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PubMed2006

Issues in the use of adaptive clinical trial designs.

Sequential sampling plans are often used in the monitoring of clinical trials in order to address the ethical and efficiency issues inherent in human testing of a new treatment or preventive agent for disease. Group sequential stopping rules are perhaps the most commonly used approaches, but in recent years, a number of authors have proposed adaptive methods of choosing a stopping rule. In general, such adaptive approaches come at a price of inefficiency (almost always) and clouding of the scientific question (sometimes). In this paper, I review the degree of adaptation possible within the largely prespecified group sequential stopping rules, and discuss the operating characteristics that can be characterized fully prior to collection of the data. I then discuss the greater flexibility possible when using several of the adaptive approaches receiving the greatest attention in the statistical literature and conclude with a discussion of the scientific and statistical issues raised by their use.

Clinical Trials as Topic↗
PubMed2006

Identification of proteins in renaissance paintings by proteomics.

The presented work proposes a new methodology based on proteomics techniques to identify proteins in old art paintings. The main challenging tasks of this work were (i) to find appropriate conditions for extracting proteins from the binding media without protein hydrolysis in amino acids and (ii) to develop analytical methods adapted to the small sample quantity available. Starting from microsamples of painting models (ovalbumin-based, which is the major egg white protein, and egg-based paintings), multiple extraction solutions (HCl, HCOOH, NH3, NaOH) and conditions (ultrasonic bath, mortar and pestle, grinding resin) were evaluated. The best results were obtained using a commercial kit including a synthetic resin, mortar and pestle to grind the sample in an aqueous solution acidified with trifluoroacetic acid at 1% with additional multiple steps of ultrasonic baths. The resulting supernatant was analyzed by MALDI-TOF in linear mode to verify the efficiency of the extraction solution. An enzymatic hydrolysis step was also performed for protein identification; the peptide mixture was analyzed by nanoLC/nanoESI/Q-q-TOF MS/MS with an adapted chromatographic run for the low sample quantity. Finally, the developed methodology was successfully applied to Renaissance art painting microsamples of approximately 10 microg from Benedetto Bonfigli's triptych, The Virgin and Child, St. John the Baptist, St. Sebastian (XVth century), and Niccolo di Pietro Gerini's painting, The Virgin and Child (XIVth century), identifying, for the first time and without ambiguity, the presence of whole egg proteins (egg yolk and egg white) in a painting binder.

Egg Proteins↗
PubMedDate not supplied

[Neonatal screening of congenital hypothyroidism with TSH measurement in dried blood spots on filter paper. A two years experience (author's transl)].

Systematic screening for congenital hypothyroidism was started in Lyon in september 1976. This screening was coupled with PKU, using the same dried blood samples on filter paper obtained on the 5th day of life. TSH levels were determined by radioimmunoassay adapted for dried blood samples (Kit Abbott). In 24 months, 56 176 samples were analyzed. The critical level calling for control was successively raised from from 20 to 30, now 40 microUI/ml of serum. A high level of TSH was found in 307 children (0,55%). Pathological deliveries were found in most of these infants (neonatal injury, cesarean, section forceps or ocytocic perfusion, neonatal icterus) and a second or a third measurement showed normal TSH level. Congenital hypothyroidism, was found detected in 18 infants: 12 ectopic gland, 5 athyreosis and 1 dyshormonogenesis. Treatment was begun at a mean age of 38 days (29 to 50 days).

Congenital Hypothyroidism↗
PubMed2004

Validation of a simplified field-adapted procedure for routine determinations of methyl mercury at trace levels in natural water samples using species-specific isotope dilution mass spectrometry.

