Patient selection for oncology phase I trials: a multi-institutional study of prognostic factors.

PURPOSE The appropriate selection of patients for early clinical trials presents a major challenge. Previous analyses focusing on this problem were limited by small size and by interpractice heterogeneity. This study aims to define prognostic factors to guide risk-benefit assessments by using a large patient database from multiple phase I trials. PATIENTS AND METHODS Data were collected from 2,182 eligible patients treated in phase I trials between 2005 and 2007 in 14 European institutions. We derived and validated independent prognostic factors for 90-day mortality by using multivariate logistic regression analysis. Results The 90-day mortality was 16.5% with a drug-related death rate of 0.4%. Trial discontinuation within 3 weeks occurred in 14% of patients primarily because of disease progression. Eight different prognostic variables for 90-day mortality were validated: performance status (PS), albumin, lactate dehydrogenase, alkaline phosphatase, number of metastatic sites, clinical tumor growth rate, lymphocytes, and WBC. Two different models of prognostic scores for 90-day mortality were generated by using these factors, including or excluding PS; both achieved specificities of more than 85% and sensitivities of approximately 50% when using a score cutoff of 5 or higher. These models were not superior to the previously published Royal Marsden Hospital score in their ability to predict 90-day mortality. CONCLUSION Patient selection using any of these prognostic scores will reduce non-drug-related 90-day mortality among patients enrolled in phase I trials by 50%. However, this can be achieved only by an overall reduction in recruitment to phase I studies of 20%, more than half of whom would in fact have survived beyond 90 days.

Towards a better understanding of the nature and contribution of the interflow to catchment dynamics.

A detailed understanding of flow and contaminant transfer along each of the key hydrological pathways within a catchment is critical for designing and implementing cost effective Programmes of Measures under the Water
Framework Directive.
The Contaminant Movement along Pathways Project (’The Pathways Project’) is an Irish, EPA STRIVE funded, large multi-disciplinary project which is focussed on understanding and modelling flow and attenuation along each of these pathways for the purposes of developing a catchment management tool. The tool will be used by EPA and RBD catchment managers to assess and manage the impacts of diffuse contamination on stream aquatic ecology. Four main contaminants of interest — nitrogen, phosphorus, sediment and pathogens — are being
investigated in four instrumented test catchments. In addition to the usual hydrological and water chemistry/quality parameters typically captured in catchment studies, field measurements at the test catchments include ecological
sampling, sediment dynamics, soil moisture dynamics, and groundwater levels and chemistry/quality, both during and between significant rainfall events. Spatial and temporal sampling of waters directly from the pathways of
interest is also being carried out.
Sixty-five percent of Ireland is underlain by poorly productive aquifers. In these hydrogeological settings, the main pathways delivering flow to streams are overland flow, interflow and shallow bedrock flow. Little is
known about the interflow pathway and its relative importance in delivery of flow and contaminants to the streams. Interflow can occur in both the topsoil and subsoil, and may include unsaturated matrix flow, bypass or macropore
flow, saturated flow in locally perched water tables and artificial field drainage.
Results to date from the test catchment experiments show that artificial field drains play an important role in the delivery of interflow to these streams, during and between rainfall events when antecedent conditions are
favourable. Hydrochemical mixing models, using silica and SAC254 (the absorbance of UV light at a wavelength of 254 nm which is a proxy for dissolved organic matter) as tracers, show that drain flow is an important end
member contributing to the stream and that proportionally, its contribution is relatively high.
Results from the study also demonstrate that waters originating from one pathway often mix with the waters from another, and are subsequently delivered to the stream at rates, and with chemical/quality characteristics,
that are not typical of either pathway. For example, pre-event shallow groundwater not far from the catchment divide comes up to the surface as rejected recharge during rainfall events and is rapidly delivered to the stream
via overland flow and/or artificial land drainage, bringing with it higher nitrate than would often be expected from a quickflow pathway contribution. This is contrary to the assumption often made in catchment studies that the
deeper hydrological pathways have slower response times in stream hydrographs during a rainfall event, and it emphasizes that it is critical to have a strong three-dimensional conceptual model as the basis for the interpretation
of catchment data.

