Assessing the performance of methods for central statistical monitoring of a binary or continuous outcome in multi-center trials: A simulation study.

BACKGROUND: Quality study monitoring is fundamental to patient safety and data integrity. Regulators and industry consortia have increasingly advocated for risk-based monitoring (RBM) and central statistical monitoring (CSM) for more effective and efficient monitoring. Assessing which statistical methods underpin these approaches can best identify unusual data patterns in multi-center clinical trials that may be driven by potential systematic errors is important. METHODS: We assessed various CSM techniques, including cross-tests, fixed-effects, mixed-effects, and finite mixture models, across scenarios with different sample sizes, contamination rates, and overdispersion via simulation. Our evaluation utilized threshold-independent metrics such as the area under the curve (AUC) and average precision (AP), offering a fuller picture of CSM performance. RESULTS: All CSM methods showed consistent characteristics across center sizes or overdispersion. The adaptive finite mixture model outperformed others in AUC and AP, especially at 30% contamination, upholding high specificity unless converging to a single-component model due to low contamination or deviation. The mixed-effects model performed well at lower contamination rates. However, it became conservative in specificity and exhibited declined performance for binary outcomes under high deviation. Cross-tests and fixed-effects methods underperformed, especially when deviation increased. CONCLUSION: Our evaluation explored the merits and drawbacks of multiple CSM methods, and found that relying on sensitivity and specificity alone is likely insufficient to fully measure predictive performance. The finite mixture method demonstrated more consistent performance across scenarios by mitigating the influence of outliers. In practice, considering the study-specific costs of false positives/negatives with available resources for monitoring is important.

The flaw of averages: Bayes factors as posterior means of the likelihood ratio.

As an alternative to the Frequentist p-value, the Bayes factor (or ratio of marginal likelihoods) has been regarded as one of the primary tools for Bayesian hypothesis testing. In recent years, several researchers have begun to re-analyze results from prominent medical journals, as well as from trials for FDA-approved drugs, to show that Bayes factors often give divergent conclusions from those of p-values. In this paper, we investigate the claim that Bayes factors are straightforward to interpret as directly quantifying the relative strength of evidence. In particular, we show that for nested hypotheses with consistent priors, the Bayes factor for the null over the alternative hypothesis is the posterior mean of the likelihood ratio. By re-analyzing 39 results previously published in the New England Journal of Medicine, we demonstrate how the posterior distribution of the likelihood ratio can be computed and visualized, providing useful information beyond the posterior mean alone.

Epistemic uncertainty in Bayesian predictive probabilities.

Bayesian predictive probabilities have become a ubiquitous tool for design and monitoring of clinical trials. The typical procedure is to average predictive probabilities over the prior or posterior distributions. In this paper, we highlight the limitations of relying solely on averaging, and propose the reporting of intervals or quantiles for the predictive probabilities. These intervals formalize the intuition that uncertainty decreases with more information. We present four different applications (Phase 1 dose escalation, early stopping for futility, sample size re-estimation, and assurance/probability of success) to demonstrate the practicality and generality of the proposed approach.

The Study of Alanine Transaminase Activity in Tissues of Silkworm (Bombyx mori) via Direct Analysis in Real-Time (DART) Mass Spectrometry.

Alanine transaminase (ALT) is an important amino acid-metabolizing enzyme in silkworm Bombyx mori L., and is mainly involved in transferring glutamate to alanine (serving as an essential precursor in silk protein synthesis) through transamination. Therefore, it is generally believed that silk protein synthesis in the silk gland and the cocoon quantity increase with the increase in ALT activity to a certain extent. Here, a novel analytical method was developed to determine the ALT activity in several key tissues of Bombyx mori L. including the posterior silk gland, midgut, fat body, middle silk gland, trachea and hemolymph, by combining the direct-analysis-in-real-time (DART) ion source with a triple-quadrupole mass spectrometer. In addition, a traditional ALT activity assay, the Reitman-Frankel method, was also used to measure ALT activity for comparison. The ALT activity results obtained via the DART-MS method are in good agreement with those obtained via the Reitman-Frankel method. However, the present DART-MS method provides a more convenient, rapid and environmentally friendly quantitative method for ALT measurement. Especially, this method can also monitor ALT activity in different tissues of Bombyx mori L. in real time.

Direct analysis in real time high-resolution mass spectrometry for authenticity assessment of lamb.