A field-adapted procedure based on species-specific isotope dilution (SSID) methodology for trace-level determinations of methyl mercury (CH(3)Hg(+)) in mire, fresh and sea water samples was developed, validated and applied in a field study. In the field study, mire water samples were filtered, standardised volumetrically with isotopically enriched CH(3) (200)Hg(+), and frozen on dry ice. The samples were derivatised in the laboratory without further pre-treatment using sodium tetraethyl borate (NaB(C(2)H(5))(4)) and the ethylated methyl mercury was purge-trapped on Tenax columns. The analyte was thermo-desorbed onto a GC-ICP-MS system for analysis. Investigations preceding field application of the method showed that when using SSID, for all tested matrices, identical results were obtained between samples that were freeze-preserved or analysed unpreserved. For DOC-rich samples (mire water) additional experiments showed no difference in CH(3)Hg(+) concentration between samples that were derivatised without pre-treatment or after liquid extraction. Extractions of samples for matrix-analyte separation prior to derivatisation are therefore not necessary. No formation of CH(3)Hg(+) was observed during sample storage and treatment when spiking samples with (198)Hg(2+). Total uncertainty budgets for the field application of the method showed that for analyte concentrations higher than 1.5 pg g(-1) (as Hg) the relative expanded uncertainty (REU) was approximately 5% and dominated by the uncertainty in the isotope standard concentration. Below 0.5 pg g(-1) (as Hg), the REU was >10% and dominated by variations in the field blank. The uncertainty of the method is sufficiently low to accurately determine CH(3)Hg(+) concentrations at trace levels. The detection limit was determined to be 4 fg g(-1) (as Hg) based on replicate analyses of laboratory blanks. The described procedure is reliable, considerably faster and simplified compared to non-SSID methods and thereby very suitable for routine applications of CH(3)Hg(+) speciation analysis in a wide range of water samples.

Environmental Monitoring↗
PubMed1999

Adaptation of solid phase extraction to an automated column switching method for online sample cleanup as the basis of a facile and sensitive high-performance liquid chromatographic assay for paclitaxel in human plasma.

An improved method for assaying paclitaxel in human plasma by high-performance liquid chromatography (HPLC) with UV detection at 227 nm has been developed by adapting previously reported sample preparation methods and chromatographic conditions to facilitate semi-automated sample cleanup using a column switching technique. Manual sample manipulations were limited to isolating the drug and internal standard from plasma (1.0 ml) by liquid-liquid extraction using tert-butyl methyl ether. The sample extract was initially loaded onto a short cartridge column containing a cyanopropyl stationary phase. During the predetermined time interval that the drug and internal standard eluted from the cartridge, 1.50-2.20 min, a fully automated 6-position switching valve was used to direct the effluent onto an octylsilica analytical column. The same mobile phase, composed of acetonitrile-methanol-ammonium acetate buffer (pH 5.0; 20 mM) (76:19:105, v/v/v) and delivered at flow rate of 1.0 ml/min, was used for both separations. The overall retention times of paclitaxel and the internal standard were 10.9 and 18.1 min, respectively. The analytical method was thoroughly validated for quantitating paclitaxel in plasma at concentrations ranging from 6 to 586 nM (5-500 ng/ml). The lowest concentration of paclitaxel measured with acceptable day-to-day accuracy (100.2%) and precision (RSD 11.7%, n = 21, 5 months) was 6 nM (5 ng/ml). The sensitivity and selectivity of the assay proved to be more than adequate for monitoring steady-state plasma concentrations of the drug when administered to cancer patients as a 96 h continuous intravenous infusion in combination with other anticancer agents, such as doxorubicin and topotecan. Moreover, the heart-cutting procedure prevented the problematic introduction of interfering nonpolar plasma components onto the analytical column, thereby enhancing sample throughput while decreasing the technical demands of the assay. The method was found to be extremely reproducible and robust during extended use for the routine analysis of plasma specimens acquired from several clinical trials.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1997

Nutritional adaptation of women living with HIV: a pilot study.

The incidence of human immunodeficiency virus (HIV) infection in women worldwide is increasing rapidly. Assumptions about HIV-related immunologic and nutritional changes are primarily based on data derived from men infected with HIV. The article reports a pilot study designed to examine the immunologic and nutritional responses of a small group of women with HIV infection and to suggest the Roy adaptation model as a framework for understanding HIV-related changes in women. A cross-sectional descriptive design was used to study physiologic mode responses in women seropositive for HIV. Results indicated that the subjects had lower than normal total CD4+ counts. The mean body mass index and midarm muscle area of this cohort of women fell between the 50th and 75th percentiles, and the triceps skinfold thickness was slightly below the 50th percentile, compared with age-matched norms derived from NHANES II data. Although wasting and nutritional problems are common in men with HIV disease the results suggest that women at the midlevel of the disease may not yet have major problems with nutritional adaptation to HIV. Future studies using the Roy adaptation model with larger samples of women who are followed over time are needed to determine whether the decline in physiologic mode adaptation level noted in men infected with HIV is also experienced by women infected with HIV.

Adaptation, Physiological↗
PubMed2004

Criterion-related validity of the three-factor model of psychopathy: personality, behavior, and adaptive functioning.

