Using historical lesion volume data in the design of a new phase II clinical trial in acute stroke

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.)

Non-genomic signalling of the retinoic X receptor through inhibition of Gq signalling in human platelets

Retinoid X receptors (RXRs) are important transcriptional nuclear hormone receptors, acting as either homodimers or the binding partner for at least one fourth of all the known human nuclear receptors. Functional nongenomic effects of nuclear receptors are poorly understood; however, recently peroxisome proliferator-activated receptor (PPAR) gamma, PPARbeta, and the glucocorticoid receptor have all been found active in human platelets. Human platelets express RXRalpha and RXRbeta. RXR ligands inhibit platelet aggregation and TXA(2) release to ADP and the TXA(2) receptors, but only weakly to collagen. ADP and TXA(2) both signal via the G protein, Gq. RXR rapidly binds Gq but not Gi/z/o/t/gust in a ligand-dependent manner and inhibits Gq-induced Rac activation and intracellular calcium release. We propose that RXR ligands may have beneficial clinical actions through inhibition of platelet activation. Furthermore, our results demonstrate a novel nongenomic mode for nuclear receptor action and a functional cross-talk between G-protein and nuclear receptor signaling families.

Nongenomic signaling of the retinoid X receptor through binding and inhibiting Gq in human platelets

Retinoid X receptors (RXRs) are important transcriptional nuclear hormone receptors, acting as either homodimers or the binding partner for at least one fourth of all the known human nuclear receptors. Functional nongenomic effects of nuclear receptors are poorly understood; however, recently peroxisome proliferator-activated receptor (PPAR) gamma, PPAR beta, and the glucocorticoid receptor have all been found active in human platelets. Human platelets express RXR alpha, and RXR beta. RXR ligands inhibit platelet aggregation and TXA(2) release to ADP and the TXA(2) receptors, but only weakly to collagen. ADP and TXA(2) both signal via the G protein, Gq. RXR rapidly binds Gq but not Gi/z/o/t/gust in a ligand-dependent manner and inhibits Gq-induced Rac activation and intracellular calcium release. We propose that RXR ligands may have beneficial clinical actions through inhibition of platelet activation. Furthermore, our results demonstrate a novel nongenomic mode for nuclear receptor action and a functional cross-talk between G-protein and nuclear receptor signaling families. (C) 2007 by The American Society of Hematology.

The loss of Normandy and the invention of Terre Normannorum, 1204

The conquest of Normandy by Philip Augustus of France effectively ended the ‘Anglo-Norman’ realm created in 1066, forcing cross-Channel landholders to choose between their English and their Norman estates. The best source for the resulting tenurial upheaval in England is the Rotulus de valore terrarum Normannorum, a list of seized properties and their former holders, and this article seeks to expand our understanding of the impact of the loss of Normandy through a detailed analysis of this document. First, it demonstrates that the compilation of the roll can be divided into two distinct stages, the first containing valuations taken before royal justices in June 1204 and enrolled before the end of July, and the second consisting of returns to orders for the valuation of particular properties issued during the summer and autumn, as part of the process by which these estates were committed to new holders. Second, study of the roll and other documentary sources permits a better understanding of the order for the seizure of the lands of those who had remained in Normandy, the text of which does not survive. This establishes that this royal order was issued in late May 1204 and, further, that it enjoined the temporary seizure rather than the permanent confiscation of these lands. Moreover, the seizure was not retrospective and covers a specific window of time in 1204. On the one hand, this means that the roll is far from a comprehensive record of terre Normannorum. On the other hand, it is possible to correlate the identities of those Anglo-Norman landholders whose English estates were seized with the military progress of the French king through the duchy in May and June and thus shed new light on the campaign of 1204. Third, the article considers the initial management of the seized estates and highlights the fact that, when making arrangements for the these lands, John was primarily concerned to maintain his freedom of manoeuvre, since he was not prepared to accept that Normandy had been lost for good.

