The Paediatric Rheumatology International Trials Organisation provisional criteria for the evaluation of response to therapy in juvenile dermatomyositis.

Objective To develop a provisional definition for the evaluation of response to therapy in juvenile dermatomyositis (DM) based on the Paediatric Rheumatology International Trials Organisation juvenile DM core set of variables. Methods Thirty-seven experienced pediatric rheumatologists from 27 countries achieved consensus on 128 difficult patient profiles as clinically improved or not improved using a stepwise approach (patient's rating, statistical analysis, definition selection). Using the physicians' consensus ratings as the “gold standard measure,” chi-square, sensitivity, specificity, false-positive and-negative rates, area under the receiver operating characteristic curve, and kappa agreement for candidate definitions of improvement were calculated. Definitions with kappa values >0.8 were multiplied by the face validity score to select the top definitions. Results The top definition of improvement was at least 20% improvement from baseline in 3 of 6 core set variables with no more than 1 of the remaining worsening by more than 30%, which cannot be muscle strength. The second-highest scoring definition was at least 20% improvement from baseline in 3 of 6 core set variables with no more than 2 of the remaining worsening by more than 25%, which cannot be muscle strength (definition P1 selected by the International Myositis Assessment and Clinical Studies group). The third is similar to the second with the maximum amount of worsening set to 30%. This indicates convergent validity of the process. Conclusion We propose a provisional data-driven definition of improvement that reflects well the consensus rating of experienced clinicians, which incorporates clinically meaningful change in core set variables in a composite end point for the evaluation of global response to therapy in juvenile DM.

Interhemispheric gradient of atmospheric radiocarbon reveals natural variability of Southern Ocean winds

Tree ring Delta C-14 data (Reimer et al., 2004; McCormac et al., 2004) indicate that atmospheric Delta C-14 varied on multi-decadal to centennial timescales, in both hemispheres, over the period between AD 950 and 1830. The Northern and Southern Hemispheric Delta C-14 records display similar variability, but from the data alone is it not clear whether these variations are driven by the production of C-14 in the stratosphere (Stuiver and Quay, 1980) or by perturbations to exchanges between carbon reservoirs (Siegenthaler et al., 1980). As the sea-air flux of (CO2)-C-14 has a clear maximum in the open ocean regions of the Southern Ocean, relatively modest perturbations to the winds over this region drive significant perturbations to the interhemispheric gradient. In this study, model simulations are used to show that Southern Ocean winds are likely a main driver of the observed variability in the interhemispheric gradient over AD 950-1830, and further, that this variability may be larger than the Southern Ocean wind trends that have been reported for recent decades (notably 1980-2004). This interpretation also implies that there may have been a significant weakening of the winds over the Southern Ocean within a few decades of AD 1375, associated with the transition between the Medieval Climate Anomaly and the Little Ice Age. The driving forces that could have produced such a shift in the winds at the Medieval Climate Anomaly to Little Ice Age transition remain unknown. Our process-focused suite of perturbation experiments with models raises the possibility that the current generation of coupled climate and earth system models may underestimate the natural background multi-decadal- to centennial-timescale variations in the winds over the Southern Ocean.

Variability of the high-velocity outflow in the quasar PDS 456

We present a comparison of two Suzaku X-ray observations of the nearby (z = 0.184), luminous (L ∼ 10 erg s) type I quasar, PDS 456. A new 125 ks Suzaku observation in 2011 caught the quasar during a period of low X-ray flux and with a hard X-ray spectrum, in contrast with a previous 190 ks Suzaku observation in 2007 when the quasar appeared brighter and had a steep (Γ > 2) X-ray spectrum. The 2011 X-ray spectrum contains a pronounced trough near 9 keV in the quasar rest frame, which can be modeled with blueshifted iron K-shell absorption, most likely from the He- and H-like transitions of iron. The absorption trough is observed at a similar rest-frame energy as in the earlier 2007 observation, which appears to confirm the existence of a persistent high-velocity wind in PDS 456, at an outflow velocity of 0.25-0.30c. The spectral variability between 2007 and 2011 can be accounted for by variations in a partial covering absorber, increasing in covering fraction from the brighter 2007 observation to the hard and faint 2011 observation. Overall, the low-flux 2011 observation can be explained if PDS 456 is observed at relatively low inclination angles through a Compton-thick wind, originating from the accretion disk, which significantly attenuates the X-ray flux from the quasar. © 2014. The American Astronomical Society. All rights reserved.

