Active control comparisons: the ideal trial design

This report describes the concept for a clinical trial that uses carbamazepine as the gold-standard active control for a study of newly diagnosed patients. The authors describe an endpoint including efficacy and tolerability, and a stopping rule that uses a series of interim analyses in order to reach a conclusion as efficiently as possible without sacrificing reliability.

Evaluation of a sequential global test of improved recovery following stroke as applied to the ICTUS trial of citicoline

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.

A simple two-stage design for quantitative responses with application to a study in diabetic neuropathic pain

Two-stage designs offer substantial advantages for early phase II studies. The interim analysis following the first stage allows the study to he stopped for futility, or more positively, it might lead to early progression to the trials needed for late phase H and phase III. If the study is to continue to its second stage, then there is an opportunity for a revision of the total sample size. Two-stage designs have been implemented widely in oncology studies in which there is a single treatment arm and patient responses are binary. In this paper the case of two-arm comparative studies in which responses are quantitative is considered. This setting is common in therapeutic areas other than oncology. It will be assumed that observations are normally distributed, but that there is some doubt concerning their standard deviation, motivating the need for sample size review. The work reported has been motivated by a study in diabetic neuropathic pain, and the development of the design for that trial is described in detail. Copyright (C) 2008 John Wiley & Sons, Ltd.

New high technology product development: The case of light emitting diodes

New high technology products usher in novel possibilities to transform the design, production and use of buildings. The high technology companies which design, develop and introduce these new products by generating and applying novel scientific and technical knowledge are faced with significant market uncertainty, technological uncertainty and competitive volatility. These characteristics present unique innovation challenges compared to low- and medium technology companies. This paper reports on an ongoing Construction Knowledge Exchange funded project which is tracking, real time, the new product development process of a new family of light emitting diode (LEDs) technologies. LEDs offer significant functional and environmental performance improvements over incumbent tungsten and halogen lamps. Hitherto, the use of energy efficient, low maintenance LEDs has been constrained by technical limitations. Rapid improvements in basic science and technology mean that for the first time LEDs can provide realistic general and accent lighting solutions. Interim results will be presented on the complex, emergent new high technology product development processes which are being revealed by the integrated supply chain of a LED module manufacture, a luminaire (light fitting) manufacture and end user involved in the project.

On the evaluation of temperature trends in the tropical troposphere

A series of model experiments with the coupled Max-Planck-Institute ECHAM5/OM climate model have been investigated and compared with microwave measurements from the Microwave Sounding Unit (MSU) and re-analysis data for the period 1979–2008. The evaluation is carried out by computing the Temperature in the Lower Troposphere (TLT) and Temperature in the Middle Troposphere (TMT) using the MSU weights from both University of Alabama (UAH) and Remote Sensing Systems (RSS) and restricting the study to primarily the tropical oceans. When forced by analysed sea surface temperature the model reproduces accurately the time-evolution of the mean outgoing tropospheric microwave radiation especially over tropical oceans but with a minor bias towards higher temperatures in the upper troposphere. The latest reanalyses data from the 25 year Japanese re-analysis (JRA25) and European Center for Medium Range Weather Forecasts Interim Reanalysis are in very close agreement with the time-evolution of the MSU data with a correlation of 0.98 and 0.96, respectively. The re-analysis trends are similar to the trends obtained from UAH but smaller than the trends from RSS. Comparison of TLT, computed from observations from UAH and RSS, with Sea Surface Temperature indicates that RSS has a warm bias after 1993. In order to identify the significance of the tropospheric linear temperature trends we determined the natural variability of 30-year trends from a 500 year control integration of the coupled ECHAM5 model. The model exhibits natural unforced variations of the 30 year tropospheric trend that vary within ±0.2 K/decade for the tropical oceans. This general result is supported by similar results from the Geophysical Fluid Dynamics Laboratory (GFDL) coupled climate model. Present MSU observations from UAH for the period 1979–2008 are well within this range but RSS is close to the upper positive limit of this variability. We have also compared the trend of the vertical lapse rate over the tropical oceans assuming that the difference between TLT and TMT is an approximate measure of the lapse rate. The TLT–TMT trend is larger in both the measurements and in the JRA25 than in the model runs by 0.04–0.06 K/decade. Furthermore, a calculation of all 30 year TLT–TMT trends of the unforced 500-year integration vary between ±0.03 K/decade suggesting that the models have a minor systematic warm bias in the upper troposphere.