Evaluation of ice cloud representation in the ECMWF and UK Met Office models using CloudSat and CALIPSO data

Ice cloud representation in general circulation models remains a challenging task, due to the lack of accurate observations and the complexity of microphysical processes. In this article, we evaluate the ice water content (IWC) and ice cloud fraction statistical distributions from the numerical weather prediction models of the European Centre for Medium-Range Weather Forecasts (ECMWF) and the UK Met Office, exploiting the synergy between the CloudSat radar and CALIPSO lidar. Using the last three weeks of July 2006, we analyse the global ice cloud occurrence as a function of temperature and latitude and show that the models capture the main geographical and temperature-dependent distributions, but overestimate the ice cloud occurrence in the Tropics in the temperature range from −60 °C to −20 °C and in the Antarctic for temperatures higher than −20 °C, but underestimate ice cloud occurrence at very low temperatures. A global statistical comparison of the occurrence of grid-box mean IWC at different temperatures shows that both the mean and range of IWC increases with increasing temperature. Globally, the models capture most of the IWC variability in the temperature range between −60 °C and −5 °C, and also reproduce the observed latitudinal dependencies in the IWC distribution due to different meteorological regimes. Two versions of the ECMWF model are assessed. The recent operational version with a diagnostic representation of precipitating snow and mixed-phase ice cloud fails to represent the IWC distribution in the −20 °C to 0 °C range, but a new version with prognostic variables for liquid water, ice and snow is much closer to the observed distribution. The comparison of models and observations provides a much-needed analysis of the vertical distribution of IWC across the globe, highlighting the ability of the models to reproduce much of the observed variability as well as the deficiencies where further improvements are required.

Evaluating forecasts of extreme events for hydrological applications: an approach for screening unfamiliar performance measures

Many different performance measures have been developed to evaluate field predictions in meteorology. However, a researcher or practitioner encountering a new or unfamiliar measure may have difficulty in interpreting its results, which may lead to them avoiding new measures and relying on those that are familiar. In the context of evaluating forecasts of extreme events for hydrological applications, this article aims to promote the use of a range of performance measures. Some of the types of performance measures that are introduced in order to demonstrate a six-step approach to tackle a new measure. Using the example of the European Centre for Medium-Range Weather Forecasts (ECMWF) ensemble precipitation predictions for the Danube floods of July and August 2002, to show how to use new performance measures with this approach and the way to choose between different performance measures based on their suitability for the task at hand is shown. Copyright © 2008 Royal Meteorological Society

Vertical structure and physical processes of the Madden-Julian oscillation: exploring key model physics in climate simulations

Aimed at reducing deficiencies in representing the Madden-Julian oscillation (MJO) in general circulation models (GCMs), a global model evaluation project on vertical structure and physical processes of the MJO was coordinated. In this paper, results from the climate simulation component of this project are reported. It is shown that the MJO remains a great challenge in these latest generation GCMs. The systematic eastward propagation of the MJO is only well simulated in about one-fourth of the total participating models. The observed vertical westward tilt with altitude of the MJO is well simulated in good MJO models, but not in the poor ones. Damped Kelvin wave responses to the east of convection in the lower troposphere could be responsible for the missing MJO preconditioning process in these poor MJO models. Several process-oriented diagnostics were conducted to discriminate key processes for realistic MJO simulations. While large-scale rainfall partition and low-level mean zonal winds over the Indo-Pacific in a model are not found to be closely associated with its MJO skill, two metrics, including the low-level relative humidity difference between high and low rain events and seasonal mean gross moist stability, exhibit statistically significant correlations with the MJO performance. It is further indicated that increased cloud-radiative feedback tends to be associated with reduced amplitude of intraseasonal variability, which is incompatible with the radiative instability theory previously proposed for the MJO. Results in this study confirm that inclusion of air-sea interaction can lead to significant improvement in simulating the MJO.

Evaluation of the Plant–Craig stochastic convection scheme (v2.0) in the ensemble forecasting system MOGREPS-R (24 km) based on the Unified Model (v7.3)

The Plant–Craig stochastic convection parameterization (version 2.0) is implemented in the Met Office Regional Ensemble Prediction System (MOGREPS-R) and is assessed in comparison with the standard convection scheme with a simple stochastic scheme only, from random parameter variation. A set of 34 ensemble forecasts, each with 24 members, is considered, over the month of July 2009. Deterministic and probabilistic measures of the precipitation forecasts are assessed. The Plant–Craig parameterization is found to improve probabilistic forecast measures, particularly the results for lower precipitation thresholds. The impact on deterministic forecasts at the grid scale is neutral, although the Plant–Craig scheme does deliver improvements when forecasts are made over larger areas. The improvements found are greater in conditions of relatively weak synoptic forcing, for which convective precipitation is likely to be less predictable.

