Modeling synergism in early phase cancer trials with drug combination with continuous dose levels: is there an added value?

In parametric Bayesian designs of early phase cancer clinical trials with drug combinations exploring a discrete set of partially ordered doses, several authors claimed that there is no added value in including an interaction term to model synergism between the two drugs. In this paper, we investigate these claims in the setting of continuous dose levels of the two agents. Parametric models will be used to describe the relationship between the doses of the two agents and the probability of dose limiting toxicity and efficacy. Trial design proceeds by treating cohorts of two patients simultaneously receiving different dose combinations and response adaptive randomization. We compare trial safety and efficiency of the estimated maximum tolerated dose (MTD) curve between models that include an interaction term with models without the synergism parameter with extensive simulations. Under a selected class of dose-toxicity models and dose escalation algorithm, we found that not including an interaction term in the model can compromise the safety of the trial and reduce the pointwise reliability of the estimated MTD curve.

Relative Humidity Predicts Day-to-Day Variations in COVID-19 Cases in the City of Buenos Aires.

Possible links between the transmission of COVID-19 and meteorology have been investigated by comparing positive cases across geographical regions or seasons. Little is known, however, about the degree to which environmental conditions modulate the daily dynamics of COVID-19 spread at a given location. One reason for this is that individual waves of the disease typically rise and decay too sharply, making it hard to isolate the contribution of meteorological cycles. To overcome this shortage, we here present a case study of the first wave of the outbreak in the city of Buenos Aires, which had a slow evolution of the caseload extending along most of 2020. We found that humidity plays a prominent role in modulating the variation of COVID-19 positive cases through a negative-slope linear relationship, with an optimal lag of 9 days between the meteorological observation and the positive case report. This relationship is specific to winter months, when relative humidity predicts up to half of the variance in positive case count. Our results provide a tool to anticipate possible local surges in COVID-19 cases after events of low humidity. More generally, they add to accumulating evidence pointing to dry air as a facilitator of COVID-19 transmission.

Natural and Anthropogenically Influenced Isoprene Oxidation in Southeastern United States and Central Amazon.

Anthropogenic emissions alter secondary organic aerosol (SOA) formation chemistry from naturally emitted isoprene. We use correlations of tracers and tracer ratios to provide new perspectives on sulfate, NOx, and particle acidity influencing isoprene-derived SOA in two isoprene-rich forested environments representing clean to polluted conditions-wet and dry seasons in central Amazonia and Southeastern U.S. summer. We used a semivolatile thermal desorption aerosol gas chromatograph (SV-TAG) and filter samplers to measure SOA tracers indicative of isoprene/HO2 (2-methyltetrols, C5-alkene triols, 2-methyltetrol organosulfates) and isoprene/NOx (2-methylglyceric acid, 2-methylglyceric acid organosulfate) pathways. Summed concentrations of these tracers correlated with particulate sulfate spanning three orders of magnitude, suggesting that 1 µg m-3 reduction in sulfate corresponds with at least ∼0.5 µg m-3 reduction in isoprene-derived SOA. We also find that isoprene/NOx pathway SOA mass primarily comprises organosulfates, ∼97% in the Amazon and ∼55% in Southeastern United States. We infer under natural conditions in high isoprene emission regions that preindustrial aerosol sulfate was almost exclusively isoprene-derived organosulfates, which are traditionally thought of as representative of an anthropogenic influence. We further report the first field observations showing that particle acidity correlates positively with 2-methylglyceric acid partitioning to the gas phase and negatively with the ratio of 2-methyltetrols to C5-alkene triols.

Organosulfates in aerosols downwind of an urban region in central Amazon.

Organosulfates are formed in the atmosphere from reactions between reactive organic compounds (such as oxidation products of isoprene) and acidic sulfate aerosol. Here we investigated speciated organosulfates in an area typically downwind of the city of Manaus situated in the Amazon forest in Brazil during "GoAmazon2014/5" in both the wet season (February-March) and dry season (August-October). We observe products consistent with the reaction of isoprene photooxidation products and sulfate aerosols, leading to formation of several types of isoprene-derived organosulfates, which contribute 3% up to 42% of total sulfate aerosol measured by aerosol mass spectrometry. During the wet season the average contribution of summed organic sulfate concentrations to total sulfate was 19 ± 10% and similarly during the dry season the contribution was 19 ± 8%. This is the highest fraction of speciated organic sulfate to total sulfate observed at any reported site. Organosulfates appeared to be dominantly formed from isoprene epoxydiols (IEPOX), averaging 104 ± 73 ng m-3 (range 15-328 ng m-3) during the wet season, with much higher abundance 610 ± 400 ng m-3 (range 86-1962 ng m-3) during the dry season. The concentration of isoprene-derived organic sulfate correlated with total inorganic sulfate (R2 = 0.35 and 0.51 during the wet and dry seasons, respectively), implying the significant influence of inorganic sulfate aerosol for the heterogeneous reactive uptake of IEPOX. Organosulfates also contributed to organic matter in aerosols (3.5 ± 1.9% during the wet season and 5.1 ± 2.5% during the dry season). The present study shows that an important fraction of sulfate in aerosols in the Amazon downwind of Manaus consists of multifunctional organic chemicals formed in the atmosphere, and that increased SO2 emissions would substantially increase SOA formation from isoprene.