In comparison to more traditional methods of determining food authenticity, such as gas chromatography analysis, the primary advantages of DART-HRMS include its high speed and throughput of analysis. This study used a non-targeted metabolomics method based on real-time high-resolution mass spectrometry combined with chemometric analysis to distinguish lamb samples from four regions. Orthogonal least squares-discriminant analysis revealed a distinct difference between these four lamb regions. The potential markers were chosen based on the variable's importance in projection values, variance, and fold change. A total of 79 markers were identified using the matching chemistry database. These markers differed significantly between lambs in four regions according to heatmap analysis. The linear discriminatory analysis model had an initial classification rate of 100.0% and a cross-validation accuracy of 82.50% on the identified markers. The research demonstrates that DART-HRMS can perform a rapid authentication evaluation of lamb samples.

Direct analysis in real time-mass spectrometry for rapid quantification of five anti-arrhythmic drugs in human serum: application to therapeutic drug monitoring.

Therapeutic drug monitoring (TDM) is necessary for the optimal administration of anti-arrhythmic drugs in the treatment of heart arrhythmia. The present study aimed to develop and validate a direct analysis in real time tandem mass spectrometry (DART-MS/MS) method for the rapid and simultaneous determination of five anti-arrhythmic drugs (metoprolol, diltiazem, amiodarone, propafenone, and verapamil) and one metabolite (5-hydroxy(OH)-propafenone) in human serum. After the addition of isotope-labeled internal standards and protein precipitation with acetonitrile, anti-arrhythmic drugs were ionized by DART in positive mode followed by multiple reaction monitoring (MRM) detection. The use of DART-MS/MS avoided the need for chromatographic separation and allowed rapid and ultrahigh throughput analysis of anti-arrhythmic drugs in a total run time of 30 s per sample. The DART-MS/MS method yielded satisfactory linearity (R2 ≥ 0.9906), accuracy (86.1-109.9%), and precision (≤ 14.3%) with minimal effect of biological matrixes. The method was successfully applied to analyzing 30 clinical TDM samples. The relative error (RE) of the concentrations obtained by DART-MS/MS and liquid chromatography-tandem mass spectrometry (LC-MS/MS) was within ± 13%. This work highlights the potential usefulness of DART for the rapid quantitative analysis of anti-arrhythmic drugs in human serum and gives rapid feedback in the clinical TDM practices.

In situ calibration of Direct Analysis in Real Time-mass spectrometry for direct quantification: Urine excretion rate index creatinine as an example.

Ambient ionization in open environment brings a capability of a coupled mass spectrometry to detect target molecules in situ. However, it is limited to qualitative and semi-quantitative analysis. By coupling of an ambient ionization-based Direct Analysis in Real Time (DART) with high-resolution quadrupole time-of-flight mass spectrometry (QTOF/MS), we observe that, in one-chemical system, the target molecule displays a non-linear response in MS signal vs concentration, accompanying with large variation in MS signal, suggesting two obstacles for quantification to be overcome. Surprisingly, in a two-chemical system, we observe an apparent suppression effect. We prove that, due to this observed suppression effect, a fluctuant response in the MS signal of the stable isotope-labeled analogue can immediately reflect the change in the analyte concentration and ionization efficiency. For example, by taking advantage of this effect, even the analyte of different concentrations despairingly displayed similar signals would be accurately calibrated through the suppression of the internal stable isotope standard. This puts an important foundation on accurate and linear quantitation of analytes in complex matrix using DART-MS assay. Moreover, we for the first time demonstrate an application of in situ calibration of DART-MS for direct and accurate quantification of target molecule (creatinine) in highly complex samples (human urine) without any pre-separation. The quantification is also validated using HPLC-UV analysis (n = 38). At last, we show that stable isotope-labeled-creatinine (m/z 117.0850 amu) can be used for simultaneous in situ calibration of some other urinary metabolites with a mass/charge ratio varying from 120.069 amu to 333.125 amu.

The direct analysis of drug distribution of rotigotine-loaded microspheres from tissue sections by LESA coupled with tandem mass spectrometry.

The direct analysis of drug distribution of rotigotine-loaded microspheres (RoMS) from tissue sections by liquid extraction surface analysis (LESA) coupled with tandem mass spectrometry (MS/MS) was demonstrated. The RoMS distribution in rat tissues assessed by the ambient LESA-MS/MS approach without extensive or tedious sample pretreatment was compared with that obtained by a conventional liquid chromatography tandem mass spectrometry (LC-MS/MS) method in which organ excision and subsequent solvent extraction were commonly employed before analysis. Results obtained from the two were well correlated for a majority of the organs, such as muscle, liver, stomach, and hippocampus. The distribution of RoMS in the brain, however, was found to be mainly focused in the hippocampus and striatum regions as shown by the LESA-imaged profiles. The LESA approach we developed is sensitive enough, with an estimated LLOQ at 0.05 ng/mL of rotigotine in brain tissue, and information-rich with minimal sample preparation, suitable, and promising in assisting the development of new drug delivery systems for controlled drug release and protection. Graphical abstract Workflow for the LESA-MS/MS imaging of brain tissue section after intramuscular RoMS administration.