Evaluating a new LISFLOOD-FP formulation with data from the summer 2007 floods in Tewkesbury, UK

Two-dimensional flood inundation modelling is a widely used tool to aid flood risk management. In urban areas, where asset value and population density are greatest, the model spatial resolution required to represent flows through a typical street network (i.e. < 10m) often results in impractical computational cost at the whole city scale. Explicit diffusive storage cell models become very inefficient at such high resolutions, relative to shallow water models, because the stable time step in such schemes scales as a quadratic of resolution. This paper presents the calibration and evaluation of a recently developed new formulation of the LISFLOOD-FP model, where stability is controlled by the Courant–Freidrichs–Levy condition for the shallow water equations, such that, the stable time step instead scales linearly with resolution. The case study used is based on observations during the summer 2007 floods in Tewkesbury, UK. Aerial photography is available for model evaluation on three separate days from the 24th to the 31st of July. The model covered a 3.6 km by 2 km domain and was calibrated using gauge data from high flows during the previous month. The new formulation was benchmarked against the original version of the model at 20 m and 40 m resolutions, demonstrating equally accurate performance given the available validation data but at 67x faster computation time. The July event was then simulated at the 2 m resolution of the available airborne LiDAR DEM. This resulted in a significantly more accurate simulation of the drying dynamics compared to that simulated by the coarse resolution models, although estimates of peak inundation depth were similar.

Evaluating a new LISFLOOD-FP formulation with data from the summer 2007 floods in Tewkesbury, UK

Two-dimensional flood inundation modelling is a widely used tool to aid flood risk management. In urban areas, the model spatial resolution required to represent flows through a typical street network often results in an impractical computational cost at the city scale. This paper presents the calibration and evaluation of a recently developed formulation of the LISFLOOD-FP model, which is more computationally efficient at these resolutions. Aerial photography was available for model evaluation on 3 days from the 24 to the 31 of July. The new formulation was benchmarked against the original version of the model at 20 and 40 m resolutions, demonstrating equally accurate simulation, given the evaluation data but at a 67 times faster computation time. The July event was then simulated at the 2 m resolution of the available airborne LiDAR DEM. This resulted in more accurate simulation of the floodplain drying dynamics compared with the coarse resolution models, although maximum inundation levels were simulated equally well at all resolutions tested.

Clouds and the atmospheric circulation response to warming

We study the effect of clouds on the atmospheric circulation response to CO2 quadrupling in an aquaplanet model with a slab-ocean lower boundary. The cloud effect is isolated by locking the clouds to either the control or 4xCO2 state in the shortwave (SW) or longwave (LW) radiation schemes. In our model, cloud-radiative changes explain more than half of the total poleward expansion of the Hadley cells, midlatitude jets, and storm tracks under CO2 quadrupling, even though they cause only one-fourth of the total global-mean surface warming. The effect of clouds on circulation results mainly from the SW cloud-radiative changes, which strongly enhance the Equator-to-pole temperature gradient at all levels in the troposphere, favoring stronger and poleward-shifted midlatitude eddies. By contrast, quadrupling CO2 while holding the clouds fixed causes strong polar amplification and weakened midlatitude baroclinicity at lower levels, yielding only a small poleward expansion of the circulation. Our results show that (a) the atmospheric circulation responds sensitively to cloud-driven changes in meridional and vertical temperature distribution, and (b) the spatial structure of cloud feedbacks likely plays a dominant role in the circulation response to greenhouse gas forcing. While the magnitude and spatial structure of the cloud feedback are expected to be highly model-dependent, an analysis of 4xCO2 simulations of CMIP5 models shows that the SW cloud feedback likely forces a poleward expansion of the tropospheric circulation in most climate models.