Sequential genome-wide association studies for monitoring adverse events in the clinical evaluation of new drugs

Pharmacovigilance, the monitoring of adverse events (AEs), is an integral part in the clinical evaluation of a new drug. Until recently, attempts to relate the incidence of AEs to putative causes have been restricted to the evaluation of simple demographic and environmental factors. The advent of large-scale genotyping, however, provides an opportunity to look for associations between AEs and genetic markers, such as single nucleotides polymorphisms (SNPs). It is envisaged that a very large number of SNPs, possibly over 500 000, will be used in pharmacovigilance in an attempt to identify any genetic difference between patients who have experienced an AE and those who have not. We propose a sequential genome-wide association test for analysing AEs as they arise, allowing evidence-based decision-making at the earliest opportunity. This gives us the capability of quickly establishing whether there is a group of patients at high-risk of an AE based upon their DNA. Our method provides a valid test which takes account of linkage disequilibrium and allows for the sequential nature of the procedure. The method is more powerful than using a correction, such as idák, that assumes that the tests are independent. Copyright © 2006 John Wiley & Sons, Ltd.

Over the counter medicines and the need for immediate action: a further evaluation of European Commission recommended wordings for communicating risk

A study examined people's interpretation of European Commission (EC) recommended verbal descriptors for risk of medicine side effects, and actions to take if they do occur. Members of the general public were presented with a fictitious (but realistic) scenario about suffering from a stiff neck, visiting the local pharmacy and purchasing an over the counter (OTC) medicine (Ibruprofen). The medicine came with an information leaflet which included information about the medicine's side effects, their risk of occurrence, and recommended actions to take if adverse effects are experienced. Probability of occurrence was presented numerically (6%) or verbally, using the recommended EC descriptor (common). Results showed that, in line with findings of our earlier work with prescribed medicines, participants significantly overestimated side effect risk. Furthermore, the differences in interpretation were reflected in their judgements of satisfaction, side effect severity, risk to health, and intention to take the medicine. Finally, we observed no significant difference between people's interpretation of the recommended action descriptors ('immediately' and 'as soon as possible'). (C) 2003 Elsevier Science Ireland Ltd. All rights reserved.

A critical evaluation of the ability of the Spinning Enhanced Visible and Infrared Imager (SEVIRI) thermal infrared red-green-blue rendering to identify dust events: theoretical analysis

Using a combination of idealized radiative transfer simulations and a case study from the first field campaign of the Saharan Mineral Dust Experiment (SAMUM) in southern Morocco, this paper provides a systematic assessment of the limitations of the widely used Spinning Enhanced Visible and Infrared Imager (SEVIRI) red-green-blue (RGB) thermal infrared dust product. Both analyses indicate that the ability of the product to identify dust, via its characteristic pink coloring, is strongly dependent on the column water vapor, the lower tropospheric lapse rate, and dust altitude. In particular, when column water vapor exceeds ∼20–25 mm, dust presence, even for visible optical depths of the order 0.8, is effectively masked. Variability in dust optical properties also has a marked impact on the imagery, primarily as a result of variability in dust composition. There is a moderate sensitivity to the satellite viewing geometry, particularly in moist conditions. The underlying surface can act to confound the signal seen through variations in spectral emissivity, which are predominantly manifested in the 8.7μm SEVIRI channel. In addition, if a temperature inversion is present, typical of early morning conditions over the Sahara and Sahel, an increased dust loading can actually reduce the pink coloring of the RGB image compared to pristine conditions. Attempts to match specific SEVIRI observations to simulations using SAMUM measurements are challenging because of high uncertainties in surface skin temperature and emissivity. Recommendations concerning the use and interpretation of the SEVIRI RGB imagery are provided on the basis of these findings.