An improved method for the determination of 5-hydroxymethylfurfural in Shenfu injection by direct analysis in real time-quadrupole time-of-flight mass spectrometry.

The emergence of direct analysis in real time (DART) ion source provides the great possibility for rapid analysis of hazardous substance in drugs. DART mass spectrometry (DART-MS) enabled the conducting of a fast and non-contact analysis of various samples, including solid or liquid ones, without complex sample preparation or chromatographic separation. In this study, a modified DART-quadrupole time-of-flight mass spectrometry (DART-QTOF-MS) method was developed for identification and determination of 5-hydroxymethylfurfural (5-HMF) in Shenfu (SF) injection. The quantitative transfer of sample solution was introduced to the glass tips of DIP-it sampler at a fixed volume, which significantly increases the repeatability and accuracy of analytical results. The protonated ion of dibutyl phthalate in the atmosphere was used as the reference mass for TOF-MS recalibration during the data acquisition for constant high accuracy mass measurements. Finally, the developed DART-MS method was used to determine 5-HMF in seven batches of SF injection, and the contents of 5-HMF were not higher than 100 µg/mL. The results obtained were further confirmed by an ultra-high performance liquid chromatography combined with triple quadrupole mass spectrometer (UHPLC-QQQ-MS). The overall results demonstrated that the DART-QTOF-MS method could be applied as an alternative technique for rapid monitoring 5-HMF in herbal medicine injection. Copyright © 2015 John Wiley & Sons, Ltd.

Simultaneous determination of 3-chlorotyrosine and 3-nitrotyrosine in human plasma by direct analysis in real time-tandem mass spectrometry.

A novel method for the simultaneous determination of 3-nitrotyrosine (NT) and 3-chlorotyrosine (CT) in human plasma has been developed based on direct analysis in real time-tandem mass spectrometry (DART-MS/MS). Analysis was performed in the positive ionization mode using multiple reaction monitoring (MRM) of the ion transitions at m/z 216.2/170.1 for CT, m/z 227.2/181.1 for NT and m/z 230.2/184.2 for the internal standard, d (3)-NT. The assay was linear in the ranges 0.5-100 µg/mL for CT and 4-100 µg/mL for NT with corresponding limits of detection of 0.2 and 2 µg/mL. Intra- and inter-day precisions and accuracies were respectively <15% and ±15%. Matrix effects were also evaluated. The method is potentially useful for high throughput analysis although sensitivity needs to be improved before it can be applied in clinical research.

Rapid determination of 1-deoxynojirimycin in Morus alba L. leaves by direct analysis in real time (DART) mass spectrometry.

A new method based on a Direct Analysis in Real Time (DART) ionization source coupled with triple quadrupole tandem mass spectrometry has been developed for rapid qualitative and quantitative analyses of 1-deoxynojirimycin (DNJ) in mulberry leaves. Two ions produced from DNJ, [M+H](+) (m/z 164) and [M-2H+H](+) (m/z 162), are observed using DART-MS in the positive ion mode. The peak areas of the two selected ions monitoring (SIM) signals of ([M+H](+) (m/z 164) and [M-2H+H](+) (m/z 162)) are integrated to determine the peak area for quantitative analyses. A reasonable linear regression equation is obtained in the range of 1.01 to 40.50 µg/mL, with a linear coefficient (R(2)) of 0.996. The limits of detection (LOD) and quantification (LOQ) of the method are 0.25 and 0.80 µg/mL, respectively. The range of recovery is shown to be 87.73-95.61%. The results derived from the developed DART-MS method are in good agreement with those from the conventional HPLC-FLD method. By contrast, DART-MS in SIM mode is a simple, rapid and high-throughput approach for the determination of the DNJ content in mulberry leaves. The present method is advantageous for the rapid screening of mulberry leaves containing high DNJ contents.

Profiling and relative quantitation of phosphoinositides by multiple precursor ion scanning based on phosphate methylation and isotopic labeling.

