Missing steps in a staircase: a qualitative study of the perspectives of key stakeholders on the use of adaptive designs in confirmatory trials

Background Despite the promising benefits of adaptive designs (ADs), their routine use, especially in confirmatory trials, is lagging behind the prominence given to them in the statistical literature. Much of the previous research to understand barriers and potential facilitators to the use of ADs has been driven from a pharmaceutical drug development perspective, with little focus on trials in the public sector. In this paper, we explore key stakeholders’ experiences, perceptions and views on barriers and facilitators to the use of ADs in publicly funded confirmatory trials. Methods Semi-structured, in-depth interviews of key stakeholders in clinical trials research (CTU directors, funding board and panel members, statisticians, regulators, chief investigators, data monitoring committee members and health economists) were conducted through telephone or face-to-face sessions, predominantly in the UK. We purposively selected participants sequentially to optimise maximum variation in views and experiences. We employed the framework approach to analyse the qualitative data. Results We interviewed 27 participants. We found some of the perceived barriers to be: lack of knowledge and experience coupled with paucity of case studies, lack of applied training, degree of reluctance to use ADs, lack of bridge funding and time to support design work, lack of statistical expertise, some anxiety about the impact of early trial stopping on researchers’ employment contracts, lack of understanding of acceptable scope of ADs and when ADs are appropriate, and statistical and practical complexities. Reluctance to use ADs seemed to be influenced by: therapeutic area, unfamiliarity, concerns about their robustness in decision-making and acceptability of findings to change practice, perceived complexities and proposed type of AD, among others. Conclusions There are still considerable multifaceted, individual and organisational obstacles to be addressed to improve uptake, and successful implementation of ADs when appropriate. Nevertheless, inferred positive change in attitudes and receptiveness towards the appropriate use of ADs by public funders are supportive and are a stepping stone for the future utilisation of ADs by researchers.

Defining key structural determinants for the pro-osteogenic activity of flavonoids

Epidemiological studies suggest that fruits and vegetables may play a role in promoting bone growth and preventing age-related bone loss, attributable, at least in part, to phytochemicals such as flavonoids stimulating osteoblastogenesis. Through systematically screening the effect of flavonoids on the osteogenic differentiation of human mesenchymal stem cells in vitro, and correlating activity with chemical structure using comparative molecular field analysis, we have successfully identified important structural features which relate to their activity, as well as reliably predicting the activity of compounds with unknown activity. Contour maps emphasised the importance of electronegativity, steric bulk, and a 2-C-3-C double bond at the flavonoid C-ring, as well as overall electropositivity and reduced steric bulk at the flavonoid B-ring. These results support a role for certain flavonoids in promoting osteogenic differentiation, thus their potential for preventing skeletal deterioration, as well as providing a foundation for the lead optimisation of novel bone anabolics.

Myostatin is a key mediator between energy metabolism and endurance capacity of skeletal muscle

Myostatin (Mstn) participates in the regulation of skeletal muscle size and has emerged as a regulator of muscle metabolism. Here, we hypothesized that lack of myostatin profoundly depresses oxidative phosphorylation-dependent muscle function. Toward this end, we explored Mstn/ mice as a model for the constitutive absence of myostatin and AAV-mediated overexpression of myostatin propeptide as a model of myostatin blockade in adult wild-type mice. We show that muscles from Mstn/ mice, although larger and stronger, fatigue extremely rapidly. Myostatin deficiency shifts muscle from aerobic toward anaerobic energy metabolism, as evidenced by decreased mitochondrial respiration, reduced expression of PPAR transcriptional regulators, increased enolase activity, and exercise-induced lactic acidosis. As a consequence, constitutively reduced myostatin signaling diminishes exercise capacity, while the hypermuscular state of Mstn/ mice increases oxygen consumption and the energy cost of running. We wondered whether these results are the mere consequence of the congenital fiber-type switch toward a glycolytic phenotype of constitutive Mstn/ mice. Hence, we overexpressed myostatin propeptide in adult mice, which did not affect fiber-type distribution, while nonetheless causing increased muscle fatigability, diminished exercise capacity, and decreased Pparb/d and Pgc1a expression. In conclusion, our results suggest that myostatin endows skeletal muscle with high oxidative capacity and low fatigability, thus regulating the delicate balance between muscle mass, muscle force, energy metabolism, and endurance capacity.

Surface termination of CePt5/Pt(111): the key to chemical inertness

The surface termination of CePt5/Pt(111) is determined experimentally by LEED-IV. In accordance with recent theoretical predictions, a dense Pt terminated surface is being found. Whereas the CePt5 volume lattice comprises Pt kagome layers, additional Pt atoms occupy the associated hole positions at the surface. This finding provides a natural explanation for the remarkable inertness of the CePt5 intermetallic. Implications of the structural relaxations determined by LEED-IV analysis are discussed with regard to observations by scanning tunneling microscopy and electron spectroscopies.

