THE EFFECTS OF A MOUNTAIN ON THE PROPAGATION OF PRE-EXISTING CONVECTION FOR DIFFERENT FROUDE NUMBER FLOW REGIMES

In this research, the tendency for squall lines to stagnate upstream of mountain ranges is investigated through a series of 2-dimensional, idealized simulations where the basic state wind was varied from 1 m s−1 to 20 m s−1. These simulations included a set of simulations with no pre-existing convection but with a mountain (MO), a set with pre-existing convection, but no mountain (SO), and a set with both the pre-existing convection and the mountain (SM). These simulations show stagnation is dependent on the Froude number of the basic state flow with stagnation appearing to occur for smaller Froude number flow regimes. For subcritical Froude number flow, the greatest precipitation accumulations were found well upstream of the mountain. This maximum in precipitation was larger than that for either the MO and SO simulations and, additionally, was farther upstream than the maxima in either of these simulations. For critical Froude number flow, the SM simulations exhibited two precipitation maxima. The upstream maximum was colocated with the precipitation maximum in the SO simulation, while the downstream maxima was colated with that in the MO simulation. Finally, for supercritical flow, the precipitation maximum in the SM simulation was positioned over the peak of the mountain. This maximum was smaller than in the MO simulation

FORMATION AND MAINTENANCE MECHANISMS OF THE STABLE LAYER OVER THE PO VALLEY DURING MAP IOP-8

During Mesoscale Alpine Program (MAP) IOP-8, a strong stable layer formed over the Po Valley and northern Ligurian Sea. Based on observations, reanalysis data and prior studies, we hypothesize that differential advection (Lin et al., 2005) led to the formation of the stable layer and differential advection along with blocking of cool easterly flow by the western flank of the Alps over the Po Valley played significant roles in the maintenance of the stable layer. Numerical sensitivity tests with the MM5 model were performed to examine these possible formation and maintenance mechanisms of the IOP-8 stable layer. When the western flank of the Alps was removed, the stable layer still formed, but eroded more quickly and became much shallower and narrower at the later stage of IOP-8, which is consistent with the hypothesis. It was also found that the Dinaric Alps and evaporative cooling did not play significant roles in forming and maintaining the stable layer

EFFECTS OF MOIST FROUDE NUMBER AND OROGRAPHIC ASPECT RATIO ON A CONDITIONALLY UNSTABLE FLOW OVER A MESOSCALE MOUNTAIN

A series of idealized simulations for an unsaturated, conditionally unstable flow over a two-dimensional mountain ridge were performed to investigate how the unsaturated moist Froude number (Fw) and the aspect ratio of mountain height to half-width (h/a), affect the propagation, cloud type and rainfall amount of orographically induced precipitation systems. The moist Froude number (Fw) was varied by increasing or decreasing the basic state wind speed (U) while the aspect ratio was varied by increasing or decreasing the mountain half-width (a). For low Fw flows, the flow is in an upstream propagating regime and shows little or no sensitivity to changes in a. For moderate or large values of Fw, the flow shifts more toward a downstream propagating regime as a is decreased (i. e. as h/a is increased). The domain integrated accumulated precipitation was not sensitive to the aspect ratio. For a fixed h/a, the flow shifts more toward a downstream propagating flow regime as Fw is increased, a result that is consistent with previous research. Additionally, the results show that there is an increase in the domain integrated precipitation as Fw is increased

INFLUENCE OF THE APENNINES ON TRACK DEFLECTION OF GENOA CYCLONES

Observations of the MAP special observing period reveal two different track patterns for Genoa cyclones as they impinge on the Apennines. In some cases, the cyclones appear to be completely blocked by the orography and are deflected southward (e. g. IOP-1). In other cases, the cyclones do cross over the Apennines, but. experience a period wherein two surface cyclones exist, one on the upstream side and a new, secondary cyclone on the downstream side of the mountains. Aloft, the system propagates without stalling. With time, the upper level trough phases with the secondary cyclone and the secondary cyclone becomes the dominant feature. Such a track is referred to as a discontinuous, but not blocked track for the purposes of this research. One such case during MAP belonging to this category is IOP-8. The aim of this study is to understand the control parameters that dictate whether a cyclone is blocked and deflected or if it is discontinuous, but not blocked. Examination of observations as well as ECMWF reanalysis data shows there is a dependency on the vortex Froude number {Fvortex) with smaller values of Fvortex indicating a greater likelihood for cyclone blocking and deflection. However, numerical sensitivity experiments indicate there are other, more important control parameters that dictate the degree of track deflection

Adding 6 months of androgen deprivation therapy to postoperative radiotherapy for prostate cancer: a comparison of short-course versus no androgen deprivation therapy in the RADICALS-HD randomised controlled trial

