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PubMed1999

Performance estimation of diagnostic tests for cervical precancer based on fluorescence spectroscopy: effects of tissue type, sample size, population, and signal-to-noise ratio.

Fluorescence spectroscopy may provide a cost-effective tool to improve precancer detection. We describe a method to estimate the diagnostic performance of classifiers based on optical spectra, and to explore the sensitivity of these estimations to factors affecting spectrometer cost. Fluorescence spectra were obtained at three excitation wavelengths in 92 patients with an abnormal Papanicolaou smear and 51 patients with no history of an abnormal smear. Bayesian classification rules were developed and evaluated at multiple misclassification costs. We explored the sensitivity of classifier performance to variations in tissue type, sample size, tested population, signal to noise ratio (SNR), and number of excitation and emission wavelengths. Sensitivity and specificity could be evaluated within +/- 7%. Minimal decrease in diagnostic performance is observed as SNR is reduced to 15, the number of excitation-emission wavelength combinations is reduced to 15 or the number of excitation wavelengths is reduced to one. Diagnostic performance is compromised when ultraviolet excitation is not included. Significant spectrometer cost reduction is possible without compromising diagnostic ability. Decision-analytic methods can be used to rate designs based on incremental cost-effectiveness.

Algorithms↗
PubMed2005

Estimating live birth rates after ovulation induction in polycystic ovary syndrome: sample size calculations for the pregnancy in polycystic ovary syndrome trial.

Polycystic ovary syndrome (PCOS) affects approximately 5% of the female population, and is a leading cause of infertility, primarily secondary to anovulation. Clomiphene citrate has been standard therapy for ovulation induction in patients seeking pregnancy, but recent evidence suggests that insulin sensitizing agents such as metformin may also be effective. The National Institute of Child Health and Human Development's Reproductive Medicine Network has begun a randomized, double-blind trial of clomiphene vs. metformin vs. clomiphene plus metformin for the induction of ovulation in patients with PCOS seeking pregnancy, with live birth rate as the primary outcome. Because the available literature was largely limited to surrogate outcomes such as ovulation and pregnancy rates, we created a Markov model to derive estimates of likely live birth rates in each arm. Using these estimates, we then constructed an algorithm that allowed only two formal comparisons between the three arms. First, we assumed that combination therapy would have to be superior to the next best single-agent therapy in order to be preferred, because of complexity, costs, increased side effects, etc. If combination therapy is not superior to the next best single agent, then the only other comparison of interest is between the two single agent therapies. Because the third possible comparison, between the best and worst of the three therapies, is not clinically relevant, it can be eliminated from formal statistical consideration, with subsequent reduction in sample size. Based on the opinion of the Network Steering Committee that a 15% absolute difference in live birth rates would be clinically relevant, our methodology resulted in a sample size of 226 per arm, or a total of 678 subjects. The PPCOS trial should definitively answer the question of the relative efficacy of metformin, clomiphene, and combination therapy in the treatment of infertile women with PCOS.

Adolescent↗
PubMed1986

Folic acid and chromosome breakage. IV. Variance estimates from longitudinal studies of normal individuals and their implications for sample size and power to detect differences between populations.

The frequency of chromosome aberrations was studied in minimal essential medium (MEM) with and without folic acid (FA) in lymphocytes of 4 normal individuals, each sampled 12 times over a 1-year period. The cells cultured without FA had significantly more breaks and gaps. In both media about 75% of aberrations were classified as gaps. Calculations based on variance estimates suggest that the use of medium without FA could enhance the statistical power to distinguish differences in proportions of chromosome breakage between groups in the same study.

Analysis of Variance↗
PubMed2003

Technical variability and required sample size of helminth egg isolation procedures.