Managing the variability of supply in the European power system with high wind energy penetration

The power system of the future will have a hierarchical structure created by layers of system control from via regional high-voltage transmission through to medium and low-voltage distribution. Each level will have generation sources such as large-scale offshore wind, wave, solar thermal, nuclear directly connected to this Supergrid and high levels of embedded generation, connected to the medium-voltage distribution system. It is expected that the fuel portfolio will be dominated by offshore wind in Northern Europe and PV in Southern Europe. The strategies required to manage the coordination of supply-side variability with demand-side variability will include large scale interconnection, demand side management, load aggregation and storage in the concept of the Supergrid combined with the Smart Grid. The design challenge associated with this will not only include control topology, data acquisition, analysis and communications technologies, but also the selection of fuel portfolio at a macro level. This paper quantifies the amount of demand side management, storage and so-called ‘back-up generation’ needed to support an 80% renewable energy portfolio in Europe by 2050.

Spatial and temporal variability of the freshwater reservoir effect (FRE) in lacustrine sediments in a cold climate zone, Northwest Territories (Canada)

Climate variability along the 600 km Tibbitt to Contwyoto Winter Road (TCWR) in central Northwest Territories is poorly understood. With the transportation of goods from Yellowknife to the mines projected to increase significantly as new mines open, it is critical that planners and mine developers have reasonable data on the future viability of the road, as alternative transportation costs (e.g. air transport) are prohibitively high.

The research presented here is part of a paleoclimate study based on the analysis of multiple proxy data derived from freeze cores in lakes along the TCWR.

Monitoring of lineage-specific chimaerism allows early prediction of response following donor lymphocyte infusions for relapsed chronic myeloid leukaemia

Donor lymphocyte infusions (DLI) have been shown to enhance the graft-versus-leukaemia (GVL) effect and induce haematological and molecular remission in patients with relapsed CML following allogeneic bone marrow transplantation (BMT). The potent donor cell-mediated cytolysis following DLI may lead to a short period of aplasia before the re-establishment of donor haematopoiesis. The absence of detectable donor cells in patients prior to DLI infusion may result in permanent aplasia in certain patients. We report on four patients who relapsed 1, 3, 6.5 and 7 years post-BMT for chronic phase CML and were treated with DLI from their original BMT donor. Polymorphic short tandem repeats (STRs) were used to assess haematological chimaerism both prior to and following DLI. At the time of relapse, STR-PCR indicated the presence of donor cells in all four patients, at levels ranging from 1-40%. A clinical and molecular response was seen in 4/4 patients following a short period of cytopenia and all patients remain in clinical remission with a follow-up of 2 months-3 years post-DLI. STR-PCR indicated that a response was occurring during the period of pancytopenia when metaphase analysis was unsuccessful. Lineage-specific analysis of the cellular response to DLI was monitored using STR-PCR of peripheral blood (PB) and bone marrow (BM) lymphocyte-enriched fractions and CD2-positive and -negative T cell fractions. In one patient BM and PB CD34-positive and -negative fractions were also assessed. A change in the ratio of donor:recipient cells in the PB lymphocyte fraction was the earliest molecular indication of an anti-leukaemic response. Subsequent conversion to donor chimaerism occurred in the other lineages and the granulocyte fraction was the last lineage to convert. In conclusion, lineage-specific STR-PCR permits detailed monitoring of subtle changes in donor/recipient cell dynamics in specific lineages following DLI during the crucial pancytopenic phase and may be a useful predictor of haematological response to DLI therapy.

Molecular predictors of response to antiangiogenesis therapies

Angiogenesis is a crucial component of tumor growth and metastasis. Targeting the vascular endothelial growth factor pathway represents therapeutic potentials for treating cancer. To date, 3 Food and Drug Administration-approved agents targeting angiogenesis have been developed, bevacizumab, sunitinib, and sorafenib. However, no validated biomarkers are available to identify those patients who are likely to benefit from antiangiogenesis therapy. Molecular biomarker research in antiangiogenesis inhibition is an actively growing field. Although current data are extremely promising, it is still uncertain which biomarker(s) can reliably predict their efficacy. With increasing numbers of inhibitors being developed, the need for biomarkers is more critical than ever. This review will focus on translational research that strives to identify molecular biomarkers (tissue, circulating and genomic) for approved antiangiogenesis therapies that can indicate benefit, resistance, and toxicity.