Understanding the processes governing climate variability and change, climate predictability and the probability of extreme events

The purpose of Research Theme 4 (RT4) was to advance understanding of the basic science issues at the heart of the ENSEMBLES project, focusing on the key processes that govern climate variability and change, and that determine the predictability of climate. Particular attention was given to understanding linear and non-linear feedbacks that may lead to climate surprises,and to understanding the factors that govern the probability of extreme events. Improved understanding of these issues will contribute significantly to the quantification and reduction of uncertainty in seasonal to decadal predictions and projections of climate change. RT4 exploited the ENSEMBLES integrations (stream 1) performed in RT2A as well as undertaking its own experimentation to explore key processes within the climate system. It was working at the cutting edge of problems related to climate feedbacks, the interaction between climate variability and climate change � especially how climate change pertains to extreme events, and the predictability of the climate system on a range of time-scales. The statisticalmethodologies developed for extreme event analysis are new and state-of-the-art. The RT4-coordinated experiments, which have been conducted with six different atmospheric GCMs forced by common timeinvariant sea surface temperature (SST) and sea-ice fields (removing some sources of inter-model variability), are designed to help to understand model uncertainty (rather than scenario or initial condition uncertainty) in predictions of the response to greenhouse-gas-induced warming. RT4 links strongly with RT5 on the evaluation of the ENSEMBLES prediction system and feeds back its results to RT1 to guide improvements in the Earth system models and, through its research on predictability, to steer the development of methods for initialising the ensembles

An evaluation of a Bayesian method of dose escalation based on bivariate binary responses

Recently, various approaches have been suggested for dose escalation studies based on observations of both undesirable events and evidence of therapeutic benefit. This article concerns a Bayesian approach to dose escalation that requires the user to make numerous design decisions relating to the number of doses to make available, the choice of the prior distribution, the imposition of safety constraints and stopping rules, and the criteria by which the design is to be optimized. Results are presented of a substantial simulation study conducted to investigate the influence of some of these factors on the safety and the accuracy of the procedure with a view toward providing general guidance for investigators conducting such studies. The Bayesian procedures evaluated use logistic regression to model the two responses, which are both assumed to be binary. The simulation study is based on features of a recently completed study of a compound with potential benefit to patients suffering from inflammatory diseases of the lung.

Overall evaluation of the PETS2009 results

This paper presents the results of the crowd image analysis challenge, as part of the PETS 2009 workshop. The evaluation is carried out using a selection of the metrics available in the Video Analysis and Content Extraction (VACE) program and the CLassification of Events, Activities, and Relationships (CLEAR) consortium. The evaluation highlights the strengths of the authors’ systems in areas such as precision, accuracy and robustness.

PETS2010 and PETS2009 evaluation of results using individual ground truthed single views

This paper presents the results of the crowd image analysis challenge of the PETS2010 workshop. The evaluation was carried out using a selection of the metrics developed in the Video Analysis and Content Extraction (VACE) program and the CLassification of Events, Activities, and Relationships (CLEAR) consortium. The PETS 2010 evaluation was performed using new ground truthing create from each independant two dimensional view. In addition, the performance of the submissions to the PETS 2009 and Winter-PETS 2009 were evaluated and included in the results. The evaluation highlights the detection and tracking performance of the authors’ systems in areas such as precision, accuracy and robustness.

An evaluation of the spatiotemporal structure of large-scale European drought within the HiGEM climate model

We compare the characteristics of synthetic European droughts generated by the HiGEM1 coupled climate model run with present day atmospheric composition with observed drought events extracted from the CRU TS3 data set. The results demonstrate consistency in both the rate of drought occurrence and the spatiotemporal structure of the events. Estimates of the probability density functions for event area, duration and severity are shown to be similar with confidence > 90%. Encouragingly, HiGEM is shown to replicate the extreme tails of the observed distributions and thus the most damaging European drought events. The soil moisture state is shown to play an important role in drought development. Once a large-scale drought has been initiated it is found to be 50% more likely to continue if the local soil moisture is below the 40th percentile. In response to increased concentrations of atmospheric CO2, the modelled droughts are found to increase in duration, area and severity. The drought response can be largely attributed to temperature driven changes in relative humidity. 1 HiGEM is based on the latest climate configuration of the Met Office Hadley Centre Unified Model (HadGEM1) with the horizontal resolution increased to 1.25 x 0.83 degrees in longitude and latitude in the atmosphere and 1/3 x 1/3 degrees in the ocean.

