Emergent constraints for the climate system as effective parameters of bulk differential equations

Planning for the impacts of climate change requires accurate projections by Earth system models (ESMs). ESMs, as developed by many research centres, estimate changes to weather and climate as atmospheric greenhouse gases (GHGs) rise, and they inform the influential Intergovernmental Panel on Climate Change (IPCC) reports. ESMs are advancing the understanding of key climate system attributes. However, there remain substantial inter-ESM differences in their estimates of future meteorological change, even for a common GHG trajectory, and such differences make adaptation planning difficult. Until recently, the primary approach to reducing projection uncertainty has been to place an emphasis on simulations that best describe the contemporary climate. Yet a model that performs well for present-day atmospheric GHG levels may not necessarily be accurate for higher GHG levels and vice versa. A relatively new approach of emergent constraints (ECs) is gaining much attention as a technique to remove uncertainty between climate models. This method involves searching for an inter-ESM link between a quantity that we can also measure now and a second quantity of major importance for describing future climate. Combining the contemporary measurement with this relationship refines the future projection. Identified ECs exist for thermal, hydrological and geochemical cycles of the climate system. As ECs grow in influence on climate policy, the method is under intense scrutiny, creating a requirement to understand them better. We hypothesise that as many Earth system components vary in both space and time, their behaviours often satisfy large-scale differential equations (DEs). Such DEs are valid at coarser scales than the equations coded in ESMs which capture finer high-resolution grid-box-scale effects. We suggest that many ECs link to such effective hidden DEs implicit in ESMs and that aggregate small-scale features. An EC may exist because its two quantities depend similarly on an ESM-specific internal bulk parameter in such a DE, with measurements constraining and revealing its (implicit) value. Alternatively, well-established process understanding coded at the ESM grid box scale, when aggregated, may generate a bulk parameter with a common “emergent” value across all ESMs. This single emerging parameter may link uncertainties in a contemporary climate driver to those of a climate-related property of interest. In these circumstances, the EC combined with a measurement of the driver that is uncertain constrains the estimate of the climate-related quantity. We offer simple illustrative examples of these concepts with generic DEs but with their solutions placed in a conceptual EC framework.</p

Fatigue reduces the complexity of knee extensor torque during fatiguing sustained isometric contractions

The temporal structure, or complexity, of muscle torque output reflects the adaptability of motor control to changes in task demands. This complexity is reduced by neuromuscular fatigue during intermittent isometric contractions. We tested the hypothesis that sustained fatiguing isometric contractions would result in a similar loss of complexity. To that end, nine healthy participants performed, on separate days, sustained isometric contractions of the knee extensors at 20% MVC to task failure and at 100% MVC for 60 s. Torque and surface EMG signals were sampled continuously. Complexity and fractal scaling were quantified by calculating approximate entropy (ApEn) and the detrended fluctuation analysis (DFA) α scaling exponent. Global, central and peripheral fatigue were quantified using maximal voluntary contractions (MVCs) with femoral nerve stimulation. Fatigue reduced the complexity of both submaximal (ApEn from 1.02 ± 0.06 to 0.41 ± 0.04, P < 0.05) and maximal contractions (ApEn from 0.34 ± 0.05 to 0.26 ± 0.04, P < 0.05; DFA α from 1.41 ± 0.04 to 1.52 ± 0.03, P < 0.05). The losses of complexity were accompanied by significant global, central and peripheral fatigue (all P < 0.05). These results demonstrate that a fatigue-induced loss of torque complexity is evident not only during fatiguing intermittent isometric contractions, but also during sustained fatiguing contractions

A study of National Health Service management of chronic osteoarthritis and low back pain