Biogeochemical cycles and biodiversity as key drivers of ecosystem services provided by soils

Soils play a pivotal role in major global biogeochemical cycles (carbon, nutrient, and water), while hosting the largest diversity of organisms on land. Because of this, soils deliver fundamental ecosystem services, and management to change a soil process in support of one ecosystem service can either provide co-benefits to other services or result in trade-offs. In this critical review, we report the state-of-the-art understanding concerning the biogeochemical cycles and biodiversity in soil, and relate these to the provisioning, regulating, supporting, and cultural ecosystem services which they underpin. We then outline key knowledge gaps and research challenges, before providing recommendations for management activities to support the continued delivery of ecosystem services from soils. We conclude that, although soils are complex, there are still knowledge gaps, and fundamental research is still needed to better understand the relationships between different facets of soils and the array of ecosystem services they underpin, enough is known to implement best practices now. There is a tendency among soil scientists to dwell on the complexity and knowledge gaps rather than to focus on what we do know and how this knowledge can be put to use to improve the delivery of ecosystem services. A significant challenge is to find effective ways to share knowledge with soil managers and policy makers so that best management can be implemented. A key element of this knowledge exchange must be to raise awareness of the ecosystems services underpinned by soils and thus the natural capital they provide. We know enough to start moving in the right direction while we conduct research to fill in our knowledge gaps. The lasting legacy of the International Year of Soils in 2015 should be for soil scientists to work together with policy makers and land managers to put soils at the centre of environmental policy making and land management decisions.

Self-concept clarity, social support, and Compulsive Internet Use: a study of the USA and the UAE

Compulsive Internet Use (CIU) has been mostly studied among adolescents, yet some studies reveal that this can be a problem for the adult population, too. The lack of agreement on diagnostic tools and cut-off points results in markedly different prevalence figures. Building on Charlton’s (2002) distinction between core CIU and positive engagement dimensions, the first objective was to confirm that prevalence figures including the core dimensions of CIU were lower than those including the engagement dimensions as well. Second, building on Davis’s (2001) diathesis-stress model, we tested the role that self-concept clarity (SCC) and social support play in predicting core CIU in US subjects (NUS = 268). Finally, we expected that, because self-concept clarity is mostly linked to well-being in Western countries, the association between this variable and core CIU would be weak in the Eastern culture sample (NUAE = 270). Our findings confirmed that prevalence figures were 20–40% lower when including the core dimensions only, and that SCC is a key predictor of CIU at low levels of social support in the US. We also confirmed that this is not the case in the UAE. Future research opportunities to advance this study were discussed.

What is the shape of an air bubble on a liquid surface?

We have calculated the equilibrium shape of the axially symmetric meniscus along which a spherical bubble contacts a flat liquid surface, by analytically integrating the Young-Laplace equation in the presence of gravity, in the limit of large Bond numbers. This method has the advantage that it provides semi-analytical expressions for key geometrical properties of the bubble in terms of the Bond number. Results are in good overall agreement with experimental data and are consistent with fully numerical (Surface Evolver) calculations. In particular, we are able to describe how the bubble shape changes from hemispherical, with a shallow flat bottom, to lenticular, with a deeper, curved bottom, as the Bond number is decreased.

On the importance of Vaisala RS92 radiosonde humidity corrections for a better agreement between measured and modeled satellite radiances

A study has been carried out to assess the importance of radiosonde corrections in improving the agreement between satellite and radiosonde measurements of upper-tropospheric humidity. Infrared [High Resolution Infrared Radiation Sounder (HIRS)-12] and microwave [Advanced Microwave Sounding Unit (AMSU)-18] measurements from the NOAA-17 satellite were used for this purpose. The agreement was assessed by comparing the satellite measurements against simulated measurements using collocated radiosonde profiles of the Atmospheric Radiation Measurement (ARM) Program undertaken at tropical and midlatitude sites. The Atmospheric Radiative Transfer Simulator (ARTS) was used to simulate the satellite radiances. The comparisons have been done under clear-sky conditions, separately for daytime and nighttime soundings. Only Vaisala RS92 radiosonde sensors were used and an empirical correction (EC) was applied to the radiosonde measurements. The EC includes correction for mean calibration bias and for solar radiation error, and it removes radiosonde bias relative to three instruments of known accuracy. For the nighttime dataset, the EC significantly reduces the bias from 0.63 to 20.10 K in AMSU-18 and from 1.26 to 0.35 K in HIRS-12. The EC has an even greater impact on the daytime dataset with a bias reduction from 2.38 to 0.28 K in AMSU-18 and from 2.51 to 0.59 K in HIRS-12. The present study promises a more accurate approach in future radiosonde-based studies in the upper troposphere.

Perfective marking in L2 Mandarin: agreement with inherent lexical aspect or the derived Sentential Aspectual class?

This study evaluates the differing claims of the Aspect Hypothesis (Anderson & Shirai 1996) and the Sentential Aspect Hypothesis (Sharma & Deo 2009) for perfective marking by L1 English learners of Mandarin. The AH predicts a narrow focus on inherent lexical aspect (the verb and predicate) in determining the use of the perfective marker le, whilst the SAH suggests that – subject to L1 influence – perfective marking agrees with the final derived aspectual class of the sentence. To test these claims data were collected using a controlled le-insertion task, combined with oral corpus data. The results show that learners’ perfective marking patterns with the sentential aspectual class and not inherent lexical aspect (where these differ), and that overall the sentential aspectual class better predicts learners’ assignment of perfective marking than lexical aspect.