Measurements of parasite load are often very variable. This implies that little confidence can be attached to single measurements of parasite numbers and egg concentrations, and that many measurements are required for the detection of differences between groups of hosts or parasites. For studies that aim to detect these differences, it is important to increase the precision (closeness of repeated measures to each other) of parasite numbers, because it determines the number of samples that is needed to find significant differences among groups. In this study, sample sizes required to detect group differences were estimated using nematode egg counts of faecal samples of dairy cattle. They were found to be much lower for a centrifugation technique than for the widely used McMaster technique in replicate samples, in spite of a generally similar mean FEC. For example, the sample size required to detect FEC differences between groups of 10, 50, and 250 eggs per gram (EPG) were 46, 25, and 27 for the McMaster technique and 8, 5, and 12 for the SSF method, respectively. Interestingly, sample sizes required for faeces with a relatively high egg concentration (approximately 1000 EPG) were also considerably lower than for the McMaster technique in spite of a higher mean EPG of the latter method. This implies that technical variation can be reduced considerably by simple methods of egg isolation. Given that the range of egg concentration is similar for a number of nematodes of livestock and human helminths, a reduction of technical error will aid studies with many group comparisons such as vaccination strategies against parasites with typically low FECs and studies of the genetics of host resistance. It may also lead to improved guidelines for measures related to public health.

Animals↗
PubMed2001

Extremely small sample size in some toxicity studies: an example from the rabbit eye irritation test.

The conventional sample-size equations based on either the precision of estimation or the power of testing a hypothesis may not be appropriate to determine sample size for a "diagnostic" testing problem, such as the eye irritant Draize test. When the animals' responses to chemical compounds are relatively uniform and extreme and the objective is to classify a compound as either irritant or nonirritant, the test using just two or three animals may be adequate.

Animals↗
PubMed1998

The utility of methacholine airway responsiveness measurements in evaluating anti-asthma drugs.

BACKGROUND: Measurements of airway responsiveness are frequently used to evaluate anti-asthma drugs. OBJECTIVE: This study investigated the utility of methacholine airway responsiveness measurements in evaluating anti-asthma medications, both in terms of a bronchoprotective effect and the ability to attenuate allergen-induced methacholine airway hyperresponsiveness. METHODS: Methacholine airway responsiveness was measured as PC20 on two occasions (separated by 35+/-17 days, mean +/- SD) in 40 subjects with mild, stable asthma. Additional subjects had PC20 measurements made before and after administration of either inhaled salbutamol (200 microg) (n = 20) or allergen inhalation challenge (n = 31). RESULTS: The reproducibility of the methacholine PC20 with this method was high (intraclass correlation coefficient = 0.94). The average shift in PC20 after salbutamol was 4.11 doubling concentrations (SD = 1.08). On the basis of these results, a sample size of 12 subjects would be required to demonstrate a 1 doubling concentration difference in the bronchoprotective effect of two drugs with a 90% power. The average shift in PC20 after allergen was 1.29 doubling concentrations. On the basis of these results and an estimated SD of 0.96, a sample size of 24 subjects would be required to demonstrate that a drug is effective in attenuating 50% of allergen-induced airway hyperresponsiveness with a 90% power. CONCLUSION: These results confirm the high reproducibility of methacholine PC20 measurements in subjects with mild, stable asthma and demonstrate its utility in evaluating the effects of anti-asthma drugs.

Administration, Inhalation↗
PubMed2003

Homogeneity score test for the intraclass version of the kappa statistics and sample-size determination in multiple or stratified studies.

When the intraclass correlation coefficient or the equivalent version of the kappa agreement coefficient have been estimated from several independent studies or from a stratified study, we have the problem of comparing the kappa statistics and combining the information regarding the kappa statistics in a common kappa when the assumption of homogeneity of kappa coefficients holds. In this article, using the likelihood score theory extended to nuisance parameters (Tarone, 1988, Communications in Statistics-Theory and Methods 17(5), 1549-1556) we present an efficient homogeneity test for comparing several independent kappa statistics and, also, give a modified homogeneity score method using a noniterative and consistent estimator as an alternative. We provide the sample size using the modified homogeneity score method and compare it with that using the goodness-of-fit method (GOF) (Donner, Eliasziw, and Klar, 1996, Biometrics 52, 176-183). A simulation study for small and moderate sample sizes showed that the actual level of the homogeneity score test using the maximum likelihood estimators (MLEs) of parameters is satisfactorily close to the nominal and it is smaller than those of the modified homogeneity score and the goodness-of-fit tests. We investigated statistical properties of several noniterative estimators of a common kappa. The estimator (Donner et al., 1996) is essentially efficient and can be used as an alternative to the iterative MLE. An efficient interval estimation of a common kappa using the likelihood score method is presented.

