Decision-theoretic designs for dose-finding clinical trials with multiple outcomes

A decision-theoretic framework is proposed for designing sequential dose-finding trials with multiple outcomes. The optimal strategy is solvable theoretically via backward induction. However, for dose-finding studies involving k doses, the computational complexity is the same as the bandit problem with k-dependent arms, which is computationally prohibitive. We therefore provide two computationally compromised strategies, which is of practical interest as the computational complexity is greatly reduced: one is closely related to the continual reassessment method (CRM), and the other improves CRM and approximates to the optimal strategy better. In particular, we present the framework for phase I/II trials with multiple outcomes. Applications to a pediatric HIV trial and a cancer chemotherapy trial are given to illustrate the proposed approach. Simulation results for the two trials show that the computationally compromised strategy can perform well and appear to be ethical for allocating patients. The proposed framework can provide better approximation to the optimal strategy if more extensive computing is available.

An extension of the continual reassessment method using decision theory

The primary goal of a phase I trial is to find the maximally tolerated dose (MTD) of a treatment. The MTD is usually defined in terms of a tolerable probability, q*, of toxicity. Our objective is to find the highest dose with toxicity risk that does not exceed q*, a criterion that is often desired in designing phase I trials. This criterion differs from that of finding the dose with toxicity risk closest to q*, that is used in methods such as the continual reassessment method. We use the theory of decision processes to find optimal sequential designs that maximize the expected number of patients within the trial allocated to the highest dose with toxicity not exceeding q*, among the doses under consideration. The proposed method is very general in the sense that criteria other than the one considered here can be optimized and that optimal dose assignment can be defined in terms of patients within or outside the trial. It includes as an important special case the continual reassessment method. Numerical study indicates the strategy compares favourably with other phase I designs.

Recipient v russkom razgovore : o raspredelenii funkcij mezhdu otvetami da, nu i tak

The study investigates actions by recipients in spontaneous Russian conversations by focusing on DA, NU and TAK, when they are used as responses to the main speaker's larger on-going turn. The database for the study consists of some 7 hours of spontaneous conversations. The participants of the conversations come from different parts of Russia. The use of DA, NU and TAK was analyzed by applying the method of ethnomethodological conversation analysis from the point of view of the type of the context, the sequential placement of the response and its manner of production. The particles were analyzed both in contexts in which they responded to an informing and in affective contexts. The particles NU and TAK were used by the speakers almost exclusively in informing contexts, whereas DA was the central response type in affective contexts. DA was also the most common response to information with affective implications. The information, to which the particle NU provided as response, was often unspesific and projected a spesification or explanation by its speaker as the next action. DA and TAK, by contrast, treated the information as one that could be followed and was sufficient in its local context. As a response to parenthetical information NU responded to information that was only loosely connected with the mainline of talk. The particle DA, by contrast, was used as a response to such parenthetical information, which was more crucial for the larger on-going activity. Only NU was used as a response that invited the main speaker to continue a turn that she or he had offered as possibly complete. NU was also used by the recipient after her or his own contribution as a continuer. In affective contexts, DA expressed, depending on its more spesific context, not only agreement but also other functions, such as giving up arguing or prior knowledge on the topic being discussed. In addition DA responses were used to display empathy and identification with the state of affairs expressed by the co-participant. NU, by contrast, was seldom used as a response to a turn that expressed affect. When it was used in affective contexts, it displayed agreement with the co-participant or just registered an assessment by her or him.

Mauwake reference grammar

This dissertation provides a synchronic grammatical description of Mauwake, a Papuan (Trans-New Guinea) language of about 2000 speakers on the North Coast of the Madang Province in Papua New Guinea. The theoretical background is that of Basic Linguistic Theory (BLT), used extensively in analysing and writing descriptive grammars. The chapters from morphology to clause level are described from form to function; in the later chapters the function is taken more often as the starting point. Any theory-specific terminology is kept to the minimum and formalisms have been avoided in accordance with BLT principles. Mauwake has a classic 5-vowel system and 14 consonant phonemes. With its simple phonology it is a typical representative of the Madang North Coast languages. For a Papuan language there are relatively few morphophonological alternations. Nouns are either alienably or inalienably possessed. There is no obligatory number marking in nouns or noun phrases. Pronouns have several different forms: five for case and three for other functions. The dative pronouns are treated as [+human] locatives, and they have also grammaticalised as possessives. The verbal morphology is agglutinative and mainly suffixal. Unusual features include two distributive suffixes, and the interaction of the derivational benefactive and the inflectional beneficiary suffixes. The applicative suffix has either transitivising or causative but not benefactive function. The switch-reference system distinguishes between simultaneous and sequential action, as well as same or different subject in relation to the following clause. There are several verbs denoting coming and going, and they may combine with one of three prefixes to indicate bringing and taking. Mauwake is a nominative-accusative type language, and the basic constituent order in a clause is SOV. Subject and object are the only syntactic arguments. There is no indirect object, but a clause can have two or even three objects. A nominalised clause with a finite verb functions as a relative clause or a complement clause; one with a nominalised verb has several different functions. Functional domains described include modality, negation, deixis, quantification, possession and comparison. As there are four negators, Mauwake has more variation in negative expressions than is usual in Papuan languages. Clause chaining is the preferred strategy for joining clauses into sentences, but coordination and subordination of finite clauses are also common. The form of a complement clause depends on whether it is of the fact, action or potential type. Tail-head linkage is used as a cohesive device between sentences. The discourse-level features described are topic and focus.