Phosphoinositides, the phosphorylated derivatives of phosphatidylinositol (PtdIns), are key regulators of many fundamental biological processes, including cell growth, proliferation, and motility. Here, we present a novel method for rapid, sensitive, and simultaneous profiling of phosphatidylinositol trisphosphate (PtdInsP3), phosphatidylinositol bisphosphate (PtdInsP2), and phosphatidylinositol phosphate (PtdInsP) of different fatty acid compositions. This method is based on a technique called "charged diacylglycerol fragment ion-specific multiple precursor ion scanning" (DAG(+)-specific MPIS), coupled with prior phosphate methylation. Using DAG(+)-specific MPIS, we were able to identify 32 PtdIns, 28 PtdInsP, 30 PtdInsP2, and 3 PtdInsP3 molecular species from bovine brain extracts or prostatic cancer cell lines in an efficient and time-saving manner. Our analysis revealed a large range of fatty acyl compositions in phosphoinositides not obtained previously from mammalian samples. We also developed a method that involves isotopic labeling of endogenous phosphoinositides with deuterated diazomethane (CD2N2) for quantitation of phosphoinositides. CD2N2 was generated in situ through acid-catalyzed H/D exchange and methanolysis of trimethylsilyl diazomethane (TMS-diazomethane). Phosphoinositides, extracted from a PC3 prostatic cancer cell line, were labeled either with CH2N2 or CD2N2 and mixed in known proportions for DAG(+)-specific MPIS-based mass spectrometry (MS) analysis. The results indicate that isotopic labeling is capable of providing accurate quantitation of PtdInsP3, PtdInsP2, and PtdInsP with adequate linearity as well as high reproducibility with an average coefficient variation of 18.9%. More importantly, this new methods excluded the need for multiple phosphoinositide internal standards. DAG(+)-specific MPIS and isotopic labeling based MS analysis of phosphoinositides offers unique advantages over existing approaches and presents a powerful tool for research of phosphoinositide metabolism.

Rapid quantification of highly polar trimethyl phosphate in wastewater via direct analysis in real-time mass spectrometry.

Trimethyl phosphate (TMP) is used extensively in industrial chemical processes. Due to the high polarity and volatility, methods for its quantification in environmental samples have not been well developed. Currently, the pollution status of TMP in the environment still has not been quantitatively analyzed. This study quantifies the TMP levels in environmental water via direct analysis real-time ionization source interfaced with a triple quadrupole mass spectrometer (DART-MS/MS) with multiple reaction monitoring (MRM). The DART parameters were optimized to achieve the most TMP-sensitive MRM responses. The water samples were analyzed directly, and an isotope-labeled internal standard (ISTD) method was applied for quantification. The method exhibits significant linearity (R>0.998) in the range of 0.05-100 ng/mL, with a limit of quantification (LOQ) of 50 pg/mL. TMP has been accurately detected in the influent and effluent water of two municipal wastewater treatment plants and a river located in Beijing. Recovery of TMP ranged 88.0-107.6% for the spiked real water samples. The results demonstrated that TMP has been existed in environmental water, and DART-MS/MS can be used for the monitoring of the pollution status and the environmental process of TMP in environmental water.

A systems approach to accident causation in mining: an application of the HFACS method.

This project aimed to provide a greater understanding of the systemic factors involved in mining accidents, and to examine those organisational and supervisory failures that are predictive of sub-standard performance at operator level. A sample of 263 significant mining incidents in Australia across 2007-2008 were analysed using the Human Factors Analysis and Classification System (HFACS). Two human factors specialists independently undertook the analysis. Incidents occurred more frequently in operations concerning the use of surface mobile equipment (38%) and working at heights (21%), however injury was more frequently associated with electrical operations and vehicles and machinery. Several HFACS categories appeared frequently: skill-based errors (64%) and violations (57%), issues with the physical environment (56%), and organisational processes (65%). Focussing on the overall system, several factors were found to predict the presence of failures in other parts of the system, including planned inappropriate operations and team resource management; inadequate supervision and team resource management; and organisational climate and inadequate supervision. It is recommended that these associations deserve greater attention in future attempts to develop accident countermeasures, although other significant associations should not be ignored. In accordance with findings from previous HFACS-based analyses of aviation and medical incidents, efforts to reduce the frequency of unsafe acts or operations should be directed to a few critical HFACS categories at the higher levels: organisational climate, planned inadequate operations, and inadequate supervision. While remedial strategies are proposed it is important that future efforts evaluate the utility of the measures proposed in studies of system safety.

Accounting for speed-accuracy tradeoff in perceptual learning.