Alcohol Drinking↗
PubMed2006

Antioxidants in prevention of cataracts in South India: methodology and baseline data*.

PURPOSE: To describe the methodology and baseline data for the Antioxidants in Prevention of Cataracts (APC) study in South India. METHODS: The APC study is a prospective, 5-year, randomized, triple-masked, placebo-controlled, field-based clinical trial to examine the effect of antioxidants (combination tablet of vitamins A, C, and E) on progression of cataract. The primary outcome variable is cataract progression (nuclear opalescence), evaluated with the slit-lamp biomicroscope by the Lens Opacification Classification System III method. Secondary outcome variables are progression in cortical and posterior subcapsular opacity and nuclear color, change in best corrected visual acuity, myopic shift, and treatment failure (progression to cataract surgery or best corrected vision worse than 20/400 in an eye). Inclusion criteria are age between 35 and 50 years and best-corrected visual acuity of 20/40 or better. Exclusion criteria are a diagnosis of diabetes mellitus or nonfasting blood glucose level>7.8 mmol/L, history or presence of various ocular conditions or treatment forms, or current use of vitamin supplements. Baseline ophthalmic, demographic, and potential cataract risk factor data (such as smoking, sunlight, or alcohol exposure) were compared between groups on an intent-to-treat basis. RESULTS: Of 954 people screened, 798 were enrolled, a sample size which exceeded the required estimate. More than 80% of subjects had 20/20 or better vision in at least one eye, and baseline prevalence of significant cataract according to the LOCS III grading scale was high. The two treatment groups were comparable for all baseline measures except alcohol intake. CONCLUSION: The sample size and group baseline characteristics will provide sufficient power to detect a change in cataract progression within 5 years.

Adult↗
PubMed1992

Quantal parameters of "minimal" excitatory postsynaptic potentials in guinea pig hippocampal slices: binomial approach.

Binomial distributions of amplitudes of excitatory postsynaptic potentials (EPSPs) mixed with Gaussian noise were simulated. The objective of Monte Carlo simulations was, firstly, to study influences of sampling size (N) and noise standard deviation (Sn) on estimates of mean quantal content (m), quantal size (v) and binomial parameters (n and p) by four methods of quantal analysis (histogram, variance, failures and combined method) based on the binomial model and, secondly, to modify these methods on the basis of comparison of estimated with simulated parameters. Reliable estimates (within +/- 10% of the simulated values) were obtained for large sample sizes (N = 500-1000) with Sn less than or equal to v by the histogram (deconvolution) method and with Sn less than or equal to 2v by the other three methods. Similar results were obtained by averages from about 10 simulations if smaller samples were used (N = 50-200). In electrophysiological experiments on slices, "minimal" EPSPs were recorded from CA1 pyramidal cells after low-intensity stimuli to stratum radiatum or stratum oriens. Amplitudes of minimal EPSPs fluctuated in a manner predicted by the quantum hypothesis. Amplitude distributions of EPSPs in the non-facilitated state were adequately described either by binomial statistics with an average p equal to about 0.4 (a range of 0.3-0.7) and an average n of about 3 (range 2-6) or by Poisson statistics with m of about 1. The quantal analysis suggests that typical values of m and v for a single activated fibre in stratum radiatum might be about 0.5-1 and 300-400 microV, respectively, with low p (0.1-0.3) and n (2-4). However, the estimates of binomial parameters should be considered as coarse approximations in view of the simulation results and a possible nonuniformity of parameter p. The comparison of results of various methods based on the binomial model, in both simulation and physiological experiments, indicates the reliability of estimates of basic quantal parameters (m and v) under realistic conditions of physiological experiments. The methods are considered to be sufficiently sensitive to make use of them for studies on mechanisms of long-term synaptic plasticity.