A Bayesian decision approach for sample size determination in phase II trials

Stallard (1998, Biometrics 54, 279-294) recently used Bayesian decision theory for sample-size determination in phase II trials. His design maximizes the expected financial gains in the development of a new treatment. However, it results in a very high probability (0.65) of recommending an ineffective treatment for phase III testing. On the other hand, the expected gain using his design is more than 10 times that of a design that tightly controls the false positive error (Thall and Simon, 1994, Biometrics 50, 337-349). Stallard's design maximizes the expected gain per phase II trial, but it does not maximize the rate of gain or total gain for a fixed length of time because the rate of gain depends on the proportion: of treatments forwarding to the phase III study. We suggest maximizing the rate of gain, and the resulting optimal one-stage design becomes twice as efficient as Stallard's one-stage design. Furthermore, the new design has a probability of only 0.12 of passing an ineffective treatment to phase III study.

Optimal designs for evaluating a series of treatments

Several articles in this journal have studied optimal designs for testing a series of treatments to identify promising ones for further study. These designs formulate testing as an ongoing process until a promising treatment is identified. This formulation is considered to be more realistic but substantially increases the computational complexity. In this article, we show that these new designs, which control the error rates for a series of treatments, can be reformulated as conventional designs that control the error rates for each individual treatment. This reformulation leads to a more meaningful interpretation of the error rates and hence easier specification of the error rates in practice. The reformulation also allows us to use conventional designs from published tables or standard computer programs to design trials for a series of treatments. We illustrate these using a study in soft tissue sarcoma.

Bias reduction using stochastic approximation

The paper studies stochastic approximation as a technique for bias reduction. The proposed method does not require approximating the bias explicitly, nor does it rely on having independent identically distributed (i.i.d.) data. The method always removes the leading bias term, under very mild conditions, as long as auxiliary samples from distributions with given parameters are available. Expectation and variance of the bias-corrected estimate are given. Examples in sequential clinical trials (non-i.i.d. case), curved exponential models (i.i.d. case) and length-biased sampling (where the estimates are inconsistent) are used to illustrate the applications of the proposed method and its small sample properties.

Error bounds for calculation of the Gittins indices

For a wide class of semi-Markov decision processes the optimal policies are expressible in terms of the Gittins indices, which have been found useful in sequential clinical trials and pharmaceutical research planning. In general, the indices can be approximated via calibration based on dynamic programming of finite horizon. This paper provides some results on the accuracy of such approximations, and, in particular, gives the error bounds for some well known processes (Bernoulli reward processes, normal reward processes and exponential target processes).

Gittins indices and constrained allocation in clinical trials

We explore the use of Gittins indices to search for near optimality in sequential clinical trials. Some adaptive allocation rules are proposed to achieve the following two objectives as far as possible: (i) to reduce the expected successes lost, (ii) to minimize the error probability at the end. Simulation results indicate the merits of the rules based on Gittins indices for small trial sizes. The rules are generalized to the case when neither of the response densities is known. Asymptotic optimality is derived for the constrained rules. A simple allocation rule is recommended for one-stage models. The simulation results indicate that it works better than both equal allocation and Bather's randomized allocation. We conclude with a discussion of possible further developments.

Quantifying progressive anterior overgrowth in the thoracic vertebrae of adolescent idiopathic scoliosis patients