The effect of extratropical cyclones on satellite-retrieved aerosol properties over ocean

Extratropical cyclones may have a signicant effect on column aerosol properties over ocean. European Centre for Medium Range Weather Forecasts (ECMWF) derived storm-centric composites of MODerate resolution Imaging Spectroradiometer (MODIS) and Advanced Along-Track Scanning Radiometer (AATSR) aerosol optical depth and aerosol size parameters are produced for the North Atlantic and the South Atlantic oceans. It is found that retrieved aerosol optical depth and aerosol size both increase near the center of the composite extratropical cyclones. Using composites of ECMWF ERA-Interim reanalysis data, it is demonstrated that wind speed is a considerably more likely explanatory variable than relative humidity for the aerosol observations. A comparison of composites for both MODIS and AATSR, which uses a wind speed dependent sea-surface brightness model in the aerosol retrieval, suggests that although surface brightness eects may contribute towards some of the observations, wind speed dependent emission of sea salt also appears to make a signicant contribution to the observed aerosol properties.

The changing atmospheric water cycle in polar regions in a warmer climate

We have examined the atmospheric water cycle of both Polar Regions, pole wards of 60°N and 60°S, using the ERA-Interim re-analysis and high-resolution simulations with the ECHAM5 model for both the present and future climate based on the IPCC, A1B scenario, representative of the last three decades of the 21st century. The annual precipitation in ERA-Interim amounts to ~17000 km3 and is more or less the same in the Arctic and the Antarctic, but it is composed differently. In the Arctic the annual evaporation is some 8000 km3 but some 3000 km3 less in the Antarctica where the net horizontal transport is correspondingly larger. The net water transport of the model is more intense than in ERA-Interim, in the Arctic the difference is 2.5% and in the Antarctic it is 6.2%. Precipitation and net horizontal transport in the Arctic has a maximum in August and September. Evaporation peaks in June and July. The seasonal cycle is similar in Antarctica with the highest precipitation in the austral autumn. The largest net transport occurs at the end of the major extra-tropical storm tracks in the Northern Hemisphere such as the eastern Pacific and eastern north Atlantic. The variability of the model is virtually identical to that of the re-analysis and there are no changes in variability between the present climate and the climate at the end of the 21st century when normalized with the higher level of moisture. The changes from year to year are substantial with the 20 and 30-year records being generally too short to identify robust trends in the hydrological cycle. In the A1B climate scenario the strength of the water cycle increases by some 25% in the Arctic and by 19% in the Antarctica, as measured by annual precipitation. The increase in the net horizontal transport is 29% and 22% respectively, and the increase in evaporation correspondingly less. The net transport follows closely the Clausius-Clapeyron relation. There is 2 a minor change in the annual cycle of the Arctic atmospheric water cycle with the maximum transport and precipitation occurring later in the year. There is a small imbalance of some 4-6% between the net transport and precipitation minus evaporation. We suggest that this is mainly due to the fact the transport is calculated from instantaneous 6-hourly data while precipitation and evaporation is accumulated over a 6 hour period. The residual difference is proportionally similar for all experiments and hardly varies from year to year.

Regime dependent changes in global precipitation

Assessment of changes in precipitation (P) as a function of percentiles of surface temperature (T) and 500 hPa vertical velocity (ω) are presented, considering present-day simulations and observational estimates from the Global Precipitation Climatology Project (GPCP) combined with the European Centre for Medium-range Weather Forecasts Interim reanalysis (ERA Interim). There is a tendency for models to overestimate P in the warm, subsiding regimes compared to GPCP, in some cases by more than 100%, while many models underestimate P in the moderate temperature regimes. Considering climate change projections between 1980–1999 and 2080–2099, responses in P are characterised by dP/dT ≥ 4%/K over the coldest 10–20% of land points and over warm, ascending ocean points while P declines over the warmest, descending regimes (dP/dT ∼ − 4%/K for model ensemble means). The reduced Walker circulation limits this contrasting dP/dT response in the tropical wet and dry regimes only marginally. Around 70% of the global surface area exhibits a consistent sign for dP/dT in at least 6 out of a 7-member model ensemble when considering P composites in terms of dynamic regime.

Changes in water vapor transports of the ascending branch of the tropical circulation

Recent studies have found contradicting results on whether tropical atmospheric circulation (TAC) has intensified or weakened in recent decades. We here re-investigate recent changes in TAC derived from moisture transports into the tropics using high temporal and spatial resolution reanalyses from ERA-interim. We found a significant strengthening of both, the lower level inward transports and the mid level outward transports over the recent two decades. However the signal in the total budget is weak, because strengthening of the in and outflow neutralize each other, at least to some extent. We found atmospheric humidity to be relatively stable, so suggest that the intensification is mainly caused by an intensification of the wind related circulation strength. The exact quantitative values were found to heavily depend on whether the calculations are based on mean or instantaneous values. We highlight the importance for using the instantaneous ones for transport calculations, as they represent the coincidence of high wind speeds and high atmospheric humidity.

