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.

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.)

The role of satellite image-processing for national-scale estimates of gene flow from genetically modified crops: rapeseed in the UK as a model.

1. There is concern over the possibility of unwanted environmental change following transgene movement from genetically modified (GM) rapeseed Brassica napus to its wild and weedy relatives. 2. The aim of this research was to develop a remote sensing-assisted methodology to help quantify gene flow from crops to their wild relatives over wide areas. Emphasis was placed on locating sites of sympatry, where the frequency of gene flow is likely to be highest, and on measuring the size of rapeseed fields to allow spatially explicit modelling of wind-mediated pollen-dispersal patterns. 3. Remote sensing was used as a tool to locate rapeseed fields, and a variety of image-processing techniques was adopted to facilitate the compilation of a spatially explicit profile of sympatry between the crop and Brassica rapa. 4. Classified satellite images containing rapeseed fields were first used to infer the spatial relationship between donor rapeseed fields and recipient riverside B. rapa populations. Such images also have utility for improving the efficiency of ground surveys by identifying probable sites of sympatry. The same data were then also used for the calculation of mean field size. 5. This paper forms a companion paper to Wilkinson et al. (2003), in which these elements were combined to produce a spatially explicit profile of hybrid formation over the UK. The current paper demonstrates the value of remote sensing and image processing for large-scale studies of gene flow, and describes a generic method that could be applied to a variety of crops in many countries. 6. Synthesis and applications. The decision to approve or prevent the release of a GM cultivar is made at a national rather than regional level. It is highly desirable that data relating to the decision-making process are collected at the same scale, rather than relying on extrapolation from smaller experiments designed at the plot, field or even regional scale. It would be extremely difficult and labour intensive to attempt to carry out such large-scale investigations without the use of remote-sensing technology. This study used rapeseed in the UK as a model to demonstrate the value of remote sensing in assembling empirical information at a national level.

The role of satellite image-processing for national-scale estimates of gene flow from genetically modified crops: rapeseed in the UK as a model

1.There is concern over the possibility of unwanted environmental change following transgene movement from genetically modified (GM) rapeseed Brassica napus to its wild and weedy relatives. 2. The aim of this research was to develop a remote sensing-assisted methodology to help quantify gene flow from crops to their wild relatives over wide areas. Emphasis was placed on locating sites of sympatry, where the frequency of gene flow is likely to be highest, and on measuring the size of rapeseed fields to allow spatially explicit modelling of wind-mediated pollen-dispersal patterns. 3. Remote sensing was used as a tool to locate rapeseed fields, and a variety of image-processing techniques was adopted to facilitate the compilation of a spatially explicit profile of sympatry between the crop and Brassica rapa. 4. Classified satellite images containing rapeseed fields were first used to infer the spatial relationship between donor rapeseed fields and recipient riverside B. rapa populations. Such images also have utility for improving the efficiency of ground surveys by identifying probable sites of sympatry. The same data were then also used for the calculation of mean field size. 5. This paper forms a companion paper to Wilkinson et al. (2003), in which these elements were combined to produce a spatially explicit profile of hybrid formation over the UK. The current paper demonstrates the value of remote sensing and image processing for large-scale studies of gene flow, and describes a generic method that could be applied to a variety of crops in many countries. 6.Synthesis and applications. The decision to approve or prevent the release of a GM cultivar is made at a national rather than regional level. It is highly desirable that data relating to the decision-making process are collected at the same scale, rather than relying on extrapolation from smaller experiments designed at the plot, field or even regional scale. It would be extremely difficult and labour intensive to attempt to carry out such large-scale investigations without the use of remote-sensing technology. This study used rapeseed in the UK as a model to demonstrate the value of remote sensing in assembling empirical information at a national level.

The economic impact of genetically modified cotton on South African smallholders: Yield, profit and health effects

Results of a large-scale survey of resource-poor smallholder cotton farmers in South Africa over three years conclusively show that adopters of Bt cotton have benefited in terms of higher yields, lower pesticide use, less labour for pesticide application and substantially higher gross margins per hectare. These benefits were clearly related to the technology, and not to preferential adoption by farmers who were already highly efficient. The smallest producers are shown to have benefited from adoption of the Bt variety as much as, if not more than, larger producers. Moreover, evidence from hospital records suggests a link between declining pesticide poisonings and adoption of the Bt variety.

Why Bt cotton pays for small-scale producers in South Africa

There is much debate about the potential benefits (and costs) of genetically modified (GM) crop technology for developing countries. Studies have been carried out in Argentina, China, Indonesia and most recently India1 to assess the impact of Bacillus thuringiensis (Bt) cotton on farmers in those regions.