Study design Anterior and posterior vertebral body heights were measured from sequential MRI scans of adolescent idiopathic scoliosis (AIS) patients and healthy controls. Objective To measure changes in vertebral body height over time during scoliosis progression to assess how vertebral body height discrepancies change during growth. Summary of background data Relative anterior overgrowth has been proposed as a potential driver for AIS initiation and progression. This theory proposes that the anterior column grows faster, and the posterior column slower, in AIS patients when compared to healthy controls. There is disagreement in the literature as to whether the anterior vertebral body heights are proportionally greater than posterior vertebral body heights in AIS patients when compared to healthy controls. To some extent, these discrepancies may be attributed to methodological differences. Methods MRI scans of the major curve of 21 AIS patients (mean age 12.5 ± 1.4 years, mean Cobb 32.2 ± 12.8º) and between T4 and T12 of 21 healthy adolescents (mean age 12.1 ± 0.5 years) were captured for this study. Of the 21 AIS patients, 14 had a second scan on average 10.8 ± 4.7 months after the first. Anterior and posterior vertebral body heights were measured from the true sagittal plane of each vertebra such that anterior overgrowth could be quantified. Results The difference between anterior and posterior vertebral body height in healthy, non-scoliotic children was significantly greater than in AIS patients with mild to moderate scoliosis. However there was no significant relationship between the overall anterior-posterior vertebral body height difference in AIS and either severity of the curve or its progression over time. Conclusions Whilst AIS patients have a proportionally longer anterior column than non-scoliotic controls, the degree of anterior overgrowth was not related to the rate of progression or the severity of the scoliotic curve.

The effect of row configuration on yield reliability in grain sorghum: II. Modelling the effects of row configuration

In recent years many sorghum producers in the more marginal (<600 mm annual rainfall) cropping areas of Qld and northern NSW have utilised skip row configurations in an attempt to improve yield reliability and reduce sorghum production risk. But will this work in the long run? What are the trade-offs between productivity and risk of crop failure? This paper describes a modelling and simulation approach to study the long-term effects of skip row configurations. Detailed measurements of light interception and water extraction from sorghum crops grown in solid, single and double skip row configurations were collected from three on-farm participatory research trials established in southern Qld and northern NSW. These measurements resulted in changes to the model that accounted for the elliptical water uptake pattern below the crop row and reduced total light interception associated with the leaf area reduction of the skip configuration. Following validation of the model, long-term simulation runs using historical weather data were used to determine the value of skip row sorghum production as a means of maintaining yield reliability in the dryland cropping regions of southern Qld and northern NSW.

Sustaining productivity of a Vertosol at Warra, Queensland, with fertilisers, no-tillage or legumes. 7. Yield, nitrogen and disease-break benefits from lucerne in a two-year lucerne–wheat rotation

Continuous cultivation and cereal cropping of southern Queensland soils previously supporting native vegetation have resulted in reduced soil nitrogen supply, and consequently decreased cereal grain yields and low grain protein. To enhance yields and protein concentrations of wheat, management practices involving N fertiliser application, with no-tillage and stubble retention, grain legumes, and legume leys were evaluated from 1987 to 1998 on a fertility-depleted Vertosol at Warra, southern Queensland. The objective of this study was to examine the effect of lucerne in a 2-year lucerne–wheat rotation for its nitrogen and disease-break benefits to subsequent grain yield and protein content of wheat as compared with continuous wheat cropping. Dry matter production and nitrogen yields of lucerne were closely correlated with the total rainfall for October–September as well as March–September rainfall. Each 100 mm of total rainfall resulted in 0.97 t/ha of dry matter and 26 kg/ha of nitrogen yield. For the March–September rainfall, the corresponding values were 1.26 t/ha of dry matter and 36 kg/ha of nitrogen yield. The latter values were 10% lower than those produced by annual medics during a similar period. Compared with wheat–wheat cropping, significant increases in total soil nitrogen were observed only in 1990, 1992 and 1994 but increases in soil mineralisable nitrogen were observed in most years following lucerne. Similarly, pre-plant nitrate nitrogen in the soil profile following lucerne was higher by 74 kg/ha (9–167 kg N/ha) than that of wheat–wheat without N fertiliser in all years except 1996. Consequently, higher wheat grain protein (7 out of 9 seasons) and grain yield (4 out of 9 seasons) were produced compared with continuous wheat. There was significant depression in grain yield in 2 (1993 and 1995) out of 9 seasons attributed to soil moisture depletion and/or low growing season rainfall. Consequently, the overall responses in yield were lower than those of 50 kg/ha of fertiliser nitrogen applied to wheat–wheat crops, 2-year medic–wheat or chickpea–wheat rotation, although grain protein concentrations were higher following lucerne. The incidence and severity of the soilborne disease, common root rot of wheat caused by Bipolaris sorokiniana, was generally higher in lucerne–wheat than in continuous wheat with no nitrogen fertiliser applications, since its severity was significantly correlated with plant available water at sowing. No significant incidence of crown rot or root lesion nematode was observed. Thus, productivity, which was mainly due to nitrogen accretion in this experiment, can be maintained where short duration lucerne leys are grown in rotations with wheat.

An overview of land application of pig effluent-P using soil P chemistry and mass balance calculations.

