37 resultados para Left-hemisphere Stroke


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We describe a novel mechanism that can significantly lower the amplitude of the climatic response to certain large volcanic eruptions and examine its impact with a coupled ocean-atmosphere climate model. If sufficiently large amounts of water vapour enter the stratosphere, a climatically significant amount of water vapour can be left over in the lower stratosphere after the eruption, even after sulphate aerosol formation. This excess stratospheric humidity warms the tropospheric climate, and acts to balance the climatic cooling induced by the volcanic aerosol, especially because the humidity anomaly lasts for a period that is longer than the residence time of aerosol in the stratosphere. In particular, northern hemisphere high latitude cooling is reduced in magnitude. We discuss this mechanism in the context of the discrepancy between the observed and modelled cooling following the Krakatau eruption in 1883. We hypothesize that moist coignimbrite plumes caused by pyroclastic flows travelling over ocean rather than land, resulting from an eruption close enough to the ocean, might provide the additional source of stratospheric water vapour.

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Northern hemisphere snow water equivalent (SWE) distribution from remote sensing (SSM/I), the ERA40 reanalysis product and the HadCM3 general circulation model are compared. Large differences are seen in the February climatologies, particularly over Siberia. The SSM/I retrieval algorithm may be overestimating SWE in this region, while comparison with independent runoff estimates suggest that HadCM3 is underestimating SWE. Treatment of snow grain size and vegetation parameterizations are concerns with the remotely sensed data. For this reason, ERA40 is used as `truth' for the following experiments. Despite the climatology differences, HadCM3 is able to reproduce the distribution of ERA40 SWE anomalies when assimilating ERA40 anomaly fields of temperature, sea level pressure, atmospheric winds and ocean temperature and salinity. However when forecasts are released from these assimilated initial states, the SWE anomaly distribution diverges rapidly from that of ERA40. No predictability is seen from one season to another. Strong links between European SWE distribution and the North Atlantic Oscillation (NAO) are seen, but forecasts of this index by the assimilation scheme are poor. Longer term relationships between SWE and the NAO, and SWE and the El Ni\~no-Southern Oscillation (ENSO) are also investigated in a multi-century run of HadCM3. SWE is impacted by ENSO in the Himalayas and North America, while the NAO affects SWE in North America and Europe. While significant connections with the NAO index were only present in DJF (and to an extent SON), the link between ENSO and February SWE distribution was seen to exist from the previous JJA ENSO index onwards. This represents a long lead time for SWE prediction for hydrological applications such as flood and wildfire forecasting. Further work is required to develop reliable large scale observation-based SWE datasets with which to test these model-derived connections.

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The Observing System Research and Predictability Experiment (THORPEX) Interactive Grand Global Ensemble (TIGGE) is a World Weather Research Programme project. One of its main objectives is to enhance collaboration on the development of ensemble prediction between operational centers and universities by increasing the availability of ensemble prediction system (EPS) data for research. This study analyzes the prediction of Northern Hemisphere extratropical cyclones by nine different EPSs archived as part of the TIGGE project for the 6-month time period of 1 February 2008–31 July 2008, which included a sample of 774 cyclones. An objective feature tracking method has been used to identify and track the cyclones along the forecast trajectories. Forecast verification statistics have then been produced [using the European Centre for Medium-Range Weather Forecasts (ECMWF) operational analysis as the truth] for cyclone position, intensity, and propagation speed, showing large differences between the different EPSs. The results show that the ECMWF ensemble mean and control have the highest level of skill for all cyclone properties. The Japanese Meteorological Administration (JMA), the National Centers for Environmental Prediction (NCEP), the Met Office (UKMO), and the Canadian Meteorological Centre (CMC) have 1 day less skill for the position of cyclones throughout the forecast range. The relative performance of the different EPSs remains the same for cyclone intensity except for NCEP, which has larger errors than for position. NCEP, the Centro de Previsão de Tempo e Estudos Climáticos (CPTEC), and the Australian Bureau of Meteorology (BoM) all have faster intensity error growth in the earlier part of the forecast. They are also very underdispersive and significantly underpredict intensities, perhaps due to the comparatively low spatial resolutions of these EPSs not being able to accurately model the tilted structure essential to cyclone growth and decay. There is very little difference between the levels of skill of the ensemble mean and control for cyclone position, but the ensemble mean provides an advantage over the control for all EPSs except CPTEC in cyclone intensity and there is an advantage for propagation speed for all EPSs. ECMWF and JMA have an excellent spread–skill relationship for cyclone position. The EPSs are all much more underdispersive for cyclone intensity and propagation speed than for position, with ECMWF and CMC performing best for intensity and CMC performing best for propagation speed. ECMWF is the only EPS to consistently overpredict cyclone intensity, although the bias is small. BoM, NCEP, UKMO, and CPTEC significantly underpredict intensity and, interestingly, all the EPSs underpredict the propagation speed, that is, the cyclones move too slowly on average in all EPSs.