Description and process evaluation of pharmacists’ interventions in a pharmacist-led information technology-enabled multicentre cluster randomised controlled trial for reducing medication errors in general practice (PINCER trial)

Objective To undertake a process evaluation of pharmacists' recommendations arising in the context of a complex IT-enabled pharmacist-delivered randomised controlled trial (PINCER trial) to reduce the risk of hazardous medicines management in general practices. Methods PINCER pharmacists manually recorded patients’ demographics, details of interventions recommended, actions undertaken by practice staff and time taken to manage individual cases of hazardous medicines management. Data were coded and double entered into SPSS v15, and then summarised using percentages for categorical data (with 95% CI) and, as appropriate, means (SD) or medians (IQR) for continuous data. Key findings Pharmacists spent a median of 20 minutes (IQR 10, 30) reviewing medical records, recommending interventions and completing actions in each case of hazardous medicines management. Pharmacists judged 72% (95%CI 70, 74) (1463/2026) of cases of hazardous medicines management to be clinically relevant. Pharmacists recommended 2105 interventions in 74% (95%CI 73, 76) (1516/2038) of cases and 1685 actions were taken in 61% (95%CI 59, 63) (1246/2038) of cases; 66% (95%CI 64, 68) (1383/2105) of interventions recommended by pharmacists were completed and 5% (95%CI 4, 6) (104/2105) of recommendations were accepted by general practitioners (GPs), but not completed at the end of the pharmacists’ placement; the remaining recommendations were rejected or considered not relevant by GPs. Conclusions The outcome measures were used to target pharmacist activity in general practice towards patients at risk from hazardous medicines management. Recommendations from trained PINCER pharmacists were found to be broadly acceptable to GPs and led to ameliorative action in the majority of cases. It seems likely that the approach used by the PINCER pharmacists could be employed by other practice pharmacists following appropriate training.

Evaluation of ECMWF medium-range ensemble forecasts of precipitation for river basins

Providing probabilistic forecasts using Ensemble Prediction Systems has become increasingly popular in both the meteorological and hydrological communities. Compared to conventional deterministic forecasts, probabilistic forecasts may provide more reliable forecasts of a few hours to a number of days ahead, and hence are regarded as better tools for taking uncertainties into consideration and hedging against weather risks. It is essential to evaluate performance of raw ensemble forecasts and their potential values in forecasting extreme hydro-meteorological events. This study evaluates ECMWF’s medium-range ensemble forecasts of precipitation over the period 2008/01/01-2012/09/30 on a selected mid-latitude large scale river basin, the Huai river basin (ca. 270,000 km2) in central-east China. The evaluation unit is sub-basin in order to consider forecast performance in a hydrologically relevant way. The study finds that forecast performance varies with sub-basin properties, between flooding and non-flooding seasons, and with the forecast properties of aggregated time steps and lead times. Although the study does not evaluate any hydrological applications of the ensemble precipitation forecasts, its results have direct implications in hydrological forecasts should these ensemble precipitation forecasts be employed in hydrology.

Performance evaluation of crowd image analysis using the PETS2009 dataset

This paper presents the PETS2009 outdoor crowd image analysis surveillance dataset and the performance evaluation of people counting, detection and tracking results using the dataset submitted to five IEEE Performance Evaluation of Tracking and Surveillance (PETS) workshops. The evaluation was carried out using well established metrics developed in the Video Analysis and Content Extraction (VACE) programme and the CLassification of Events, Activities, and Relationships (CLEAR) consortium. The comparative evaluation highlights the detection and tracking performance of the authors’ systems in areas such as precision, accuracy and robustness and provides a brief analysis of the metrics themselves to provide further insights into the performance of the authors’ systems.

Evaluation of ERA-Interim reanalysis precipitation products using England and Wales observations

Precipitation forecast data from the ERA-Interim reanalysis (33 years) are evaluated using the daily England and Wales Precipitation (EWP) observations obtained from a rain gauge network. Observed and reanalysis daily precipitation data are both described well by Weibull distributions with indistinguishable shapes but different scale parameters, such that the reanalysis underestimates the observations by an average factor of 22%. The correlation between the observed and ERA-Interim time series of regional, daily precipitation is 0.91. ERA-Interim also captures the statistics of extreme precipitation including a slightly lower likelihood of the heaviest precipitation events (>15 mm day− 1 for the regional average) than indicated by the Weibull fit. ERA-Interim is also closer to EWP for the high precipitation events. Since these carry weight in longer accumulations, a smaller underestimation of 19% is found for monthly mean precipitation. The partition between convective and stratiform precipitation in the ERA-Interim forecast is also examined. In summer both components contribute equally to the total precipitation amount, while in winter the stratiform precipitation is approximately double convective. These results are expected to be relevant to other regions with low orography on the coast of a continent at the downstream end of mid-latitude stormtracks.

