality and bulk copper concentration in solution (R-2 = 0.88, P less than or equal to 0.001), and a significant positive increase in earthworm tissue copper concentration with increasing copper concentration in solution (R-2 = 0.97, P less than or equal to 0.001). It is anticipated that quantifying the effect of soil solution chemical speciation on copper bioavailability will provide an excellent aid to understanding the importance of chemical composition and the speciation of metals, in the calculation of toxicological parameters.

Single versus multiple occupancy - Effects on toxicity parameters measured on Eisenia fetida in lead nitrate-treated soil

The mortality (7 and 14 d), weight change (7 and 14 d), and metal uptake of Eisenia fetida (Savigny, 1826) kept in Pb(NO3)(2)-treated Kettering loam soil in single- and multiple-occupancy (10 earthworms) test containers were determined. The number of earthworms to dry mass (g) ratio of soil was 1:50 in both sets of test containers. Lead concentrations were in the nominal range of 0 to 10,000 mg Pb/kg soil (mg/kg hereafter). Levels of mortality at a given concentration were statistically identical between the single- and multiple-occupancy tests, except at 1,800 mg/kg, at which significantly (p less than or equal to 0.05) more mortality occurred in the multiple-occupancy tests. Death of individual earthworms in the multiple-occupancy tests did not trigger death of the other earthworms in that soil. The LC50 values (concentration statistically likely to kill 50% of the population) were identical between the multiple- and single-occupancy soils: 2,662 mg/kg (2,598-2,984, 7 d) and 2,589 mg/kg (2,251-3,013, 14 d) for the multiple-occupancy soils and 2,827 mg/kg (2,443-3,168, both 7 and 14 d) for the single-occupancy soils (values in brackets represent the 95% confidence intervals). Data were insufficient to calculate the concentration statistically likely to reduce individual earthworm mass by 50% (EC50), but after 14 d, the decrease in earthworm weight in the 1,800 and 3,000 mg/kg tests was significantly greater in the multiple- than in the single-occupancy soils. At 1,000, 1,800, and 3,000 mg/kg tests, earthworm Pb tissue concentration was significantly (p less than or equal to 0.05) greater in earthworms from the multiple-occupancy soils. The presence of earthworms increased the NH3 content of the soil; earthworm mortality increased NH3 concentrations further but not to toxic levels.

Assessing the uncertainty associated with intermittent rainfall fields

[1] In many practical situations where spatial rainfall estimates are needed, rainfall occurs as a spatially intermittent phenomenon. An efficient geostatistical method for rainfall estimation in the case of intermittency has previously been published and comprises the estimation of two independent components: a binary random function for modeling the intermittency and a continuous random function that models the rainfall inside the rainy areas. The final rainfall estimates are obtained as the product of the estimates of these two random functions. However the published approach does not contain a method for estimation of uncertainties. The contribution of this paper is the presentation of the indicator maximum likelihood estimator from which the local conditional distribution of the rainfall value at any location may be derived using an ensemble approach. From the conditional distribution, representations of uncertainty such as the estimation variance and confidence intervals can be obtained. An approximation to the variance can be calculated more simply by assuming rainfall intensity is independent of location within the rainy area. The methodology has been validated using simulated and real rainfall data sets. The results of these case studies show good agreement between predicted uncertainties and measured errors obtained from the validation data.

Family-based association analysis with ordered categorical phenotypes, covariates and interactions

Genetic association analyses of family-based studies with ordered categorical phenotypes are often conducted using methods either for quantitative or for binary traits, which can lead to suboptimal analyses. Here we present an alternative likelihood-based method of analysis for single nucleotide polymorphism (SNP) genotypes and ordered categorical phenotypes in nuclear families of any size. Our approach, which extends our previous work for binary phenotypes, permits straightforward inclusion of covariate, gene-gene and gene-covariate interaction terms in the likelihood, incorporates a simple model for ascertainment and allows for family-specific effects in the hypothesis test. Additionally, our method produces interpretable parameter estimates and valid confidence intervals. We assess the proposed method using simulated data, and apply it to a polymorphism in the c-reactive protein (CRP) gene typed in families collected to investigate human systemic lupus erythematosus. By including sex interactions in the analysis, we show that the polymorphism is associated with anti-nuclear autoantibody (ANA) production in females, while there appears to be no effect in males.