Animals↗
PubMed2004

Usefulness of an increase in size of motor unit potential sample.

OBJECTIVE: It is known that the sensitivity of quantitative electromyographic (EMG) analysis of motor unit potentials (MUPs) improves with an increase in MUP sample size to more than 20. However, no normative data and estimate of sensitivity have been published. METHODS: In the present study sample sizes of 5, 10, 15, 20, 30 and 40 MUPs were obtained from the external anal sphincter (EAS) muscles of 81 controls and 70 patients with cauda equina lesions. For each sample size normative limits and sensitivities for mean values and 'outliers' were calculated for 8 MUP parameters. RESULTS: As the size of the MUP samples increased, normative limits narrowed and sensitivities increased for both statistics of all MUP parameters (sensitivities were 26% at 10, 44% at 20, and 67% at 40 MUPs with mean values and outliers of MUP area, duration and number of turns). CONCLUSIONS: Our results confirmed a substantial increase in the sensitivity of MUP analysis by enlargement of the MUP sample size to more than 20 MUPs. The gain in sensitivity seem to be greater than the increase obtained by examination of contralateral EAS muscle. SIGNIFICANCE: Findings might be useful to clinical neurophysiologists planning strategies for electrodiagnostic evaluation of lower sacral segments.

Anal Canal↗
PubMed2002

Surveillance in a time of changing health care practices: estimating ectopic pregnancy incidence in the United States.

OBJECTIVES: Ectopic pregnancy is a common condition with significant health consequences; complications are a major cause of maternal mortality in the United States. Accurate ascertainment of the number of ectopic pregnancies occurring in the United States has been dramatically affected by changing medical practices, causing estimates based on hospital data to be falsely low. This study was performed to identify nationally representative data on ectopic pregnancies and determine overlap of these data, to calculate the annual weighted number of ectopic pregnancies and confidence intervals for these estimates, and to determine barriers to estimation of ectopic pregnancy incidence. METHODS: To assess whether a national estimate of the incidence of ectopic pregnancy could be calculated, we analyzed 1992-99 data from the six nationally representative data sets that include information on ectopic pregnancy. We examined relevant data in each data set and assessed whether any combination of data sets could be used to estimate ectopic pregnancy incidence. We calculated weighted estimates and 95% confidence intervals for hospitalizations, outpatient surgeries, outpatient medical procedures, and physician visits for and self-reports of ectopic pregnancy. RESULTS: Small sample sizes severely limited calculation of estimates of ectopic pregnancy. Data needed for assessing multiple counting was not available consistently. The likelihood of multiple counting of cases was substantial when data set counts were combined. CONCLUSIONS: A reliable incidence rate for ectopic pregnancy in the United States could not be estimated from existing nationally representative data sources. Major advances in diagnosis and treatment of ectopic pregnancy have affected surveillance in two ways: inpatient hospital treatment of ectopic pregnancy has decreased, and multiple health care visits for a single ectopic pregnancy have increased. Alternate means of surveillance are needed to improve understanding of risk factors and trends for ectopic pregnancy, and we recommend examination of the databases of public and private insurance systems and managed care systems. Similar alternate means of surveillance may be needed for other health conditions with comparable changes in management of care.

Adolescent↗
PubMed2005

Assessing terminal restriction fragment length polymorphism suitability for the description of bacterial community structure and dynamics in hydrocarbon-polluted marine environments.