Evaluation of satellite-based and model re-analysis rainfall estimates for Uganda

The dependence of much of Africa on rain fed agriculture leads to a high vulnerability to fluctuations in rainfall amount. Hence, accurate monitoring of near-real time rainfall is particularly useful, for example in forewarning possible crop shortfalls in drought-prone areas. Unfortunately, ground based observations are often inadequate. Rainfall estimates from satellite-based algorithms and numerical model outputs can fill this data gap, however rigorous assessment of such estimates is required. In this case, three satellite based products (NOAA-RFE 2.0, GPCP-1DD and TAMSAT) and two numerical model outputs (ERA-40 and ERA-Interim) have been evaluated for Uganda in East Africa using a network of 27 rain gauges. The study focuses on the years 2001 to 2005 and considers the main rainy season (February to June). All data sets were converted to the same temporal and spatial scales. Kriging was used for the spatial interpolation of the gauge data. All three satellite products showed similar characteristics and had a high level of skill that exceeded both model outputs. ERA-Interim had a tendency to overestimate whilst ERA-40 consistently underestimated the Ugandan rainfall.

Sequential methods for pharmacogenetic studies

A study or experiment can be described as sequential if its design includes one or more interim analyses at which it is possible to stop the study, having reached a definitive conclusion concerning the primary question of interest. The potential of the sequential study to terminate earlier than the equivalent fixed sample size study means that, typically, there are ethical and economic advantages to be gained from using a sequential design. These advantages have secured a place for the methodology in the conduct of many clinical trials of novel therapies. Recently, there has been increasing interest in pharmacogenetics: the study of how DNA variation in the human genome affects the safety and efficacy of drugs. The potential for using sequential methodology in pharmacogenetic studies is considered and the conduct of candidate gene association studies, family-based designs and genome-wide association studies within the sequential setting is explored. The objective is to provide a unified framework for the conduct of these types of studies as sequential designs and hence allow experimenters to consider using sequential methodology in their future pharmacogenetic studies.

Improved predictability of the troposphere using stratospheric final warmings

The final warming of the stratospheric polar vortex at the end of northern hemisphere winter is examined in ECMWF ERA-Interim reanalysis data and an ensemble of chemistry climate models, using 20 years of data from each. In some years the final warming is found to occur first in the mid-stratosphere, and in others to occur first in the upper stratosphere. The strength of the winter stratospheric polar vortex, refraction of planetary waves, and the altitudes at which the planetary waves break in the northern extratropics lead to this difference in the vertical profile of the final warming. Years in which the final warming occurs first in the mid-stratosphere show, on average, a more negative NAO pattern in April mean sea level pressure than years in which the warming occurs first in the upper stratosphere. Thus, in the northern hemisphere, additional predictive skill of tropospheric climate in April can be gained from a knowledge of the vertical profile of the stratospheric final warming.

A global blended tropopause based on ERA data, Part I: Climatology

A new tropopause definition, based on a flow-dependent blending of the traditional thermal tropopause with one based on potential vorticity, has been developed. The benefits of such a blending algorithm are most apparent in regions with synoptic scale fluctuations between tropical and extratropical airmasses. The properties of the local airmass determine the relative contributions to the location of the blended tropopause, rather than this being determined by a specified function of latitude. Global climatologies of tropopause height, temperature, potential temperature and zonal wind, based on European Centre for Medium-Range Weather Forecasts (ECMWF) reanalysis (ERA) ERA-Interim data, are presented for the period 1989-2007. Features of the seasonal-mean tropopause are discussed on a global scale, alongside a focus on selected monthly climatologies for the two high latitude regions and the tropical belt. The height differences between climatologies based on ERA-Interim and ERA-40 data are also presented. Key spatial and temporal features seen in earlier climatologies, based mainly on the World Meteorological Organization thermal tropopause definition, are reproduced with the new definition. Tropopause temperatures are consistent with those from earlier climatologies, despite some differences in height in the extratropics.

A global blended tropopause based on ERA data, Part II: trends and tropical broadening

A new tropopause definition involving a flow-dependent blending of the traditional thermal tropopause with one based on potential vorticity has been developed and applied to the European Centre for Medium-Range Weather Forecasts (ECMWF) reanalyses (ERA), ERA-40 and ERA-Interim. Global and regional trends in tropopause characteristics for annual and solsticial seasonal means are presented here, with emphasis on significant results for the newer ERA-Interim data for 1989-2007. The global-mean tropopause is rising at a rate of 47 m decade−1 , with pressure falling at 1.0 hPa decade−1 , and temperature falling at 0.18 K decade−1 . The Antarctic tropopause shows decreasing heights,warming,and increasing westerly winds. The Arctic tropopause also shows a warming, but with decreasing westerly winds. In the tropics the trends are small, but at the latitudes of the sub-tropical jets they are almost double the global values. It is found that these changes are mainly concentrated in the eastern hemisphere. Previous and new metrics for the rate of broadening of the tropics, based on both height and wind, give trends in the range 0.9◦ decade−1 to 2.2◦ decade−1 . For ERA-40 the global height and pressure trends for the period 1979-2001 are similar: 39 m decade−1 and -0.8 hPa decade−1. These values are smaller than those found from the thermal tropopause definition with this data set, as was used in most previous studies.