Effect of patient age on management decisions in breast cancer: consensus from a national consultation

This qualitative study investigated the attitudes, perceptions, and practices of breast cancer specialists with reference to the effect of patient age on management decisions in breast cancer, and attempted to identify national consensus on this issue. One hundred thirty-three relevant specialists, including 75 surgeons and 43 oncologists, participated in a virtual consultation using e-mailed questionnaires and open-ended discussion documents, culminating in the development of proposed consensus statements sent to participants for validation. A strong consensus was seen in favor of incorporating minimum standards of diagnostic services, treatment, and care for older patients with breast cancer into relevant national guidance, endorsed by professional bodies. Similarly, an overwhelming majority of participants agreed that simple, evidence-based protocols or guidelines on standardizing assessment of biological and chronological age should be produced by the National Institute for Health and Clinical Excellence and the Scottish Medicines Consortium, developed in collaboration with specialist oncogeriatricians, and endorsed by professional bodies. A further recommendation that all breast cancer patient treatment and diagnostic procedures be undertaken in light of up-to-date, relevant scientific data met with majority support. This study was successful in gauging national specialist opinion regarding the effect of patient age on management decisions in breast cancer in the U.K.

Analysis of moisture variability in the European Centre for Medium-Range Weather Forecasts 15-year reanalysis over the tropical oceans

We compare European Centre for Medium-Range Weather Forecasts 15-year reanalysis (ERA-15) moisture over the tropical oceans with satellite observations and the U.S. National Centers for Environmental Prediction (NCEP) National Center for Atmospheric Research 40-year reanalysis. When systematic differences in moisture between the observational and reanalysis data sets are removed, the NCEP data show excellent agreement with the observations while the ERA-15 variability exhibits remarkable differences. By forcing agreement between ERA-15 column water vapor and the observations, where available, by scaling the entire moisture column accordingly, the height-dependent moisture variability remains unchanged for all but the 550–850 hPa layer, where the moisture variability reduces significantly. Thus the excess variation of column moisture in ERA-15 appears to originate in this layer. The moisture variability provided by ERA-15 is not deemed of sufficient quality for use in the validation of climate models.

The ERA-40 re-analysis

ERA-40 is a re-analysis of meteorological observations from September 1957 to August 2002 produced by the European Centre for Medium-Range Weather Forecasts (ECMWF) in collaboration with many institutions. The observing system changed considerably over this re-analysis period, with assimilable data provided by a succession of satellite-borne instruments from the 1970s onwards, supplemented by increasing numbers of observations from aircraft, ocean-buoys and other surface platforms, but with a declining number of radiosonde ascents since the late 1980s. The observations used in ERA-40 were accumulated from many sources. The first part of this paper describes the data acquisition and the principal changes in data type and coverage over the period. It also describes the data assimilation system used for ERA-40. This benefited from many of the changes introduced into operational forecasting since the mid-1990s, when the systems used for the 15-year ECMWF re-analysis (ERA-15) and the National Centers for Environmental Prediction/National Center for Atmospheric Research (NCEP/NCAR) re-analysis were implemented. Several of the improvements are discussed. General aspects of the production of the analyses are also summarized. A number of results indicative of the overall performance of the data assimilation system, and implicitly of the observing system, are presented and discussed. The comparison of background (short-range) forecasts and analyses with observations, the consistency of the global mass budget, the magnitude of differences between analysis and background fields and the accuracy of medium-range forecasts run from the ERA-40 analyses are illustrated. Several results demonstrate the marked improvement that was made to the observing system for the southern hemisphere in the 1970s, particularly towards the end of the decade. In contrast, the synoptic quality of the analysis for the northern hemisphere is sufficient to provide forecasts that remain skilful well into the medium range for all years. Two particular problems are also examined: excessive precipitation over tropical oceans and a too strong Brewer-Dobson circulation, both of which are pronounced in later years. Several other aspects of the quality of the re-analyses revealed by monitoring and validation studies are summarized. Expectations that the second-generation ERA-40 re-analysis would provide products that are better than those from the firstgeneration ERA-15 and NCEP/NCAR re-analyses are found to have been met in most cases. © Royal Meteorological Society, 2005. The contributions of N. A. Rayner and R. W. Saunders are Crown copyright.