AIM: To describe treatment and referral patterns and National Health Service resource use in patients with chronic pain associated with low back pain or osteoarthritis, from a Primary Care perspective. BACKGROUND: Osteoarthritis and low back pain are the two commonest debilitating causes of chronic pain, with high health and social costs, and particularly important in primary care. Understanding current practice and resource use in their management will inform health service and educational requirements and the design and optimisation of future care. METHOD: Multi-centre, retrospective, descriptive study of adults (⩾18 years) with chronic pain arising from low back pain or osteoarthritis, identified through primary care records. Five general practices in Scotland, England (two), Northern Ireland and Wales. All patients with a diagnosis of low back pain or osteoarthritis made on or before 01/09/2006 who had received three or more prescriptions for pain medication were identified and a sub-sample randomly selected then consented to an in-depth review of their medical records (n=264). Data on management of chronic pain were collected retrospectively from patients’ records for three years from diagnosis (‘newly diagnosed’ patients) or for the most recent three years (‘established’ patients). FINDINGS: Patients received a wide variety of pain medications with no overall common prescribing pattern. GP visits represented the majority of the resource use and ‘newly diagnosed’ patients were significantly more likely to visit their GP for pain management than ‘established’ patients. Although ‘newly diagnosed’ patients had more referrals outside the GP practice, the number of visits to secondary care for pain management was similar for both groups. CONCLUSION: This retrospective study confirmed the complexity of managing these causes of chronic pain and the associated high resource use. It provides an in-depth picture of prescribing and referral patterns and of resource use

Selective inhibition of FLT3 by gilteritinib in relapsed or refractory acute myeloid leukaemia: a multicentre, first-in-human, open-label, phase 1-2 study.

BackgroundInternal tandem duplication mutations in FLT3 are common in acute myeloid leukaemia and are associated with rapid relapse and short overall survival. The clinical benefit of FLT3 inhibitors in patients with acute myeloid leukaemia has been limited by rapid generation of resistance mutations, particularly in codon Asp835 (D835). We aimed to assess the highly selective oral FLT3 inhibitor gilteritinib in patients with relapsed or refractory acute myeloid leukaemia.MethodsIn this phase 1-2 trial, we enrolled patients aged 18 years or older with acute myeloid leukaemia who either were refractory to induction therapy or had relapsed after achieving remission with previous treatment. Patients were enrolled into one of seven dose-escalation or dose-expansion cohorts assigned to receive once-daily doses of oral gilteritinib (20 mg, 40 mg, 80 mg, 120 mg, 200 mg, 300 mg, or 450 mg). Cohort expansion was based on safety and tolerability, FLT3 inhibition in correlative assays, and antileukaemic activity. Although the presence of an FLT3 mutation was not an inclusion criterion, we required ten or more patients with locally confirmed FLT3 mutations (FLT3mut+) to be enrolled in expansion cohorts at each dose level. On the basis of emerging findings, we further expanded the 120 mg and 200 mg dose cohorts to include FLT3mut+ patients only. The primary endpoints were the safety, tolerability, and pharmacokinetics of gilteritinib. Safety and tolerability were assessed in the safety analysis set (all patients who received at least one dose of gilteritinib). Responses were assessed in the full analysis set (all patients who received at least one dose of study drug and who had at least one datapoint post-treatment). Pharmacokinetics were assessed in a subset of the safety analysis set for which sufficient data for concentrations of gilteritinib in plasma were available to enable derivation of one or more pharmacokinetic variables. This study is registered with ClinicalTrials.gov, number NCT02014558, and is ongoing.FindingsBetween Oct 15, 2013, and Aug 27, 2015, 252 adults with relapsed or refractory acute myeloid leukaemia received oral gilteritinib once daily in one of seven dose-escalation (n=23) or dose-expansion (n=229) cohorts. Gilteritinib was well tolerated; the maximum tolerated dose was established as 300 mg/day when two of three patients enrolled in the 450 mg dose-escalation cohort had two dose-limiting toxicities (grade 3 diarrhoea and grade 3 elevated aspartate aminotransferase). The most common grade 3-4 adverse events irrespective of relation to treatment were febrile neutropenia (97 [39%] of 252), anaemia (61 [24%]), thrombocytopenia (33 [13%]), sepsis (28 [11%]), and pneumonia (27 [11%]). Commonly reported treatment-related adverse events were diarrhoea (92 [37%] of 252]), anaemia (86 [34%]), fatigue (83 [33%]), elevated aspartate aminotransferase (65 [26%]), and increased alanine aminotransferase (47 [19%]). Serious adverse events occurring in 5% or more of patients were febrile neutropenia (98 [39%] of 252; five related to treatment), progressive disease (43 [17%]), sepsis (36 [14%]; two related to treatment), pneumonia (27 [11%]), acute renal failure (25 [10%]; five related to treatment), pyrexia (21 [8%]; three related to treatment), bacteraemia (14 [6%]; one related to treatment), and respiratory failure (14 [6%]). 95 people died in the safety analysis set, of which seven deaths were judged possibly or probably related to treatment (pulmonary embolism [200 mg/day], respiratory failure [120 mg/day], haemoptysis [80 mg/day], intracranial haemorrhage [20 mg/day], ventricular fibrillation [120 mg/day], septic shock [80 mg/day], and neutropenia [120 mg/day]). An exposure-related increase in inhibition of FLT3 phosphorylation was noted with increasing concentrations in plasma of gilteritinib. In-vivo inhibition of FLT3 phosphorylation occurred at all dose levels. At least 90% of FLT3 phosphorylation inhibition was seen by day 8 in most patients receiving a daily dose of 80 mg or higher. 100 (40%) of 249 patients in the full analysis set achieved a response, with 19 (8%) achieving complete remission, ten (4%) complete remission with incomplete platelet recovery, 46 (18%) complete remission with incomplete haematological recovery, and 25 (10%) partial remission INTERPRETATION: Gilteritinib had a favourable safety profile and showed consistent FLT3 inhibition in patients with relapsed or refractory acute myeloid leukaemia. These findings confirm that FLT3 is a high-value target for treatment of relapsed or refractory acute myeloid leukaemia; based on activity data, gilteritinib at 120 mg/day is being tested in phase 3 trials.FundingAstellas Pharma, National Cancer Institute (Leukemia Specialized Program of Research Excellence grant), Associazione Italiana Ricerca sul Cancro