Cross-sector surveys assessing perceptions of key stakeholders towards barriers, concerns and facilitators to the appropriate use of adaptive designs in confirmatory trials

Background Appropriately conducted adaptive designs (ADs) offer many potential advantages over conventional trials. They make better use of accruing data, potentially saving time, trial participants, and limited resources compared to conventional, fixed sample size designs. However, one can argue that ADs are not implemented as often as they should be, particularly in publicly funded confirmatory trials. This study explored barriers, concerns, and potential facilitators to the appropriate use of ADs in confirmatory trials among key stakeholders. Methods We conducted three cross-sectional, online parallel surveys between November 2014 and January 2015. The surveys were based upon findings drawn from in-depth interviews of key research stakeholders, predominantly in the UK, and targeted Clinical Trials Units (CTUs), public funders, and private sector organisations. Response rates were as follows: 30(55 %) UK CTUs, 17(68 %) private sector, and 86(41 %) public funders. A Rating Scale Model was used to rank barriers and concerns in order of perceived importance for prioritisation. Results Top-ranked barriers included the lack of bridge funding accessible to UK CTUs to support the design of ADs, limited practical implementation knowledge, preference for traditional mainstream designs, difficulties in marketing ADs to key stakeholders, time constraints to support ADs relative to competing priorities, lack of applied training, and insufficient access to case studies of undertaken ADs to facilitate practical learning and successful implementation. Associated practical complexities and inadequate data management infrastructure to support ADs were reported as more pronounced in the private sector. For funders of public research, the inadequate description of the rationale, scope, and decision-making criteria to guide the planned AD in grant proposals by researchers were all viewed as major obstacles. Conclusions There are still persistent and important perceptions of individual and organisational obstacles hampering the use of ADs in confirmatory trials research. Stakeholder perceptions about barriers are largely consistent across sectors, with a few exceptions that reflect differences in organisations’ funding structures, experiences and characterisation of study interventions. Most barriers appear connected to a lack of practical implementation knowledge and applied training, and limited access to case studies to facilitate practical learning. Keywords: Adaptive designs; flexible designs; barriers; surveys; confirmatory trials; Phase 3; clinical trials; early stopping; interim analyses

Scale interactions between the MJO and the western maritime continent

State-of-the-art regional climate model simulations that are able to resolve key mesoscale circulations are used, for the first time, to understand the interaction between the large-scale convective environment of the MJO and processes governing the strong diurnal cycle over the islands of the Maritime Continent (MC). Convection is sustained in the late afternoon just inland of the coasts due to sea breeze convergence. Previous work has shown that the variability in MC rainfall associated with the MJO is manifested in changes to this diurnal cycle; land-based rainfall peaks before the active convective envelope of the MJO reaches the MC, whereas oceanic rainfall rates peak whilst the active envelope resides over the region. The model simulations show that the main controls on oceanic MC rainfall in the early active MJO phases are the large-scale environment and atmospheric stability, followed by high oceanic latent heat flux forced by high near-surface winds in the later active MJO phases. Over land, rainfall peaks before the main convective envelope arrives (in agreement with observations), even though the large-scale convective environment is only moderately favourable for convection. The causes of this early rainfall peak are convective triggers from land-sea breeze circulations that are strong due to high surface insolation and surface heating. During the peak MJO phases cloud cover increases and surface insolation decreases, which weakens the strength of the mesoscale circulations and reduces land-based rainfall, even though the large-scale environment remains favourable for convection at this time. Hence, scale interactions are an essential part of the MJO transition across the MC.

How much flower-rich habitat is enough for wild pollinators? Answering a key policy question with incomplete knowledge

In 2013, an opportunity arose in England to develop an agri-environment package for wild pollinators, as part of the new Countryside Stewardship scheme launched in 2015. It can be understood as a 'policy window', a rare and time-limited opportunity to change policy, supported by a narrative about pollinator decline and widely supported mitigating actions. An agri-environment package is a bundle of management options that together supply sufficient resources to support a target group of species. This paper documents information that was available at the time to develop such a package for wild pollinators. Four questions needed answering: (1) Which pollinator species should be targeted? (2) Which resources limit these species in farmland? (3) Which management options provide these resources? (4) What area of each option is needed to support populations of the target species? Focussing on wild bees, we provide tentative answers that were used to inform development of the package. There is strong evidence that floral resources can limit wild bee populations, and several sources of evidence identify a set of agri-environment options that provide flowers and other resources for pollinators. The final question could only be answered for floral resources, with a wide range of uncertainty. We show that the areas of some floral resource options in the basic Wild Pollinator and Farmland Wildlife Package (2% flower-rich habitat and 1 km flowering hedgerow), are sufficient to supply a set of six common pollinator species with enough pollen to feed their larvae at lowest estimates, using minimum values for estimated parameters where a range was available. We identify key sources of uncertainty, and stress the importance of keeping the Package flexible, so it can be revised as new evidence emerges about how to achieve the policy aim of supporting pollinators on farmland.