Estimators in capture–recapture studies with two sources

This paper investigates the applications of capture–recapture methods to human populations. Capture–recapture methods are commonly used in estimating the size of wildlife populations but can also be used in epidemiology and social sciences, for estimating prevalence of a particular disease or the size of the homeless population in a certain area. Here we focus on estimating the prevalence of infectious diseases. Several estimators of population size are considered: the Lincoln–Petersen estimator and its modified version, the Chapman estimator, Chao’s lower bound estimator, the Zelterman’s estimator, McKendrick’s moment estimator and the maximum likelihood estimator. In order to evaluate these estimators, they are applied to real, three-source, capture-recapture data. By conditioning on each of the sources of three source data, we have been able to compare the estimators with the true value that they are estimating. The Chapman and Chao estimators were compared in terms of their relative bias. A variance formula derived through conditioning is suggested for Chao’s estimator, and normal 95% confidence intervals are calculated for this and the Chapman estimator. We then compare the coverage of the respective confidence intervals. Furthermore, a simulation study is included to compare Chao’s and Chapman’s estimator. Results indicate that Chao’s estimator is less biased than Chapman’s estimator unless both sources are independent. Chao’s estimator has also the smaller mean squared error. Finally, the implications and limitations of the above methods are discussed, with suggestions for further development.

The use of bootstrapped Malmquist indices to reassess productivity change findings: an application to a sample of Polish farms

This article assesses the extent to which sampling variation affects findings about Malmquist productivity change derived using data envelopment analysis (DEA), in the first stage by calculating productivity indices and in the second stage by investigating the farm-specific change in productivity. Confidence intervals for Malmquist indices are constructed using Simar and Wilson's (1999) bootstrapping procedure. The main contribution of this article is to account in the second stage for the information in the second stage provided by the first-stage bootstrap. The DEA SEs of the Malmquist indices given by bootstrapping are employed in an innovative heteroscedastic panel regression, using a maximum likelihood procedure. The application is to a sample of 250 Polish farms over the period 1996 to 2000. The confidence intervals' results suggest that the second half of 1990s for Polish farms was characterized not so much by productivity regress but rather by stagnation. As for the determinants of farm productivity change, we find that the integration of the DEA SEs in the second-stage regression is significant in explaining a proportion of the variance in the error term. Although our heteroscedastic regression results differ with those from the standard OLS, in terms of significance and sign, they are consistent with theory and previous research.

The effects of different knowledge-dissemination interventions on the mastitis knowledge of Tanzanian smallholder dairy farmers

We developed three different knowledge-dissemination methods for educating Tanzanian smallholder farmers about mastitis in their dairy cattle. The effectiveness of these methods (and their combinations) was evaluated and quantified using a randomised controlled trial and multilevel statistical modelling. To our knowledge, this is the first study that has used such techniques to evaluate the effectiveness of different knowledge-dissemination interventions for adult learning in developing countries. Five different combinations of knowledge-dissemination method were compared: 'diagrammatic handout' ('HO'), 'village meeting' ('VM'), 'village meeting and video' ('VM + V), 'village meeting and diagrammatic handout' ('VM + HO') and 'village meeting, video and diagrammatic handout' ('VM + V + HO'). Smallholder dairy farmers were exposed to only one of these interventions, and the effectiveness of each was compared to a control ('C') group, who received no intervention. The mastitis knowledge of each farmer (n = 256) was evaluated by questionnaire both pre- and post-dissemination. Generalised linear mixed models were used to evaluate the effectiveness of the different interventions. The outcome variable considered was the probability of volunteering correct responses to mastitis questions post-dissemination, with 'village' and 'farmer' considered as random effects in the model. Results showed that all five interventions, 'HO' (odds ratio (OR) = 3.50, 95% confidence intervals (CI) = 3.10, 3.96), 'VM + V + HO' (OR = 3.34, 95% CI = 2.94, 3.78), 'VM + HO, (OR=3.28, 95% CI=2.90, 3.71), WM+V (OR=3.22, 95% CI=2.84, 3.64) and 'VM' (OR = 2.61, 95% CI = 2.31, 2.95), were significantly (p < 0.0001) more effective at disseminating mastitis knowledge than no intervention. In addition, the 'VM' method was less effective at disseminating mastitis knowledge than other interventions. Combinations of methods showed no advantage over the diagrammatic handout alone. Other explanatory variables with significant positive associations on mastitis knowledge included education to secondary school level or higher, and having previously learned about mastitis by reading pamphlets or attendance at an animal-health course. (c) 2005 Elsevier B.V. All rights reserved.

