Multiarm, multistage randomized controlled trials with stopping boundaries for efficacy and lack of benefit: An update to nstage

Royston et al.’s (2011, Trials 12: 81) multiarm, multistage (MAMS) framework for the design of randomized clinical trials uses intermediate outcomes to drop research arms early for lack of benefit at interim stages, increasing efficiency in multiarm designs. However, additionally permitting interim evaluation of efficacy on the primary outcome measure could increase adoption of the design and result in practical benefits, such as savings in patient numbers and cost, should any efficacious arm be identified early. The nstage command, which aids the design of MAMS trial designs, has been updated to support this methodological extension. Operating characteristics can now be calculated for a design with binding or nonbinding stopping rules for lack of benefit and with efficacy stopping boundaries. An additional option searches for a design that strongly controls the familywise error rate at the desired level. We illustrate how the new features can be used to design a trial with the drop-down menu, using the original comparisons from the MAMS trial STAMPEDE as an example. The new functionality of the command will serve a broader range of trial objectives and increase efficiency of the design and thus increase uptake of the MAMS design in practice

Climate change impact on the leaching of a heavy metal contamination in a small lowland catchment

The objective of this study was to assess the potential effects of climate change on the transport of pre-existing spatially-extensive trace metal contamination to a small lowland catchment in the south of the Netherlands. The area surrounding the Keersop has been contaminated with heavy metals by the atmospheric emissions of four zinc ore smelters. This heavy metal contamination, e.g. with Cd and Zn, has accumulated in the topsoil and leaches towards surface water system, especially during high groundwater levels and high discharge rates. Simulated projections of future climate predict increased precipitation in winter, less precipitation in summer, and higher air temperatures throughout the year. These climate change scenarios projected lower groundwater levels and lower discharge rates. As a result of lower groundwater levels, transport of Cd and Zn towards surface water is also projected to decrease in the future climate. These results indicate a positive effect of climate change on a limited aspect of surface water quality

Climate change: Attitudes and concerns of, and learnings from, people with neurological conditions, carers, and health care professionals

\ua9 2023 The Authors. Epilepsia published by Wiley Periodicals LLC on behalf of International League Against Epilepsy. Objective: Concern about climate change among the general public is acknowledged by surveys. The health care sector must play its part in reducing greenhouse gas emissions and adapting to a changing climate, which will require the support of its stakeholders including those with epilepsy, who may be especially vulnerable. It is important to understand this community\u27s attitudes and concerns about climate change and societal responses. Methods: A survey was made available to more than 100 000 people among a section of the neurological community (patients, carers, and clinicians), focused on epilepsy. We applied quantitative analysis of Likert scale responses supported by qualitative analyses of free-text questions with crossover analyses to identify consonance and dissonance between the two approaches. Results: A small proportion of potential respondents completed the survey; of 126 respondents, 52 had epilepsy and 56 explicitly declared no illness. The survey indicated concern about the impact of climate change on health within this neurological community focused on epilepsy. More than half of respondents considered climate change to have been bad for their health, rising to 68% in a subgroup with a neurological condition; over 80% expected climate change to harm their health in future. Most (>75%) believed that action to reduce greenhouse gas emissions will lead to improved health and well-being. The crossover analysis identified cost and accessibility as significant barriers. Significance: The high level of concern about climate change impacts and positive attitudes toward policies to reduce greenhouse gas emissions provide support for climate action from the epilepsy community. However, if policies are implemented without considering the needs of patients, they risk being exclusionary, worsening inequalities, and further threatening neurological health and well-being

The effect of ball impact location on racket and forearm joint angle changes for one-handed tennis backhand groundstrokes

Recreational tennis players tend to have higher incidence of tennis elbow, and this has been hypothesised to be related to one-handed backhand technique and off-centre ball impacts on the racket face. This study aimed to investigate for a range of participants the effect of off-longitudinal axis and off-lateral axis ball-racket impact locations on racket and forearm joint angle changes immediately following impact in one-handed tennis backhand groundstrokes. Three-dimensional racket and wrist angular kinematic data were recorded for fourteen university tennis players each performing thirty ‘flat’ one-handed backhand groundstrokes. Off-longitudinal axis ball-racket impact locations explained over 70% of the variation in racket rotation about the longitudinal axis and wrist flexion / extension angles during the 30 ms immediately following impact. Off-lateral axis ball-racket impact locations had a less clear cut influence on racket and forearm rotations. Specifically off-longitudinal impacts below the longitudinal axis forced the wrist into flexion for all participants with there being between 11º and 32º of forced wrist flexion for an off-longitudinal axis impact that was one ball diameter away from the mid-line. This study has confirmed that off-longitudinal impacts below the longitudinal axis contribute to forced wrist flexion and eccentric stretch of the wrist extensors and there can be large differences in the amount of forced wrist flexion from individual to individual and between strokes with different impact locations

A COMPARISON OF SPRINT TECHNIQUE BETWEEN PROFESSIONAL FOOTBALL PLAYERS AND ELITE SPRINTERS

This study compared sprint technique between professional footballer players and elite sprinters. Professional football players sprint technique was assessed using 2D video analysis and compared to publicly available data of elite sprinters from the IAAF biomechanical reports. Results showed sprinters had higher step frequencies and contacted the ground further back, with lower touchdown and higher toe-off distances