Abelson kinase acts as a robust, multifunctional scaffold in regulating embryonic morphogenesis

Abelson family kinases (Abl) are key regulators of cell behavior and the cytoskeleton during development and in leukemia. Abl's SH3, SH2, and tyrosine kinase domains are joined via a linker to an F-actin-binding domain (FABD). Research on Abl's roles in cell culture led to several hypotheses for its mechanism of action: 1) Abl phosphorylates other proteins, modulating their activity. 2) Abl directly regulates the cytoskeleton via its cytoskeletal interaction domains, and/or 3) Abl is a scaffold for a signaling complex. The importance of these roles during normal development remains untested. We tested these mechanistic hypotheses during Drosophila morphogenesis using a series of mutants to examine Abl's many cell biological roles. Strikingly, Abl lacking the FABD fully rescued morphogenesis, cell shape change, actin regulation, and viability, while kinase dead Abl, though reduced in function, retained substantial rescuing ability in some but not all Abl functions. We also tested the function of four conserved motifs in the linker region, revealing a key role for a conserved PXXP motif known to bind Crk and Abi. We propose Abl acts as a robust multi-domain scaffold with different protein motifs and activities contributing differentially to diverse cellular behaviors

Acceleration of daily land temperature extremes and correlations with surface energy fluxes