The Psychopathy Checklist-Revised (PCL-R) has been conceptualized as indexing two distinct but correlated factors. Previous research has established that these factors demonstrate distinct patterns of relations with external criteria. However, more recent findings suggest that the PCL-R psychopathy construct may encompass three distinguishable factors, reflecting affective, interpersonal, and behavioral symptoms. Here, we evaluated the validity of this newer three-factor model of the PCL-R factors with reference to external criteria from the domains of personality, antisocial behavior; and adaptive functioning in a sample of 310 incarcerated offenders. The interpersonal factor was related to social dominance, low stress reactivity, and higher adaptive functioning; the affective factor was correlated with low social closeness and violent offending; and the behavioral factor was associated with negative emotionality, disinhibition, reactive aggression, and poor adaptive functioning. These findings provide support for the convergent and discriminant validity of these psychopathy facets.

Adult↗
PubMedDate not supplied

[Neonatal screening for congenital hypothyroidism by measuring TSH in dried blood samples. Two years experience in the method (author's transl)].

Systematic screening for congenital hypothyroidism was started in Lyon in September 1976. This screening was coupled with PKU screening, using the same dried blood samples in filter paper obtained on the 5 th day of life. TSH levels were determined by radioimmunoassay adapted for dried blood samples (Kit Abbott). In 24 months, 56 176 samples were analyzed. The critical level calling for control was successively raised from 20 to 30 now 40 muUl/ml of serum. A high level of TSH was found in 307 children (0.55 p. 100). Pathological deliveries were found in most of these infants (neonatal injury, cesarean section, forceps or ocytocic perfusion, neonatal icterus) and a second or a third measurement showed normal TSH level. Congenital hypothyroidism, was detected in 18 infants: 12 ectopic gland, 5 athyreosis and 1 dyshormonogenesis. Treatment was begun at a mean age of 38 days (29 to 50 days). Despite a short follow-up the psychomotor development of the infants seems to be normal in all cases but one (one athyreosis with a neonatal injury and a malformative syndrome).

Blood Specimen Collection↗
PubMed1992

Lack of adaptive response to low doses of ionizing radiation in human lymphocytes from five different donors.

Various investigators reported a reduced yield of chromosome and chromatid aberrations in short-term cultures of human lymphocytes if a 'challenge' exposure to ionizing radiation was preceded by an 'adaptive' exposure. In order to examine the cell cycle dependence of the 'adaptive response', chromosome and chromatid aberration yields were estimated after challenge doses in the G1, S or G2 phase of lymphocytes which had been adapted in the early G1 phase. On testing two donors no protective adaptive response was found. Blood samples of four donors were tested for their capability to evoke the adaptive response in a standard experiment with the adaptive dose in the S phase and the challenge dose in the G2 phase. A synergistic response occurred in one out of two similar experiments performed with the same blood sample. The three other blood samples tested did not respond. Apparently these data indicate a high frequency of human lymphocyte cultures that do not display an adaptive response.

Adaptation, Physiological↗
PubMed1989

Adolescent ego development: relationship to family cohesion and adaptability.

Adolescence has been a focus of research for several decades. Recently, a portion of this body of research has addressed the relationship between adolescent development and family functioning. The intent of much of this research has been the attempt to determine how family dynamics influence the developmental processes of adolescents. Adolescents' perceptions of family cohesion and adaptability, as well as their levels of satisfaction with those perceptions, have been correlated with ego development within a sample of middle adolescents. Adaptability and cohesion were found to be significantly related to ego development, but interactions among the two variables, as well as with family structure were important.

Adaptation, Psychological↗
PubMed1999

Evaluation of linear diaphragm-chest expansion models for magnetic resonance imaging motion artifact correction.

The efficacy of Fourier analysis, autoregressive with exogenous input (ARX) and adaptive models to estimate diaphragm position from respiratory belt signal (a measure of chest expansion) was evaluated for the purpose of correcting respiratory motion artifacts in magnetic resonance imaging (MRI). Respiratory belt signal and diaphragm position data were obtained simultaneously during one-dimensional MRI scans with sampling intervals of 100 ms for 128 s (1280 samples). The models were trained using the first 512 data samples for the Fourier method and the first 640 samples for the ARX and adaptive methods. The remaining samples were used as a test set for evaluating the models. Both ARX and adaptive methods produced more accurate results than the Fourier method as reflected by the normalized mean square error (NMSE) and correlation coefficient (R) between the estimated and actual diaphragm position during normal breathing (P < 0.05). However, all three models had difficulty modeling diaphragm positions during breathing plateaus.