Background Previous evidence indicates that adjuvant, short-course androgen deprivation therapy (ADT) improves metastasis-free survival when given with primary radiotherapy for intermediate-risk and high-risk localised prostate cancer. However, the value of ADT with postoperative radiotherapy after radical prostatectomy is unclear. Methods RADICALS-HD was an international randomised controlled trial to test the efficacy of ADT used in combination with postoperative radiotherapy for prostate cancer. Key eligibility criteria were indication for radiotherapy after radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to radiotherapy alone (no ADT) or radiotherapy with 6 months of ADT (short-course ADT), using monthly subcutaneous gonadotropin-releasing hormone analogue injections, daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as distant metastasis arising from prostate cancer or death from any cause. Standard survival analysis methods were used, accounting for randomisation stratification factors. The trial had 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 80% to 86% (hazard ratio [HR] 0·67). Analyses followed the intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov, NCT00541047. Findings Between Nov 22, 2007, and June 29, 2015, 1480 patients (median age 66 years [IQR 61–69]) were randomly assigned to receive no ADT (n=737) or short-course ADT (n=743) in addition to postoperative radiotherapy at 121 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 9·0 years (IQR 7·1–10·1), metastasis-free survival events were reported for 268 participants (142 in the no ADT group and 126 in the short-course ADT group; HR 0·886 [95% CI 0·688–1·140], p=0·35). 10-year metastasis-free survival was 79·2% (95% CI 75·4–82·5) in the no ADT group and 80·4% (76·6–83·6) in the short-course ADT group. Toxicity of grade 3 or higher was reported for 121 (17%) of 737 participants in the no ADT group and 100 (14%) of 743 in the short-course ADT group (p=0·15), with no treatment-related deaths. Interpretation Metastatic disease is uncommon following postoperative bed radiotherapy after radical prostatectomy. Adding 6 months of ADT to this radiotherapy did not improve metastasis-free survival compared with no ADT. These findings do not support the use of short-course ADT with postoperative radiotherapy in this patient population

Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial

Background Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. Methods RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov , NCT00541047 . Findings Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. Interpretation Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. Funding Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society

Supporting adolescents’ participation in muscle-strengthening physical activity: protocol for the ‘Resistance Training for Teens’ (RT4T) hybrid type III implementation–effectiveness trial

Introduction In Australia, only 22% of male and 8% of female adolescents meet the muscle-strengthening physical activity guidelines, and few school-based interventions support participation in resistance training (RT). After promising findings from our effectiveness trial, we conducted a state-wide dissemination of the ‘Resistance Training for Teens’ (RT4T) intervention from 2015 to 2020. Despite high estimated reach, we found considerable variability in programme delivery and teachers reported numerous barriers to implementation. Supporting schools when they first adopt evidence-based programmes may strengthen programme fidelity, sustainability, and by extension, programme impact. However, the most effective implementation support model for RT4T is unclear.Objective To compare the effects of three implementation support models on the reach (primary outcome), dose delivered, fidelity, sustainability, impact and cost of RT4T.Methods and analysis We will conduct a hybrid type III implementation–effectiveness trial involving grade 9 and 10 (aged 14–16 years) students from 90 secondary schools in New South Wales (NSW), Australia. Schools will be recruited across one cohort in 2023, stratified by school type, socioeconomic status and location, and randomised in a 1:1:1 ratio to receive one of the following levels of implementation support: (1) ‘low’ (training and resources), (2) ‘moderate’ (training and resources+external support) or ‘high’ (training and resources+external support+equipment). Training includes a teacher workshop related to RT4T programme content (theory and practical sessions) and the related resources. Additional support will be provided by trained project officers from five local health districts. Equipment will consist of a pack of semiportable RT equipment (ie, weighted bars, dumbbells, resistance bands and inverted pull up bar stands) valued at ~$A1000 per school. Study outcomes will be assessed at baseline (T0), 6 months (T1) and 18 months (T2). A range of quantitative (teacher logs, observations and teacher surveys) and qualitative (semistructured interviews with teachers) methods will be used to assess primary (reach) and secondary outcomes (dose delivered, fidelity, sustainability, impact and cost of RT4T). Quantitative analyses will use logistic mixed models for dichotomous outcomes, and ordinal or linear mixed effects regression models for continuous outcomes, with alpha levels set at p<0.025 for the outcomes and cost comparisons of the moderate and high support arms against the low support arm.Ethics and dissemination Ethics approval has been obtained from the University of Newcastle (H-2021-0418), the NSW Department of Education (SERAP:2022215), Hunter New England Human Research Ethics Committee (2023/ETH00052) and the Catholic Schools Office. The design, conduct and reporting will adhere to the Consolidated Standards of Reporting Trials statement, the Standards for Reporting Implementation Studies statement and the Template for Intervention Description and Replication checklist. Findings will be published in open access peer-reviewed journals, key stakeholders will be provided with a detailed report. We will support ongoing dissemination of RT4T in Australian schools via professional learning for teachers.Trial registration number ACTRN12622000861752