Assessment of climate reanalysis data for land (ECMWF Re-Analysis v5; ERA5-Land) covering the last seven decades reveals regions where extreme daily mean temperatures are rising faster than the average rate of temperature rise of the 6 months of highest background warmth. However, such extreme temperature acceleration is very heterogeneous, occurring only in some places including regions of Europe, the western part of North America, parts of southeast Asia and much of South America. An ensemble average of Earth System Models (ESMs) over the same period also shows acceleration across land areas, but this enhancement is much more spatially uniform in the models than it is for ERA5-Land. Examination of projections from now to the end of the 21st Century, with ESMs driven by the highest emissions Shared Socio-economic Pathway scenario (SSP585) of future changes to atmospheric greenhouse gases, also reveals larger warming during extreme days for most land areas. The increase in high-temperature extremes is driven by different processes depending on location. In northern mid-latitudes, a key driver is often a decrease in the evaporative fraction of the available energy, consistent with soil drying. By contrast, the acceleration of high-temperature extremes in tropical Africa is primarily due to increased available energy. These two drivers combine via the surface energy balance to equal the sensible heat flux, which we find is often strongly correlated with the areas where the acceleration of high-temperature extremes is largest

A Systematic Mapping Approach of 16q12.2/FTO and BMI in More Than 20,000 African Americans Narrows in on the Underlying Functional Variation: Results from the Population Architecture using Genomics and Epidemiology (PAGE) Study

Genetic variants in intron 1 of the fat mass- and obesity-associated (FTO) gene have been consistently associated with body mass index (BMI) in Europeans. However, follow-up studies in African Americans (AA) have shown no support for some of the most consistently BMI-associated FTO index single nucleotide polymorphisms (SNPs). This is most likely explained by different race-specific linkage disequilibrium (LD) patterns and lower correlation overall in AA, which provides the opportunity to fine-map this region and narrow in on the functional variant. To comprehensively explore the 16q12.2/FTO locus and to search for second independent signals in the broader region, we fine-mapped a 646-kb region, encompassing the large FTO gene and the flanking gene RPGRIP1L by investigating a total of 3,756 variants (1,529 genotyped and 2,227 imputed variants) in 20,488 AAs across five studies. We observed associations between BMI and variants in the known FTO intron 1 locus: the SNP with the most significant p-value, rs56137030 (8.3×10-6) had not been highlighted in previous studies. While rs56137030was correlated at r2>0.5 with 103 SNPs in Europeans (including the GWAS index SNPs), this number was reduced to 28 SNPs in AA. Among rs56137030 and the 28 correlated SNPs, six were located within candidate intronic regulatory elements, including rs1421085, for which we predicted allele-specific binding affinity for the transcription factor CUX1, which has recently been implicated in the regulation of FTO. We did not find strong evidence for a second independent signal in the broader region. In summary, this large fine-mapping study in AA has substantially reduced the number of common alleles that are likely to be functional candidates of the known FTO locus. Importantly our study demonstrated that comprehensive fine-mapping in AA provides a powerful approach to narrow in on the functional candidate(s) underlying the initial GWAS findings in European populations

Taking Action Together: A YMCA-based protocol to prevent Type-2 Diabetes in high-BMI inner-city African American children

<p>Abstract</p> <p>Background</p> <p>Associated with a tripling in obesity since 1970, type 2 diabetes mellitus (T2DM) in children has risen 9-10 fold. There is a critical need of protocols for trials to prevent T2DM in children.</p> <p>Methods/Design</p> <p>This protocol includes the theory, development, evaluation components and lessons learned from a novel YMCA-based T2DM prevention intervention designed specifically for high-BMI African American children from disadvantaged, inner-city neighborhoods of Oakland, California. The intervention was developed on the basis of: review of epidemiological and intervention studies of pediatric T2DM; a conceptual theory (social cognitive); a comprehensive examination of health promotion curricula designed for children; consultation with research, clinical experts and practitioners and; input from community partners. The intervention, <it>Taking Action Together</it>, included culturally sensitive and age-appropriate programming on: healthy eating; increasing physical activity and, improving self esteem.</p> <p>Discussion</p> <p>Evaluations completed to date suggest that <it>Taking Action Together </it>may be an effective intervention, and results warrant an expanded evaluation effort. This protocol could be used in other community settings to reduce the risk of children developing T2DM and related health consequences.</p> <p>Trial registration</p> <p>ClinicalTrials.gov NCT01039116.</p