Adolescent↗
PubMed1993

Is n-pentane really an index of lipid peroxidation in humans and animals? A methodological reevaluation.

Volatile hydrocarbons such as ethane and n-pentane are known to originate from peroxidation of polyunsaturated fatty acids in membrane lipids and they are accepted as a sensitive and direct index of lipid peroxidation both in vitro and in vivo. Until now, an appropriate and commonly accepted method for the analysis of volatile hydrocarbons in exhalation air has not been described. We therefore developed a methodology for routine application in humans that is based on cryofocusing in combination with gas chromatography and is adaptable to mass spectrometry. The samples may be stored in stainless steel bombs up to 3 weeks, and sample volumes necessary to analysis are variable and can be adapted to analytical requirements. The interference by water and carbon dioxide, always present in excess, is strongly reduced. Mass spectroscopic analysis of exhalation air in human control subjects demonstrates, however, the presence of isoprene as the major constituent hitherto identified as n-pentane. The commonly used columns fail to separate n-pentane and isoprene. Based upon studies of the diverse methodologies reported in literature, it must be assumed that the reported responses of the gas chromatographic "n-pentane" peak in exhalation air of humans and animals, hitherto identified exclusively by authentic reference gases, are actually responses to isoprene or, at least, a mixture of both n-pentane and isoprene.

Adult↗
PubMed1996

Implementation of OSPOP, an algorithm for the estimation of optimal sampling times in pharmacokinetics by the ED, EID and API criteria.

The most common approach to optimize the sampling schedule in parameter estimation experiments is the D-optimality criterion, which consists in maximizing the determinant of the Fisher information matrix (max det F). In order to incorporate prior parameter uncertainty in the optimal design, other criteria have been proposed: The ED = max E (det F), EID = min E (l/det F) and API = max E (log det F) criteria, where the expectation is with respect to the given prior distribution of the parameters. Previously described algorithm for the estimation of optimal sampling times according to these criteria are adaptive random search (ARS), a robust and global but slow optimizer for API, and stochastic gradient (SG), a fast but local optimizer for ED and EID. We implemented an algorithm named OSPOP 1.0, based on non-adaptive random search (RS) followed by stochastic gradient to determine optimal sampling times for parameter estimation in various pharmacokinetic models according to ED, EID and API criteria. Prior distributions are allowed to be uniform, normal or lognormal. This algorithm combines the robustness of RS and the speediness of SG (convergence is obtained in a few minutes on a microcomputer). The results of the SG algorithm have been compared to those described in the literature using the ARS algorithm on a one compartment model with first- order absorption and were very similar. Also, the CPU time needed by SG and ARS algorithms were compared and the former proved to be much faster. Then, it has been applied to a five parameters stochastic model with zero-order absorption rate and Weibull-distributed residence times which was shown to describe adequately the kinetics of metacycline in humans. Population pharmacokinetic parameters of metacycline were estimated from a six subject pilot study, by the iterative two-staged method, using ADAPT II repeatedly. Optimal sampling times were determined with each criterion (ED, EID, API) with a multivariate normal prior parameter distribution. Six to seven distinct sampling times could be estimated. Higher numbers of samples revealed coalescing of design points.

Algorithms↗
PubMed2000

Interim analysis and sample size reassessment.

This article deals with sample size reassessment for adaptive two-stage designs based on conditional power arguments utilizing the variability observed at the first stage. Fisher's product test for the p-values from the disjoint samples at the two stages is considered in detail for the comparison of the means of two normal populations. We show that stopping rules allowing for the early acceptance of the null hypothesis that are optimal with respect to the average sample size may lead to a severe decrease of the overall power if the sample size is a priori underestimated. This problem can be overcome by choosing designs with low probabilities of early acceptance or by midtrial adaptations of the early acceptance boundary using the variability observed in the first stage. This modified procedure is negligibly anticonservative and preserves the power.

Animals↗
PubMed2006

Investigation of the ultraviolet photolysis method for the determination of organic nitrogen in aerosol samples.