The distribution of bacterial communities terminal restriction fragment length polymorphism (T-RFLP) fingerprint patterns was evaluated at three proximal hydrocarbon-contaminated sites located within the harbour of Messina. In order to analyse the short-term variability of the individual terminal restriction fragment (T-RF) patterns, water samples were collected at the three sites on three occasions within 3 months (T(0), T(90) and T(91)). Four sample sizes, from 50 to 1000 ml for each collected sample, were analysed separately (36 total analysed samples) to evaluate the relationship between the sample size and the bacterial diversity estimates. The dominant T-RF groups mostly belonged to signatures of putative hydrocarbon-degrading bacteria, as revealed by the virtual analysis of the obtained bands. In order to test whether significant differences were occurring between the analysed samples, the Kruskal-Wallis non-parametric test was applied to the T-RF data set. Neither significant influence of the sample size nor short spatial variability within the three sampled sites was detected for each sampling time. On the contrary, significant temporal changes in the diversity of the bacterial communities were observed. These results were confirmed by the non-metric multidimensional scales (nMDS) analysis of the whole set of samples, which indicated three main groups corresponding to the three different sampling times. In summary, the T-RFLP technique, although a polymerase chain reaction-based method, proved to be a suitable technique for monitoring polluted marine environments, typically characterized by low diversity and high relative abundances of a few dominant groups.

Bacteria↗
PubMed1999

Modification of sample size in group sequential clinical trials.

In group sequential clinical trials, sample size reestimation can be a complicated issue when it allows for change of sample size to be influenced by an observed sample path. Our simulation studies show that increasing sample size based on an interim estimate of the treatment difference can substantially inflate the probability of type I error in most practical situations. A new group sequential test procedure is developed by modifying the weights used in the traditional repeated significance two-sample mean test. The new test has the type I error probability preserved at the target level and can provide a substantial gain in power with the increase of sample size. Generalization of the new procedure is discussed.

Biometry↗
PubMed2005

A method to estimate the variance of an endpoint from an on-going blinded trial.

Blinded estimation of variance allows for changing the sample size without compromising the integrity of the trial. Some of the methods that estimate the variance in a blinded manner either make untenable assumptions or are only applicable to two-treatment trials. We propose a new method for continuous endpoints that makes minimal assumptions. The method uses the enrollment order of subjects and the randomization block size to estimate the variance. It can be applied to normal or non-normal data, trials with two or more treatments, equal or unequal allocation schemes, fixed or random randomization block sizes, and single or multi-centre trials. The variance estimator is unbiased and performs best when the randomization block size is the smallest. Simulation results suggest that for many commonly used randomization block sizes the proposed estimator is expected to perform well. The proposed method is used to estimate the variance of the endpoint for two trials and is shown to perform well by comparison with its unblinded counterpart.

Analysis of Variance↗
PubMed2005

Biased estimators of quantitative trait locus heritability and location in interval mapping.

In many empirical studies, it has been observed that genome scans yield biased estimates of heritability, as well as genetic effects. It is widely accepted that quantitative trait locus (QTL) mapping is a model selection procedure, and that the overestimation of genetic effects is the result of using the same data for model selection as estimation of parameters. There are two key steps in QTL modeling, each of which biases the estimation of genetic effects. First, test procedures are employed to select the regions of the genome for which there is significant evidence for the presence of QTL. Second, and most important for this demonstration, estimates of the genetic effects are reported only at the locations for which the evidence is maximal. We demonstrate that even when we know there is just one QTL present (ignoring the testing bias), and we use interval mapping to estimate its location and effect, the estimator of the effect will be biased. As evidence, we present results of simulations investigating the relative importance of the two sources of bias and the dependence of bias of heritability estimators on the true QTL heritability, sample size, and the length of the investigated part of the genome. Moreover, we present results of simulations demonstrating the skewness of the distribution of estimators of QTL locations and the resulting bias in estimation of location. We use computer simulations to investigate the dependence of this bias on the true QTL location, heritability, and the sample size.

Bias↗
PubMed2006

Bayesian analysis for the meiosis I non-disjunction fraction in numerical chromosomal anomalies.