Attention is directed at land application of piggery effluent (containing urine, faeces, water, and wasted feed) as a potential source of water resource contamination with phosphorus (P). This paper summarises P-related properties of soil from 0-0.05 m depth at 11 piggery effluent application sites, in order to explore the impact that effluent application has had on the potential for run-off transport of P. The sites investigated were situated on Alfisol, Mollisol, Vertisol, and Spodosol soils in areas that received effluent for 1.5-30 years (estimated effluent-P applications of 100-310000 kg P/ha in total). Total (PT), bicarbonate extractable (PB), and soluble P forms were determined for the soil (0-0.05 m) at paired effluent and no-effluent sites, as well as texture, oxalate-extractable Fe and Al, organic carbon, and pH. All forms of soil P at 0-0.05 m depth increased with effluent application (PB at effluent sites was 1.7-15 times that at no-effluent sites) at 10 of the 11 sites. Increases in PB were strongly related to net P applications (regression analysis of log values for 7 sites with complete data sets: 82.6 % of variance accounted for, p <0.01). Effluent irrigation tended to increase the proportion of soil PT in dilute CaCl2-extractable forms (PTC: effluent average 2.0 %; no-effluent average 0.6%). The proportion of PTC in non-molybdate reactive forms (centrifuged supernatant) decreased (no-effluent average, 46.4 %; effluent average, 13.7 %). Anaerobic lagoon effluent did not reliably acidify soil, since no consistent relationship was observed for pH with effluent application. Soil organic carbon was increased in most of the effluent areas relative to the no-effluent areas. The four effluent areas where organic carbon was reduced had undergone intensive cultivation and cropping. Current effluent management at many of the piggeries failed to maximise the potential for waste P recapture. Ten of the case-study effluent application areas have received effluent-P in excess of crop uptake. While this may not represent a significant risk of leaching where sorption retains P, it has increased the risk of transport of P by run-off. Where such sites are close to surface water, run-off P loads should be managed.

A thermometer for interdependence: Exploring patterns of interdependence using networks of affordances

Interdependence is a central concept in systems and organizations, yet our methods for measuring it are not well developed. Here, we report on a novel method for transforming digital trace data into networks of events that can be used to visualize and measure interdependence. The edges in the network represent sequential flow and the vertices represent actors, actions and artifacts. We refer to this representation as an affordance network. As with conventional approaches such as process mining, our method uses input from a stream of time-stamped occurrences, but the representation is simpler and more appropriate for exploration and theory building. As digital trace data becomes more widely available, this method may become more useful in information systems research and practice. Like a thermometer, it helps us measure a basic property of a system that would otherwise be difficult to see.

Sustaining productivity of a Vertosol at Warra, Queensland, with fertilisers, no-tillage or legumes. 8. Effect of duration of lucerne ley on soil nitrogen and water, wheat yield and protein.

Soil nitrogen (N) supply in the Vertosols of southern Queensland, Australia has steadily declined as a result of long-term cereal cropping without N fertiliser application or rotations with legumes. Nitrogen-fixing legumes such as lucerne may enhance soil N supply and therefore could be used in lucerne-wheat rotations. However, lucerne leys in this subtropical environment can create a soil moisture deficit, which may persist for a number of seasons. Therefore, we evaluated the effect of varying the duration of a lucerne ley (for up to 4 years) on soil N increase, N supply to wheat, soil water changes, wheat yields and wheat protein on a fertility-depleted Vertosol in a field experiment between 1989 and 1996 at Warra (26degrees 47'S, 150degrees53'E), southern Queensland. The experiment consisted of a wheat-wheat rotation, and 8 treatments of lucerne leys starting in 1989 (phase 1) or 1990 (phase 2) for 1,2,3 or 4 years duration, followed by wheat cropping. Lucerne DM yield and N yield increased with increasing duration of lucerne leys. Soil N increased over time following 2 years of lucerne but there was no further significant increase after 3 or 4 years of lucerne ley. Soil nitrate concentrations increased significantly with all lucerne leys and moved progressively downward in the soil profile from 1992 to 1995. Soil water, especially at 0.9-1.2 m depth, remained significantly lower for the next 3 years after the termination of the 4 year lucerne ley than under continuous wheat. No significant increase in wheat yields was observed from 1992 to 1995, irrespective of the lucerne ley. However, wheat grain protein concentrations were significantly higher under lucerne-wheat than under wheat wheat rotations for 3-5 years. The lucerne yield and soil water and nitrate-N concentrations were satisfactorily simulated with the APSIM model. Although significant N accretion occurred in the soil following lucerne leys, in drier seasons, recharge of the drier soil profile following long duration lucerne occurred after 3 years. Consequently, 3- and 4-year lucerne-wheat rotations resulted in more variable wheat yields than wheat-wheat rotations in this region. The remaining challenge in using lucerne-wheat rotations is balancing the N accretion benefits with plant-available water deficits, which are most likely to occur in the highly variable rainfall conditions of this region.