Refinement of the Clinical Scenario Evaluation Framework for Assessment of Competing Development Strategies with an Application to Multiple Sclerosis

When competing strategies for development programs, clinical trial designs, or data analysis methods exist, the alternatives need to be evaluated in a systematic way to facilitate informed decision making. Here we describe a refinement of the recently proposed clinical scenario evaluation framework for the assessment of competing strategies. The refinement is achieved by subdividing key elements previously proposed into new categories, distinguishing between quantities that can be estimated from preexisting data and those that cannot and between aspects under the control of the decision maker from those that are determined by external constraints. The refined framework is illustrated by an application to a design project for an adaptive seamless design for a clinical trial in progressive multiple sclerosis.

A practical comparison of blinded methods for sample size reviews in survival data clinical trials.

This paper presents practical approaches to the problem of sample size re-estimation in the case of clinical trials with survival data when proportional hazards can be assumed. When data are readily available at the time of the review, on a full range of survival experiences across the recruited patients, it is shown that, as expected, performing a blinded re-estimation procedure is straightforward and can help to maintain the trial's pre-specified error rates. Two alternative methods for dealing with the situation where limited survival experiences are available at the time of the sample size review are then presented and compared. In this instance, extrapolation is required in order to undertake the sample size re-estimation. Worked examples, together with results from a simulation study are described. It is concluded that, as in the standard case, use of either extrapolation approach successfully protects the trial error rates. Copyright © 2012 John Wiley & Sons, Ltd.

The teleconnection of the tropical Atlantic to Indo-Pacific sea surface temperatures on inter-annual to centennial time scales: a review of recent findings

In this paper, the teleconnections from the tropical Atlantic to the Indo-Pacific region from inter-annual to centennial time scales will be reviewed. Identified teleconnections and hypotheses on mechanisms at work are reviewed and further explored in a century-long pacemaker coupled ocean-atmosphere simulation ensemble. There is a substantial impact of the tropical Atlantic on the Pacific region at inter-annual time scales. An Atlantic Niño (Niña) event leads to rising (sinking) motion in the Atlantic region, which is compensated by sinking (rising) motion in the central-western Pacific. The sinking (rising) motion in the central-western Pacific induces easterly (westerly) surface wind anomalies just to the west, which alter the thermocline. These perturbations propagate eastward as upwelling (downwelling) Kelvin-waves, where they increase the probability for a La Niña (El Niño) event. Moreover, tropical North Atlantic sea surface temperature anomalies are also able to lead La Niña/El Niño development. At multidecadal time scales, a positive (negative) Atlantic Multidecadal Oscillation leads to a cooling (warming) of the eastern Pacific and a warming (cooling) of the western Pacific and Indian Ocean regions. The physical mechanism for this impact is similar to that at inter-annual time scales. At centennial time scales, the Atlantic warming induces a substantial reduction of the eastern Pacific warming even under CO2 increase and to a strong subsurface cooling.