The research objective was to adapt the ultraviolet (UV)-photolysis method to determine dissolved organic nitrogen (DON) in aqueous extracts of aerosol samples. DON was assumed to be the difference in total concentration of inorganic nitrogen forms before and after sample irradiation. Using a 2(2) factorial design the authors found that the optimal conversion of urea, amino acids (alanine, aspartic acid, glycine, and serine), and methylamine for a reactor temperature of 44 degrees C occurred at pH 2.0 with a 24-hr irradiance period at concentrations <33 microM of organic nitrogen. Different decomposition mechanisms were evident: the photolysis of amino acids and methylamine released mainly ammonium (NH4+), but urea released a near equimolar ratio of NH4+ and nitrate (NO3-). The method was applied to measure DON in the extracts of aerosol samples from Tampa, FL, over a 32-day sampling period. Average dissolved inorganic (DIN) and DON concentrations in the particulate matter fraction PM10 were 78.1 +/- 29.2 nmol-Nm(-3) and 8.3 +/- 4.9 nmol-Nm(-3), respectively. The ratio between DON and total dissolved nitrogen ([TDN] = DIN + DON) was 10.1 +/- 5.7%, and the majority of the DON (79.1 +/- 18.2%) was found in the fine particulate matter (PM2.5) fraction. The average concentrations of DIN and DON in the PM2.5 fraction were 54.4 +/- 25.6 nmol-Nm(-3) and 6.5 +/- 4.4 nmol-Nm(-3), respectively.

Aerosols↗
PubMed1996

Nocturnal ACTH, cortisol, growth hormone, and prolactin secretion in prepubertal depression.

OBJECTIVE: To examine nocturnal secretion of adrenocorticotropin, cortisol, growth hormone, and prolactin in 38 medically healthy children with prepubertal major depression compared with 28 medically and psychiatrically healthy control children. METHOD: Prior to sampling, subjects underwent an "adaptation night" with the intravenous catheter in place and electroencephalographic (EEG) electrodes for standard all-night polysomnogram. On the following night, plasma samples were obtained every 20 minutes through an indwelling catheter. Hormonal concentrations were measured by specific radioimmunoassay and aligned by EEG-confirmed sleep onset. Areas under the curve were calculated for total secretion and compared using analysis of variance. RESULTS: Prepubertal depressed children had lower cortisol secretion during the first 4 hours after sleep onset compared with controls. Adrenocorticotropin, prolactin, and growth hormone secretion did not differ between groups. Examination of clinical characteristics in depressed children revealed lower nocturnal adrenocorticotropin concentrations in depressed inpatients versus depressed outpatients and in depressed sexually abused versus depressed nonabused children. A significant sex by diagnosis effect revealed lower growth hormone secretion in depressed females compared with depressed males. CONCLUSIONS: In contrast to neuroendocrine challenge studies in these same subjects, nocturnal neuroendocrine measures did not reveal any of the expected group differences. These results emphasize the contrasts between unstimulated and challenge studies of neuroendocrine secretion and of the importance of considering clinical characteristics and maturation influences in biological studies of prepubertal depression.

Adolescent↗
PubMed1994

Development of a new method for the determination of thyroxine in serum based on isotope dilution gas chromatography mass spectrometry.

A new gas chromatographic/mass spectrometric method in combination with isotope dilution for the determination of thyroxine in serum is described. Special attention was paid to the methylation step of thyroxine, which was investigated using methanolic HCl, dimethylformamide/dimethylacetal and diazomethane, the latter giving the best results in terms of reproducible isotope ratios. For internal standardization, (13C6)-thyroxine was dissolved in fraction V human albumin solution (70 g l-1). The internal standard-in-albumin solution was mixed with known amounts of thyroxine standard, dissolved in 0.05 M Na2HPO4 buffer at pH 11.6, to give isotope ratios of 0.75, 1.00 and 1.25. The same internal standard solution was also used for isotope dilution of the unknown serum samples. The volume of serum was adapted to give a 1:1 isotope ratio. Sample pretreatment consisted of protein precipitation and a two-step liquid/liquid extraction procedure. After methylation of unlabelled and labelled thyroxine with diazomethane and perfluoroacylation with pentafluoropropionic anhydride and heptafluorobutyric anhydride, respectively, mass spectrometric monitoring was done at m/z 951/957 and 1001/1007. Quantitative determination of thyroxine in five serum samples in duplicate, during three consecutive days, showed a mean overall imprecision of 1.0% and a deviation of +0.4% from the target value as determined by a definitive method.

Albumins↗