A multi-center study of ACE and the risk of late-onset Alzheimer's disease

A key pathological feature of late-onset Alzheimer's disease (LOAD) is the abnormal extracellular accumulation of the amyloid-ß (Aß) peptide. Thus, altered Aß degradation could be a major contributor to the development of LOAD. Variants in the gene encoding the Aß-degrading enzyme, angiotensin-1 converting enzyme (ACE) therefore represent plausible candidates for association with LOAD pathology and risk. Following Alzgene meta-analyses of all published case-control studies, the ACE variants rs4291 and rs1800764 showed significant association with LOAD risk. Furthermore ACE haplotypes are associated with both plasma ACE levels and LOAD risk. We tested three ACE variants (rs4291, rs4343, and rs1800764) for association with LOAD in ten Caucasian case-control populations (n = 8,212). No association was found using multiple logistic models (all p > 0.09). We found no population heterogeneity (all p > 0.38) or evidence for association with LOAD risk following meta-analysis of the ten populations for rs4343 (OR = 1.00), rs4291 (OR = 0.97), or rs1800764 (OR = 0.99). Although we found no haplotypic association in our complete dataset (p = 0.51), a significant global haplotypic p-value was observed in one population (p = 0.007) due to an association of the H3 haplotype (OR = 0.72, p = 0.02) and a trend towards an association of H4 (OR = 1.38, p = 0.09) and H7 (OR = 2.07, p = 0.08) although these did not survive Bonferroni correction. Previously reported associations of ACE variants with LOAD will be diminished following this study. At best, ACE variants have modest effect sizes, which are likely part of a complex interaction between genetic, phenotypic and pharmacological effects that would be undetected in traditional case-control studies.

Assessing modern ground survey methods and airborne laser scanning for digital terrain modelling:A case study from the Lake District, England

This paper compares the applicability of three ground survey methods for modelling terrain: one man electronic tachymetry (TPS), real time kinematic GPS (GPS), and terrestrial laser scanning (TLS). Vertical accuracy of digital terrain models (DTMs) derived from GPS, TLS and airborne laser scanning (ALS) data is assessed. Point elevations acquired by the four methods represent two sections of a mountainous area in Cumbria, England. They were chosen so that the presence of non-terrain features is constrained to the smallest amount. The vertical accuracy of the DTMs was addressed by subtracting each DTM from TPS point elevations. The error was assessed using exploratory measures including statistics, histograms, and normal probability plots. The results showed that the internal measurement accuracy of TPS, GPS, and TLS was below a centimetre. TPS and GPS can be considered equally applicable alternatives for sampling the terrain in areas accessible on foot. The highest DTM vertical accuracy was achieved with GPS data, both on sloped terrain (RMSE 0.16. m) and flat terrain (RMSE 0.02. m). TLS surveying was the most efficient overall but veracity of terrain representation was subject to dense vegetation cover. Therefore, the DTM accuracy was the lowest for the sloped area with dense bracken (RMSE 0.52. m) although it was the second highest on the flat unobscured terrain (RMSE 0.07. m). ALS data represented the sloped terrain more realistically (RMSE 0.23. m) than the TLS. However, due to a systematic bias identified on the flat terrain the DTM accuracy was the lowest (RMSE 0.29. m) which was above the level stated by the data provider. Error distribution models were more closely approximated by normal distribution defined using median and normalized median absolute deviation which supports the use of the robust measures in DEM error modelling and its propagation. © 2012 Elsevier Ltd.

Rapid changes in the level of Kluane Lake in Yukon Territory over the last millennium

The level of Kluane Lake, the largest lake in Yukon Territory, was lower than at present during most of the Holocene. The lake rose rapidly in the late seventeenth century to a level 12 m above present, drowning forest and stranding driftwood on a conspicuous high-stand beach, remnants of which are preserved at the south end of the lake. Kluane Lake fell back to near its present level by the end of the eighteenth century and has fluctuated within a range of about 3 m over the last 50 yr. The primary control on historic fluctuations in lake level is the discharge of Slims River, the largest source of water to the lake. We use tree ring and radiocarbon ages, stratigraphy and sub-bottom acoustic data to evaluate two explanations for the dramatic changes in the level of Kluane Lake. Our data support the hypothesis of Hugh Bostock, who suggested in 1969 that the maximum Little Ice Age advance of Kaskawulsh Glacier deposited large amounts of sediment in the Slims River valley and established the present course of Slims River into Kluane Lake. Bostock argued that these events caused the lake to rise and eventually overflow to the north. The overflowing waters incised the Duke River fan at the north end of Kluane Lake and lowered the lake to its present level. This study highlights the potentially dramatic impacts of climate change on regional hydrology during the Little Ice Age in glacierised mountains. © 2006 University of Washington.