Bt-cotton boosts the gross margin of small-scale cotton producers in South Africa

This paper explores some of the issues involved in the Genetic Modification (GM) debate by focusing on one crop that has been modified for pest resistance, cotton (Gossypium hirsutum), and commercially released to small-scale farmers in the Makhathini Flats, KwaZulu Natal, the Republic of South Africa. This was the first commercial release of a GM variety (Bt-cotton) in Sub-Saharan Africa, and thus provides valuable and timely insights into some of the potential advantages and disadvantages of the technology for small-scale farmers in Africa. Even though there are wider concerns regarding the vulnerability of small-scale farmers in the area, the survey results suggest that Bt-cotton generated higher yields and gross margins than non-Bt-cotton. In addition, Bt-cotton significantly reduced the use of pesticide with consequent potential benefits to human health and the environment.

Environmental impact of genetically modified cotton in South Africa

This paper presents the results of a large-scale study designed to monitor the impact arising from the introduction of insect-resistant Bt cotton in the Makhathini Flats, Republic of South Africa. Bt cotton provides a degree of resistance to cotton bollworm complex (Lepidoptera). Data were collected on the use of insecticides (type and quantity) as well as the farm-level economics of production from over 2200 farmers in three growing seasons (1998/1999, 1999/2000 and 2000/2001). and the results are discussed within the context of environmental impact brought about by insecticide. Over the three seasons of the study it was clear that Bt cotton provided benefits in terms of higher yield and gross margin relative to farmers growing conventional (non-Bt) cotton, and the benefits were particularly apparent for the smallest producers. Bt growers also used significantly less insecticide than growers of non-Bt cotton. Once quantities of insecticide applied to Bt and non-Bt cotton were converted into a Biocide Index and an Environmental Impact Quotient (EIQ) in order to allow for differences in terms of toxicity and persistence in the environment, it was apparent that the growing of Bt had a less negative impact on the environment. While this points to beneficial impacts on agricultural sustainability there are wider concerns regarding the vulnerability of resource-poor farmers in an area with limited (as yet) marketing options for their product and options for livelihood diversification both within and outside agriculture. Cotton producers in Makhathini are vulnerable as they rely on just One company for inputs (including, credit) and for their market. While Bt cotton provides benefits it does not in itself address some of the structural limitations that farmers face. (c) 2006 Elsevier B.V. All rights reserved.

Can genetically-modified cotton contribute to sustainable development in Africa?

Genetically modified (GM) crops and sustainable development remain the foci of much media attention, especially given current concerns about a global food crisis. However, whilst the latter is embraced with enthusiasm by almost all groups, GM crops generate very mixed views. Some countries have welcomed GM, but others, notably those in Europe, adopt a cautious stance. This article aims to review the contribution that GM crops can make to agricultural sustainability in the developing world. Following brief reviews of both issues and their linkages, notably the pros and cons of GM cotton as a contributory factor in sustainability, a number of case studies from resourcepoor cotton farmers in Makhathini Flats, South Africa, is presented for a six-year period. Data on expenditure, productivity and income indicate that Bacillus thuringiensis (Bt) cotton is advantageous because it reduces costs, for example, of pesticides, and increases income, and the indications are that those benefits continued over at least the six years covered by the studies. There are repercussions of the additional income in the households; debts are reduced and money is invested in children's education and in the farms. However, in the general GM debate, the results show that GM crops are not miracle products which alleviate poverty at a stroke, but nor is there evidence that they will cause the scale of environmental damage associated with indiscriminate pesticide use. Indeed, for some GM antagonists, perhaps even the majority, such debates are irrelevant – the transfer of genes between species is unnatural and unethical. For them, GM crops will never be acceptable despite the evidence and pressure to increase world food production.

Atmosphere feedbacks during ENSO in a coupled GCM with a modified atmospheric convection scheme

The too diverse representation of ENSO in a coupled GCM limits one’s ability to describe future change of its properties. Several studies pointed to the key role of atmosphere feedbacks in contributing to this diversity. These feedbacks are analyzed here in two simulations of a coupled GCM that differ only by the parameterization of deep atmospheric convection and the associated clouds. Using the Kerry–Emanuel (KE) scheme in the L’Institut Pierre-Simon Laplace Coupled Model, version 4 (IPSL CM4; KE simulation), ENSO has about the right amplitude, whereas it is almost suppressed when using the Tiedke (TI) scheme. Quantifying both the dynamical Bjerknes feedback and the heat flux feedback in KE, TI, and the corresponding Atmospheric Model Intercomparison Project (AMIP) atmosphere-only simulations, it is shown that the suppression of ENSO in TI is due to a doubling of the damping via heat flux feedback. Because the Bjerknes positive feedback is weak in both simulations, the KE simulation exhibits the right ENSO amplitude owing to an error compensation between a too weak heat flux feedback and a too weak Bjerknes feedback. In TI, the heat flux feedback strength is closer to estimates from observations and reanalysis, leading to ENSO suppression. The shortwave heat flux and, to a lesser extent, the latent heat flux feedbacks are the dominant contributors to the change between TI and KE. The shortwave heat flux feedback differences are traced back to a modified distribution of the large-scale regimes of deep convection (negative feedback) and subsidence (positive feedback) in the east Pacific. These are further associated with the model systematic errors. It is argued that a systematic and detailed evaluation of atmosphere feedbacks during ENSO is a necessary step to fully understand its simulation in coupled GCMs.