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.

The APE atlas

This Atlas presents statistical analyses of the simulations submitted to the Aqua-Planet Experiment (APE) data archive. The simulations are from global Atmospheric General Circulation Models (AGCM) applied to a water-covered earth. The AGCMs include ones actively used or being developed for numerical weather prediction or climate research. Some are mature, application models and others are more novel and thus less well tested in Earth-like applications. The experiment applies AGCMs with their complete parameterization package to an idealization of the planet Earth which has a greatly simplified lower boundary that consists of an ocean only. It has no land and its associated orography, and no sea ice. The ocean is represented by Sea Surface Temperatures (SST) which are specified everywhere with simple, idealized distributions. Thus in the hierarchy of tests available for AGCMs, APE falls between tests with simplified forcings such as those proposed by Held and Suarez (1994) and Boer and Denis (1997) and Earth-like simulations of the Atmospheric Modeling Intercomparison Project (AMIP, Gates et al., 1999). Blackburn and Hoskins (2013) summarize the APE and its aims. They discuss where the APE fits within a modeling hierarchy which has evolved to evaluate complete models and which provides a link between realistic simulation and conceptual models of atmospheric phenomena. The APE bridges a gap in the existing hierarchy. The goals of APE are to provide a benchmark of current model behaviors and to stimulate research to understand the cause of inter-model differences., APE is sponsored by the World Meteorological Organization (WMO) joint Commission on Atmospheric Science (CAS), World Climate Research Program (WCRP) Working Group on Numerical Experimentation (WGNE). Chapter 2 of this Atlas provides an overview of the specification of the eight APE experiments and of the data collected. Chapter 3 lists the participating models and includes brief descriptions of each. Chapters 4 through 7 present a wide variety of statistics from the 14 participating models for the eight different experiments. Additional intercomparison figures created by Dr. Yukiko Yamada in AGU group are available at http://www.gfd-dennou.org/library/ape/comparison/. This Atlas is intended to present and compare the statistics of the APE simulations but does not contain a discussion of interpretive analyses. Such analyses are left for journal papers such as those included in the Special Issue of the Journal of the Meteorological Society of Japan (2013, Vol. 91A) devoted to the APE. Two papers in that collection provide an overview of the simulations. One (Blackburn et al., 2013) concentrates on the CONTROL simulation and the other (Williamson et al., 2013) on the response to changes in the meridional SST profile. Additional papers provide more detailed analysis of the basic simulations, while others describe various sensitivities and applications. The APE experiment data base holds a wealth of data that is now publicly available from the APE web site: http://climate.ncas.ac.uk/ape/. We hope that this Atlas will stimulate future analyses and investigations to understand the large variation seen in the model behaviors.

Infection Control in design and construction work

Objective: To clarify how infection control requirements are represented, communicated, and understood in work interactions through the medical facility construction project life cycle. To assist project participants with effective infection control management by highlighting the nature of such requirements and presenting recommendations to aid practice. Background: A 4-year study regarding client requirement representation and use on National Health Service construction projects in the United Kingdom provided empirical evidence of infection control requirement communication and understanding through design and construction work interactions. Methods: An analysis of construction project resources (e.g., infection control regulations and room data sheets) was combined with semi-structured interviews with hospital client employees and design and construction professionals to provide valuable insights into the management of infection control issues. Results: Infection control requirements are representationally indistinct but also omnipresent through all phases of the construction project life cycle: Failure to recognize their nature, relevance, and significance can result in delays, stoppages, and redesign work. Construction project resources (e.g., regulatory guidance and room data sheets) can mask or obscure the meaning of infection control issues. Conclusions: A preemptive identification of issues combined with knowledge sharing activities among project stakeholders can enable infection control requirements to be properly understood and addressed. Such initiatives should also reference existing infection control regulatory guidance and advice.