Causes of plasma flow bursts and dayside auroral transients: An evaluation of two models Invoking reconnection pulses and changes in the Y component of the magnetosheath field

Longitudinal flow bursts observed by the European Incoherent Scatter (EISCAT) radar, in association with dayside auroral transients observed from Svalbard, have been interpreted as resulting from pulses of enhanced reconnection at the dayside magnetopause. However, an alternative model has recently been proposed for a steady rate of magnetopause reconnection, in which the bursts of longitudinal flow are due to increases in the field line curvature force, associated with the By component of the magnetosheath field. We here evaluate these two models, using observations on January 20, 1990, by EISCAT and a 630-nm all-sky camera at Ny Ålesund. For both models, we predict the behavior of both the dayside flows and the 630-nm emissions on newly opened field lines. It is shown that the signatures of steady reconnection and magnetosheath By changes could possibly resemble the observed 630-nm auroral events, but only for certain locations of the observing site, relative to the ionospheric projection of the reconnection X line: however, in such cases, the flow bursts would be seen between the 630-nm transients and not within them. On the other hand, the model of reconnection rate pulses predicts that the flows will be enhanced within each 630-nm transient auroral event. The observations on January 20, 1990, are shown to be consistent with the model of enhanced reconnection rate pulses over a background level and inconsistent with the effects of periodic enhancements of the magnitude of the magnetosheath By component. We estimate that the reconnection rate within the pulses would have to be at least an order of magnitude larger than the background level between the pulses.

Evaluation of a polynya flux model by means of thermal infrared satellite estimates

We test the ability of a two-dimensional flux model to simulate polynya events with narrow open-water zones by comparing model results to ice-thickness and ice-production estimates derived from thermal infrared Moderate Resolution Imaging Spectroradiometer (MODIS) observations in conjunction with an atmospheric dataset. Given a polynya boundary and an atmospheric dataset, the model correctly reproduces the shape of an 11 day long event, using only a few simple conservation laws. Ice production is slightly overestimated by the model, owing to an underestimated ice thickness. We achieved best model results with the consolidation thickness parameterization developed by Biggs and others (2000). Observed regional discrepancies between model and satellite estimates might be a consequence of the missing representation of the dynamic of the thin-ice thickening (e.g. rafting). We conclude that this simplified polynya model is a valuable tool for studying polynya dynamics and estimating associated fluxes of single polynya events.

Evaluation of moisture sources for the Central European summer flood of May/June 2013 based on regional climate model simulations

Heavy precipitation affected Central Europe in May/June 2013, triggering damaging floods both on the Danube and the Elbe rivers. Based on a modelling approach with COSMO-CLM, moisture fluxes, backward trajectories, cyclone tracks and precipitation fields are evaluated for the relevant time period 30 May–2 June 2013. We identify potential moisture sources and quantify their contribution to the flood event focusing on the Danube basin through sensitivity experiments: Control simulations are performed with undisturbed ERA-Interim boundary conditions, while multiple sensitivity experiments are driven with modified evaporation characteristics over selected marine and land areas. Two relevant cyclones are identified both in reanalysis and in our simulations, which moved counter-clockwise in a retrograde path from Southeastern Europe over Eastern Europe towards the northern slopes of the Alps. The control simulations represent the synoptic evolution of the event reasonably well. The evolution of the precipitation event in the control simulations shows some differences in terms of its spatial and temporal characteristics compared to observations. The main precipitation event can be separated into two phases concerning the moisture sources. Our modelling results provide evidence that the two main sources contributing to the event were the continental evapotranspiration (moisture recycling; both phases) and the North Atlantic Ocean (first phase only). The Mediterranean Sea played only a minor role as a moisture source. This study confirms the importance of continental moisture recycling for heavy precipitation events over Central Europe during the summer half year.