Hybridization between Brassica napus and B. rapa on a national scale in the United Kingdom

Measures blocking hybridization would prevent or reduce biotic or environmental change caused by gene flow from genetically modified (GM) crops to wild relatives. The efficacy of any such measure depends on hybrid numbers within the legislative region over the life-span of the GM cultivar. We present a national assessment of hybridization between rapeseed (Brassica napus) and B. rapa from a combination of sources, including population surveys, remote sensing, pollen dispersal profiles, herbarium data, local Floras, and other floristic databases. Across the United Kingdom, we estimate that 32,000 hybrids form annually in waterside B. rapa populations, whereas the less abundant weedy populations contain 17,000 hybrids. These findings set targets for strategies to eliminate hybridization and represent the first step toward quantitative risk assessment on a national scale.

The economic impact of genetically modified cotton on South African smallholders: Yield, profit and health effects

Results of a large-scale survey of resource-poor smallholder cotton farmers in South Africa over three years conclusively show that adopters of Bt cotton have benefited in terms of higher yields, lower pesticide use, less labour for pesticide application and substantially higher gross margins per hectare. These benefits were clearly related to the technology, and not to preferential adoption by farmers who were already highly efficient. The smallest producers are shown to have benefited from adoption of the Bt variety as much as, if not more than, larger producers. Moreover, evidence from hospital records suggests a link between declining pesticide poisonings and adoption of the Bt variety.

Comparative advantage in demand: Experimental evidence of preferences for genetically modified food in the United States and European Union

The United States (US) exports more than US$6 billion in agricultural commodities to the European Union (EU) each year, but one issue carries the potential to diminish this trade: use of biotechnology in food production. The EU has adopted more stringent policies towards biotechnology than the US. Understanding differences in European and American policies towards genetically modified (GM) foods requires a greater understanding of consumers' attitudes and preferences. This paper reports results from the first large-scale, cross-Atlantic study to analyse consumer demand for genetically modified food in a non-hypothetical market environment. We strongly reject the frequent if convenient assumption in trade theory that consumer preferences are identical across countries: the median level of compensation demanded by English and French consumers to consume a GM food is found to be more than twice that in any of the US locations. Results have important implications for trade theory, which typically focusses on differences in specialization, comparative advantage and factor endowments across countries, and for on-going trade disputes at the World Trade Organization.

Environmental impact of genetically modified cotton in South Africa

This paper presents the results of a large-scale study designed to monitor the impact arising from the introduction of insect-resistant Bt cotton in the Makhathini Flats, Republic of South Africa. Bt cotton provides a degree of resistance to cotton bollworm complex (Lepidoptera). Data were collected on the use of insecticides (type and quantity) as well as the farm-level economics of production from over 2200 farmers in three growing seasons (1998/1999, 1999/2000 and 2000/2001). and the results are discussed within the context of environmental impact brought about by insecticide. Over the three seasons of the study it was clear that Bt cotton provided benefits in terms of higher yield and gross margin relative to farmers growing conventional (non-Bt) cotton, and the benefits were particularly apparent for the smallest producers. Bt growers also used significantly less insecticide than growers of non-Bt cotton. Once quantities of insecticide applied to Bt and non-Bt cotton were converted into a Biocide Index and an Environmental Impact Quotient (EIQ) in order to allow for differences in terms of toxicity and persistence in the environment, it was apparent that the growing of Bt had a less negative impact on the environment. While this points to beneficial impacts on agricultural sustainability there are wider concerns regarding the vulnerability of resource-poor farmers in an area with limited (as yet) marketing options for their product and options for livelihood diversification both within and outside agriculture. Cotton producers in Makhathini are vulnerable as they rely on just One company for inputs (including, credit) and for their market. While Bt cotton provides benefits it does not in itself address some of the structural limitations that farmers face. (c) 2006 Elsevier B.V. All rights reserved.