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The Northern Hemisphere stratospheric polar vortex is linked to surface weather. After Stratospheric Sudden Warmings in winter, the tropospheric circulation is often nudged towards the negative phase of the Northern Annular Mode (NAM) and the North Atlantic Oscillation (NAO). A strong stratospheric vortex is often associated with subsequent positive NAM/NAO conditions. For stratosphere–troposphere associations to be useful for forecasting purposes it is crucial that changes to the stratospheric vortex can be understood and predicted. Recent studies have proposed that there exist tropospheric precursors to anomalous vortex events in the stratosphere and that these precursors may be understood by considering the relationship between stationary wave patterns and regional variability. Another important factor is the extent to which the inherent variability of the stratosphere in an atmospheric model influences its ability to simulate stratosphere–troposphere links. Here we examine the lower stratosphere variability in 300-year pre-industrial control integrations from 13 coupled climate models. We show that robust precursors to stratospheric polar vortex anomalies are evident across the multi-model ensemble. The most significant tropospheric component of these precursors consists of a height anomaly dipole across northern Eurasia and large anomalies in upward stationary wave fluxes in the lower stratosphere over the continent. The strength of the stratospheric variability in the models was found to depend on the variability of the upward stationary wave fluxes and the amplitude of the stationary waves.

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While planning the GAIN International Study of gavestinel in acute stroke, a sequential triangular test was proposed but not implemented. Before the trial commenced it was agreed to evaluate the sequential design retrospectively to evaluate the differences in the resulting analyses, trial durations and sample sizes in order to assess the potential of sequential procedures for future stroke trials. This paper presents four sequential reconstructions of the GAIN study made under various scenarios. For the data as observed, the sequential design would have reduced the trial sample size by 234 patients and shortened its duration by 3 or 4 months. Had the study not achieved a recruitment rate that far exceeded expectation, the advantages of the sequential design would have been much greater. Sequential designs appear to be an attractive option for trials in stroke. Copyright 2004 S. Karger AG, Basel

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The International Citicoline Trial in acUte Stroke is a sequential phase III study of the use of the drug citicoline in the treatment of acute ischaemic stroke, which was initiated in 2006 in 56 treatment centres. The primary objective of the trial is to demonstrate improved recovery of patients randomized to citicoline relative to those randomized to placebo after 12 weeks of follow-up. The primary analysis will take the form of a global test combining the dichotomized results of assessments on three well-established scales: the Barthel Index, the modified Rankin scale and the National Institutes of Health Stroke Scale. This approach was previously used in the analysis of the influential National Institute of Neurological Disorders and Stroke trial of recombinant tissue plasminogen activator in stroke. The purpose of this paper is to describe how this trial was designed, and in particular how the simultaneous objectives of taking into account three assessment scales, performing a series of interim analyses and conducting treatment allocation and adjusting the analyses to account for prognostic factors, including more than 50 treatment centres, were addressed. Copyright (C) 2008 John Wiley & Sons, Ltd.

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Background and Purpose-Clinical research into the treatment of acute stroke is complicated, is costly, and has often been unsuccessful. Developments in imaging technology based on computed tomography and magnetic resonance imaging scans offer opportunities for screening experimental therapies during phase II testing so as to deliver only the most promising interventions to phase III. We discuss the design and the appropriate sample size for phase II studies in stroke based on lesion volume. Methods-Determination of the relation between analyses of lesion volumes and of neurologic outcomes is illustrated using data from placebo trial patients from the Virtual International Stroke Trials Archive. The size of an effect on lesion volume that would lead to a clinically relevant treatment effect in terms of a measure, such as modified Rankin score (mRS), is found. The sample size to detect that magnitude of effect on lesion volume is then calculated. Simulation is used to evaluate different criteria for proceeding from phase II to phase III. Results-The odds ratios for mRS correspond roughly to the square root of odds ratios for lesion volume, implying that for equivalent power specifications, sample sizes based on lesion volumes should be about one fourth of those based on mRS. Relaxation of power requirements, appropriate for phase II, lead to further sample size reductions. For example, a phase III trial comparing a novel treatment with placebo with a total sample size of 1518 patients might be motivated from a phase II trial of 126 patients comparing the same 2 treatment arms. Discussion-Definitive phase III trials in stroke should aim to demonstrate significant effects of treatment on clinical outcomes. However, more direct outcomes such as lesion volume can be useful in phase II for determining whether such phase III trials should be undertaken in the first place. (Stroke. 2009;40:1347-1352.)