Oxygen isotopes from Phorcus (Osilinus) turbinatus shells as a proxy for sea surface temperature in the central Mediterranean: a case study from Malta.

The marine topshell, Phorcus (Osilinus) turbinatus, is a common component of many archaeological sites in the Mediterranean. This species has been successfully used as a palaeoclimate proxy in Italy. To test whether d18O from P. turbinatus shells can serve as a reliable palaeoclimate archive for other regions of the Mediterranean, we collected live P. turbinatus from the northeast coast of Malta each month for a year. The d18OSHELL values of the outermost growth increments of these live-collected shells ranged between-0.4 and+2.4‰. These values correspond to growing temperatures calculated from shell edge d18O of between 15 °C and 27 °C. Calculated shell edge sea surface temperatures are highly correlated with instrumental records of sea surface temperature recorded over the period of collection. The individuals analysed for this study are smaller than P. turbinatus from populations studied elsewhere in the Mediterranean. Nonetheless, d18OSHELL provides a robust record of sea surface temperatures, suggesting that smaller/younger shells in archaeological deposits can still provide reliable palaeothermometry records. This study extends the upper growth limit P. turbinatus by 2 °C compared with the previous studies of P. turbinatus in the Mediterranean and suggests that, contrary to the previous studies, growth shutdown does not occur in all P. turbinatus when sea surface temperatures exceed 25 °C. This may reflect the higher sample resolution that can be obtained from smaller/faster growing shells, or it may reflect actual higher growth tolerances of P. turbinatus populations in Malta. By showing that P. turbinatus precipitate their shells in d18O equilibrium with surrounding sea water, this study reinforces the potential for the stable isotope chemistry of P. turbinatus shells preserved in Mediterranean archaeological sites to provide a window into the climate and seasonality regimes of the past.

Vegetation changes and human settlement of Easter Island during the last millennia: a multiproxy study of the Lake Raraku sediments

Earlier palynological studies of lake sediments from Easter Island suggest that the island underwent a recent and abrupt replacement of palm-dominated forests by grasslands, interpreted as a deforestation by indigenous people. However, the available evidence is inconclusive due to the existence of extended hiatuses and ambiguous chronological frameworks in most of the sedimentary sequences studied. This has given rise to an ongoing debate about the timing and causes of the assumed ecological degradation and cultural breakdown. Our multiproxy study of a core recovered from Lake Raraku highlights the vegetation dynamics and environmental shifts in the catchment and its surroundings during the late Holocene. The sequence contains shorter hiatuses than in previously recovered cores and provides a more continuous history of environmental changes. The results show a long, gradual and stepped landscape shift from palm-dominated forests to grasslands. This change started c. 450 BC and lasted about two thousand years. The presence of Verbena litoralis, a common weed, which is associated with human activities in the pollen record, the significant correlation between shifts in charcoal influx, and the dominant pollen types suggest human disturbance of the vegetation. Therefore, human settlement on the island occurred c. 450 BC, some 1500 years earlier than is assumed. Climate variability also exerted a major influence on environmental changes. Two sedimentary gaps in the record are interpreted as periods of droughts that could have prevented peat growth and favoured its erosion during the Medieval Climate Anomaly and the Little Ice Age, respectively. At c. AD 1200, the water table rose and the former Raraku mire turned into a shallow lake, suggesting higher precipitation/evaporation rates coeval with a cooler and wetter Pan-Pacific AD 1300 event. Pollen and diatom records show large vegetation changes due to human activities c. AD 1200. Other recent vegetation changes also due to human activities entail the introduction of taxa (e.g. Psidium guajava, Eucalyptus sp.) and the disappearance of indigenous plants such as Sophora toromiro during the two last centuries. Although the evidence is not conclusive, the American origin of V. litoralis re-opens the debate about the possible role of Amerindians in the human colonisation of Easter Island.