The main causes of numerical chromosomal anomalies, including trisomies, arise from an error in the chromosomal segregation during the meiotic process, named a non-disjunction. One of the most used techniques to analyze chromosomal anomalies nowadays is the polymerase chain reaction (PCR), which counts the number of peaks or alleles in a polymorphic microsatellite locus. It was shown in previous works that the number of peaks has a multinomial distribution whose probabilities depend on the non-disjunction fraction F. In this work, we propose a Bayesian approach for estimating the meiosis I non-disjunction fraction F. in the absence of the parental information. Since samples of trisomic patients are, in general, small, the Bayesian approach can be a good alternative for solving this problem. We consider the sampling/importance resampling technique and the Simpson rule to extract information from the posterior distribution of F. Bayes and maximum likelihood estimators are compared through a Monte Carlo simulation, focusing on the influence of different sample sizes and prior specifications in the estimates. We apply the proposed method to estimate F. for patients with trisomy of chromosome 21 providing a sensitivity analysis for the method. The results obtained show that Bayes estimators are better in almost all situations.

Algorithms↗
PubMed1998

A cost-benefit analysis of a cardiovascular disease prevention trial, using folate supplementation as an example.

OBJECTIVES: This study illustrates a cost-benefit analysis of clinical trial design, using as an example a trial of folate supplementation to prevent cardiovascular disease. METHODS: Bayesian statistical and decision-analytic techniques were used to estimate the cost-benefit and sample size of a placebo-controlled trial of folate targeted to US citizens, aged 35 to 84 years, with elevated serum homocysteine levels. The main end point is event-free survival (i.e., survival without new ischemic heart disease or stroke) at 5 years. RESULTS: Because the screening cost and annual cost and inconvenience of taking folate is small compared with the consequences of stroke, ischemic heart disease, or death, the increase in 5-year event-free survival with folate that should compel the use of folate is just 1.1%. The sample size per group needed to establish this level of folate's medical effectiveness is estimated to be 17310. Such a trial would provide an expected societal cost-benefit savings exceeding $11 billion within 15 years. CONCLUSIONS: This study illustrates how Bayesian methods may help in assessing the societal cost-benefit consequences of proposed disease prevention trials, deciding which trials are worth sponsoring, and designing cost-effective trials.

Adult↗
PubMed1986

Life expectancy and health status of the aged.

There are several research issues which need further exploration if we are to better understand the implications of what appears to be increased levels of morbidity. Three general areas require additional research: the time of onset of chronic illness, the progression rate of illness, and the overlap and interaction between chronic and non-chronic conditions as well as multiple chronic conditions in a single individual. A major reason for the present uncertainty about morbidity is that information is unavailable regarding the incidence of chronic illness. However, incidence of chronic disease is difficult to measure unless there are either clear clinical indications or functional limitations. Work by survey researchers in defining initial reports of functional limitations associated with chronic illness would be very helpful. Furthermore, an understanding of incidence is necessary to further our understanding of the rate of progression of illness. The concept of a progression rate of illness makes sense only if we can have agreed upon measures of the onset of the illness. Both of these issues clearly require the use of longitudinal data. In fact any serious attempt to predict changes in health status over time as well as to relate changing patterns of mortality with changing patterns of morbidity will require a longitudinal data base. The difficulty in establishing a longitudinal data base is not only the time and expense of follow given set of individuals over a prolonged period of time, but also the problem of having a sample large enough to include individuals with specific chronic conditions of illness. One way to resolve the problem of sufficient sample size may be to do a combined survey which includes both a national probability sample of individuals as well as a sample of individuals with specific chronic diseases. Monitoring a group of individuals known to have specific chronic conditions would provide information about the progression and impact of the disease over time. Including a national probability sample of the entire population would provide information on the impact over time of changing health conditions for the entire population. While screening for specific conditions is an expensive procedure, it is likely to be far cheaper than including a sample size large enough to provide reliable estimates for specific conditions based on a national probability sample. Because the effects of postponed social security benefit eligibility will not be felt for many years, the opportunity for fruitful research is great. For now, we will summarize what we know from current research.

Adolescent↗