Carbon emission savings and short-term health care impacts from telemedicine: An evaluation in epilepsy

Objective: Health systems make a sizeable contribution to national emissions of greenhouse gases that contribute to global climate change. The UK National Health Service is committed to being a net zero emitter by 2040, and a potential contribution to this target could come from reductions in patient travel. Achieving this will require actions at many levels. We sought to determine potential savings and risks over the short term from telemedicine through virtual clinics. Methods: During the severe acute respiratory syndrome coronavirus 2 (SARS-2-CoV) pandemic, scheduled face-to-face epilepsy clinics at a specialist site were replaced by remote teleclinics. We used a standard methodology applying conversion factors to calculate emissions based on the total saved travel distance. A further conversion factor was used to derive emissions associated with electricity consumption to deliver remote clinics from which net savings could be calculated. Patients’ records and clinicians were interrogated to identify any adverse clinical outcomes. Results: We found that enforced telemedicine delivery for over 1200 patients resulted in the saving of ~224 000 km of travel with likely avoided emissions in the range of 35 000–40 000 kg carbon dioxide equivalent (CO2e) over a six and half month period. Emissions arising directly from remote delivery were calculated to be <200 kg CO2e (~0.5% of those for travel), representing a significant net reduction of greenhouse gas emissions. Only one direct adverse outcome was identified, with some additional benefits identified anecdotally. Significance: The use of telemedicine can make a contribution toward reduced emissions in the health care sector and, in the delivery of specialized epilepsy services, had minimal adverse clinical outcomes over the short term. However, these outcomes will likely vary with clinic locations, medical specialties and conditions

Application of a stochastic weather generator to assess climate change impacts in a semi-arid climate: The Upper Indus Basin

Assessing local climate change impacts requires downscaling from Global Climate Model simulations. Here, a stochastic rainfall model (RainSim) combined with a rainfall conditioned weather generator (CRU WG) have been successfully applied in a semi-arid mountain climate, for part of the Upper Indus Basin (UIB), for point stations at a daily time-step to explore climate change impacts. Validation of the simulated time-series against observations (1961–1990) demonstrated the models’ skill in reproducing climatological means of core variables with monthly RMSE of <2.0 mm for precipitation and ⩽0.4 °C for mean temperature and daily temperature range. This level of performance is impressive given complexity of climate processes operating in this mountainous context at the boundary between monsoonal and mid-latitude (westerly) weather systems. Of equal importance the model captures well the observed interannual variability as quantified by the first and last decile of 30-year climatic periods. Differences between a control (1961–1990) and future (2071–2100) regional climate model (RCM) time-slice experiment were then used to provide change factors which could be applied within the rainfall and weather models to produce perturbed ‘future’ weather time-series. These project year-round increases in precipitation (maximum seasonal mean change:+27%, annual mean change: +18%) with increased intensity in the wettest months (February, March, April) and year-round increases in mean temperature (annual mean +4.8 °C). Climatic constraints on the productivity of natural resource-dependent systems were also assessed using relevant indices from the European Climate Assessment (ECA) and indicate potential future risk to water resources and local agriculture. However, the uniformity of projected temperature increases is in stark contrast to recent seasonally asymmetrical trends in observations, so an alternative scenario of extrapolated trends was also explored. We conclude that interannual variability in climate will continue to have the dominant impact on water resources management whichever trajectory is followed. This demonstrates the need for sophisticated downscaling methods which can evaluate changes in variability and sequencing of events to explore climate change impacts in this region

New age constraints for the Tommy Creek domain of the Mount Isa Inlier, Australia

The Tommy Creek Domain is a complex, yet little studied, terrane in the Eastern Subprovince of the Mount Isa Province, northwest Queensland Australia. In this study, we take advantage of modern low-cost and rapid geochronology techniques to undertake an iterative dating approach integrated with detailed fieldwork to define the ages and extents of numerous lithologies and units of the Tommy Creek Domain. This includes some units not previously identified, lithologies previously grouped together based on field observations but now shown to have multiple distinct ages and dates not commonly represented in Mount Isan time–space plots. We identify an episode of felsic magmatism at ca 1640 Ma, and multimodal intrusions (ca 1615 Ma) immediately preceding the onset of the Isan Orogeny. A major rock package of the Tommy Creek Domain, the Milo beds, are characterised here as the youngest pre-Isan Orogeny sedimentary unit in the Eastern Subprovince (1660–1620 Ma), confirming that sedimentation and possibly rifting continued after deposition of the Soldiers Cap, Mount Albert and Kuridala groups (ca 1690–1650 Ma) before the onset of the Isan Orogeny (ca 1600 Ma). The Milo beds are thus age equivalent to the Mount Isa and McNamara groups of the Western Succession. There is evidence of a compositional shift in sedimentation coincident with the ca 1640 Ma Riversleigh Inversion event, previously only observed in the Western Subprovince in the Lawn Hill Platform. The application of geochronology as part of the mapping workflow can assist with differentiating geological units in terranes where field evidence is ambiguous and can aid in the focusing of objectives for field campaigns to enable the best possible interpretations to be made