In the perceptual learning (PL) literature, researchers typically focus on improvements in accuracy, such as d'. In contrast, researchers who investigate the practice of cognitive skills focus on improvements in response times (RT). Here, we argue for the importance of accounting for both accuracy and RT in PL experiments, due to the phenomenon of speed-accuracy tradeoff (SAT): at a given level of discriminability, faster responses tend to produce more errors. A formal model of the decision process, such as the diffusion model, can explain the SAT. In this model, a parameter known as the drift rate represents the perceptual strength of the stimulus, where higher drift rates lead to more accurate and faster responses. We applied the diffusion model to analyze responses from a yes-no coherent motion detection task. The results indicate that observers do not use a fixed threshold for evidence accumulation, so changes in the observed accuracy may not provide the most appropriate estimate of learning. Instead, our results suggest that SAT can be accounted for by a modeling approach, and that drift rates offer a promising index of PL.

Application of radio-frequency identification in perioperative care.

Every perioperative department could benefit from having an information system that facilitates managerial function and improves efficiency in the OR. The Patient Advancement Monitoring System-Surgical implemented in a hospital in Taipei, Taiwan, is one such a system that uses radio-frequency identification technology for tracking perioperative care of patients along workflow checkpoints. This web-based medical information system can facilitate care provided throughout perioperative services by providing instant patient information to staff members in cross-functional health care teams. Manpower is not wasted on duplicating data entry because the surgical progression is displayed in real time. Satisfaction with the system has been high for both nurses and administrators.

RFID-initiated workflow control to facilitate patient safety and utilization efficiency in operation theater.

OBJECTIVE: To control the workflow for surgical patients, we in-cooperate radio-frequency identification (RFID) technology to develop a Patient Advancement Monitoring System (PAMS) in operation theater. METHODS: The web-based PAMS is designed to monitor the whole workflow for the handling of surgical patients. The system integrates multiple data entry ports Across the multi-functional surgical teams. Data are entered into the system through RFID, bar code, palm digital assistance (PDA), ultra-mobile personal computer (UMPC), or traditional keyboard at designated checkpoints. Active radio-frequency identification (RFID) tag can initiate data demonstration on the computer screens upon a patient's arrival at any particular checkpoint along the advancement pathway. RESULTS: The PAMS can manage the progress of operations, patient localization, identity verification, and peri-operative care. The workflow monitoring provides caregivers' instant information sharing to enhance management efficiency. CONCLUSION: RFID-initiate surgical workflow control is valuable to meet the safety, quality, efficiency requirements in operation theater.

Summation of visual motion across eye movements reflects a nonspatial decision mechanism.

Human vision remains perceptually stable even though retinal inputs change rapidly with each eye movement. Although the neural basis of visual stability remains unknown, a recent psychophysical study pointed to the existence of visual feature-representations anchored in environmental rather than retinal coordinates (e.g., "spatiotopic" receptive fields; Melcher and Morrone, 2003). In that study, sensitivity to a moving stimulus presented after a saccadic eye movement was enhanced when preceded by another moving stimulus at the same spatial location before the saccade. The finding is consistent with spatiotopic sensory integration, but it could also have arisen from a probabilistic improvement in performance due to the presence of more than one motion signal for the perceptual decision. Here we show that this statistical advantage accounts completely for summation effects in this task. We first demonstrate that measurements of summation are confounded by noise related to an observer's uncertainty about motion onset times. When this uncertainty is minimized, comparable summation is observed regardless of whether two motion signals occupy the same or different locations in space, and whether they contain the same or opposite directions of motion. These results are incompatible with the tuning properties of motion-sensitive sensory neurons and provide no evidence for a spatiotopic representation of visual motion. Instead, summation in this context reflects a decision mechanism that uses abstract representations of sensory events to optimize choice behavior.

The visual search patterns and hazard responses of experienced and inexperienced motorcycle riders.

Hazard perception is a critical skill for road users. In this study, an open-loop motorcycle simulator was used to examine the effects of motorcycle riding and car driving experience on hazard perception and visual scanning patterns. Three groups of participants were tested: experienced motorcycle riders who were experienced drivers (EM-ED), inexperienced riders/experienced drivers (IM-ED), and inexperienced riders/inexperienced drivers (IM-ID). Participants were asked to search for hazards in simulated scenarios, and click a response button when a hazard was identified. The results revealed a significant monotonic decrease in hazard response times as experience increased from IM-ID to IM-ED to EM-ED. Compared to the IM-ID group, both the EM-ED and IM-ED groups exhibited more flexible visual scanning patterns that were sensitive to the presence of hazards. These results point to the potential benefit of training hazard perception and visual scanning in motorcycle riders, as has been successfully demonstrated in previous studies with car drivers.