Application of a double bootstrap to investigation of determinants of technical efficiency of farms in Central Europe

The paper provides one of the first applications of the double bootstrap procedure (Simar and Wilson 2007) in a two-stage estimation of the effect of environmental variables on non-parametric estimates of technical efficiency. This procedure enables consistent inference within models explaining efficiency scores, while simultaneously producing standard errors and confidence intervals for these efficiency scores. The application is to 88 livestock and 256 crop farms in the Czech Republic, split into individual and corporate.

Productivity change in Polish agriculture: an illustration of a bootstrapping procedure applied to Malmquist indices

This article illustrates the usefulness of applying bootstrap procedures to total factor productivity Malmquist indices, derived with data envelopment analysis (DEA), for a sample of 250 Polish farms during 1996-2000. The confidence intervals constructed as in Simar and Wilson suggest that the common portrayal of productivity decline in Polish agriculture may be misleading. However, a cluster analysis based on bootstrap confidence intervals reveals that important policy conclusions can be drawn regarding productivity enhancement.

Application of a double bootstrap to investigation of determinants of technical efficiency of farms in Central Europe

The paper provides one of the first applications of the double bootstrap procedure (Simar and Wilson 2007) in a two-stage estimation of the effect of environmental variables on non-parametric estimates of technical efficiency. This procedure enables consistent inference within models explaining efficiency scores, while simultaneously producing standard errors and confidence intervals for these efficiency scores. The application is to 88 livestock and 256 crop farms in the Czech Republic, split into individual and corporate.

The effect of selective decontamination of the digestive tract on mortality in multiple trauma patients: a multicenter randomized controlled trial

Objective: Evaluation of selective decontamination of the digestive tract (SDD) on late mortality in ventilated trauma patients in an intensive care unit (ICU). Methods: A multicenter, randomized controlled trial was undertaken in 401 trauma patients with Hospital Trauma Index-Injury Severity Score of 16 or higher. Patients were randomized to control (n = 200) or SDD (n = 201), using polymyxin E, tobramycin, and amphotericin B in throat and gut throughout ICU treatment combined with cefotaxime for 4 days. Primary endpoint was late mortality excluding early death from hemorrhage or craniocerebral injury. Secondary endpoints were infection and organ dysfunction. Results: Mortality was 20.9% with SDD and 22.0% in controls. Overall late mortality was 15.3% (57/372) as 29 patients died from cerebral injury, 16 SDD and 13 control. The odds ratio (95% confidence intervals) of late mortality for SDD relative to control was 0.75 (0.40-1.37), corresponding to estimates of 13.4% SDD and 17.2% control. The overall infection rate was reduced in the test group (48.8% vs. 61.0%). SDD reduced lower airway infections (30.9% vs. 50.0%) and bloodstream infections due to aerobic Gram-negative bacilli (2.5% vs. 7.5%). No difference in organ dysfunction was found. Concluson: This study demonstrates that SDD significantly reduces infection in multiple trauma, although this RCT in 401 patients was underpowered to detect a mortality benefit.

Estimating numbers of infectious units from serial dilution assays

The paper concerns the design and analysis of serial dilution assays to estimate the infectivity of a sample of tissue when it is assumed that the sample contains a finite number of indivisible infectious units such that a subsample will be infectious if it contains one or more of these units. The aim of the study is to estimate the number of infectious units in the original sample. The standard approach to the analysis of data from such a study is based on the assumption of independence of aliquots both at the same dilution level and at different dilution levels, so that the numbers of infectious units in the aliquots follow independent Poisson distributions. An alternative approach is based on calculation of the expected value of the total number of samples tested that are not infectious. We derive the likelihood for the data on the basis of the discrete number of infectious units, enabling calculation of the maximum likelihood estimate and likelihood-based confidence intervals. We use the exact probabilities that are obtained to compare the maximum likelihood estimate with those given by the other methods in terms of bias and standard error and to compare the coverage of the confidence intervals. We show that the methods have very similar properties and conclude that for practical use the method that is based on the Poisson assumption is to be recommended, since it can be implemented by using standard statistical software. Finally we consider the design of serial dilution assays, concluding that it is important that neither the dilution factor nor the number of samples that remain untested should be too large.