Medication use in older patients and age-blind approach: narrative literature review (insufficient evidence on the efficacy and safety of drugs in older age, frequent use of PIMs and polypharmacy, and underuse of highly beneficial nonpharmacological strat

IntroductionThe importance of rational drug therapy is increasing with the aging of the population. Since one of the main reasons for inappropriate drug prescribing is also the age-blind approach, which results in ageist practices, this narrative literature review focuses on the description of the main barriers related to insufficient individualization of drug regimens associated with such age-blind approaches.MethodologyA narrative literature review using the PubMed, WoS, Embase, and Scopus databases was conducted by the EU COST Action IS1402. Experts in different scientific fields from six countries (the Czech Republic, Spain, Portugal, Hungary, Serbia, and Turkey) worked in four specific areas: (1) underrepresentation of older adults in clinical trials and clinical and ethical consequences; (2) insufficient consideration of age-related changes and geriatric frailty in the evaluation of the therapeutic value of drugs; (3) frequent prescribing of potentially inappropriate medications (PIMs); and (4) frequent underuse of highly beneficial nonpharmacological strategies (e.g., exercise).ResultsOlder patients are underrepresented in clinical trials. Therefore, rigorous observational geriatric research is needed in order to obtain evidence on the real efficacy and safety of frequently used drugs, and e.g. developed geriatric scales and frailty indexes for claims databases should help to stimulate such research. The use of PIMs, unfortunately, is still highly prevalent in Europe: 22.6% in community-dwelling older patients and 49.0% in institutionalized older adults. Specific tests to detect the majority of age-related pharmacological changes are usually not available in everyday clinical practice, which limits the estimation of drug risks and possibilities to individualize drug therapy in geriatric patients before drug prescription. Moreover, the role of somenonpharmacological strategies is highly underestimated in older adultsin contrast to frequent use of polypharmacy. Among nonpharmacological strategies, particularly physical exercise was highly effective in reducing functional decline, frailty, and the risk of falls in the majority of clinicalstudies.ConclusionSeveral regulatory and clinical barriers contribute to insufficient knowledge on the therapeutic value of drugs in older patients, age-blind approach, and inappropriate prescribing. New clinical and observational research is needed, including data on comprehensive geriatric assessment and frailty, to document the real efficacy and safety of frequently used medications

How Modelers Model: the Overlooked Social and Human Dimensions in Model Intercomparison Studies

There is a growing realization that the complexity of model ensemble studies depends not only on the models used but also on the experience and approach used by modelers to calibrate and validate results, which remain a source of uncertainty. Here, we applied a multi-criteria decision-making method to investigate the rationale applied by modelers in a model ensemble study where 12 process-based different biogeochemical model types were compared across five successive calibration stages. The modelers shared a common level of agreement about the importance of the variables used to initialize their models for calibration. However, we found inconsistency among modelers when judging the importance of input variables across different calibration stages. The level of subjective weighting attributed by modelers to calibration data decreased sequentially as the extent and number of variables provided increased. In this context, the perceived importance attributed to variables such as the fertilization rate, irrigation regime, soil texture, pH, and initial levels of soil organic carbon and nitrogen stocks was statistically different when classified according to model types. The importance attributed to input variables such as experimental duration, gross primary production, and net ecosystem exchange varied significantly according to the length of the modeler’s experience. We argue that the gradual access to input data across the five calibration stages negatively influenced the consistency of the interpretations made by the modelers, with cognitive bias in “trial-and-error” calibration routines. Our study highlights that overlooking human and social attributes is critical in the outcomes of modeling and model intercomparison studies. While complexity of the processes captured in the model algorithms and parameterization is important, we contend that (1) the modeler’s assumptions on the extent to which parameters should be altered and (2) modeler perceptions of the importance of model parameters are just as critical in obtaining a quality model calibration as numerical or analytical details.info:eu-repo/semantics/acceptedVersio

WIMP physics with ensembles of direct-detection experiments

The search for weakly-interacting massive particle (WIMP) dark matter is multi-pronged. Ulti- mately, the WIMP-dark-matter picture will only be confirmed if different classes of experiments see consistent signals and infer the same WIMP properties. In this work, we review the ideas, meth- ods, and status of direct-detection searches. We focus in particular on extracting WIMP physics (WIMP interactions and phase-space distribution) from direct-detection data in the early discov- ery days when multiple experiments see of order dozens to hundreds of events. To demonstrate the essential complementarity of different direct-detection experiments in this context, we create mock data intended to represent the data from the near-future Generation 2 experiments. We consider both conventional supersymmetry-inspired benchmark points (with spin-independent and -dependent elastic cross sections just below current limits), as well as benchmark points for other classes of models (inelastic and effective-operator paradigms). We also investigate the effect on parameter estimation of loosening or dropping the assumptions about the local WIMP phase-space distribution. We arrive at two main conclusions. Firstly, teasing out WIMP physics with experi- ments depends critically on having a wide set of detector target materials, spanning a large range of target nuclear masses and spin-dependent sensitivity. It is also highly desirable to obtain data from low-threshold experiments. Secondly, a general reconstruction of the local WIMP velocity distribu- tion, which will only be achieved if there are multiple experiments using different target materials, is critical to obtaining a robust and unbiased estimate of the WIMP mass

All-sky Medium Energy Gamma-ray Observatory: Exploring the Extreme Multimessenger Universe

The All-sky Medium Energy Gamma-ray Observatory (AMEGO) is a probe class mission concept that will provide essential contributions to multimessenger astrophysics in the late 2020s and beyond. AMEGO combines high sensitivity in the 200 keV to 10 GeV energy range with a wide field of view, good spectral resolution, and polarization sensitivity. Therefore, AMEGO is key in the study of multimessenger astrophysical objects that have unique signatures in the gamma-ray regime, such as neutron star mergers, supernovae, and flaring active galactic nuclei. The order-of-magnitude improvement compared to previous MeV missions also enables discoveries of a wide range of phenomena whose energy output peaks in the relatively unexplored medium-energy gamma-ray band

Broadband Multi-wavelength Properties of M87 during the 2017 Event Horizon Telescope Campaign

Abstract: In 2017, the Event Horizon Telescope (EHT) Collaboration succeeded in capturing the first direct image of the center of the M87 galaxy. The asymmetric ring morphology and size are consistent with theoretical expectations for a weakly accreting supermassive black hole of mass ∼6.5 × 109 M ⊙. The EHTC also partnered with several international facilities in space and on the ground, to arrange an extensive, quasi-simultaneous multi-wavelength campaign. This Letter presents the results and analysis of this campaign, as well as the multi-wavelength data as a legacy data repository. We captured M87 in a historically low state, and the core flux dominates over HST-1 at high energies, making it possible to combine core flux constraints with the more spatially precise very long baseline interferometry data. We present the most complete simultaneous multi-wavelength spectrum of the active nucleus to date, and discuss the complexity and caveats of combining data from different spatial scales into one broadband spectrum. We apply two heuristic, isotropic leptonic single-zone models to provide insight into the basic source properties, but conclude that a structured jet is necessary to explain M87’s spectrum. We can exclude that the simultaneous γ-ray emission is produced via inverse Compton emission in the same region producing the EHT mm-band emission, and further conclude that the γ-rays can only be produced in the inner jets (inward of HST-1) if there are strongly particle-dominated regions. Direct synchrotron emission from accelerated protons and secondaries cannot yet be excluded

Dosage form data used for estimating pediatric antibiotic use

We aimed to report a simple estimation method to enable quantification of pediatric antibiotic exposure in large aggregated datasets. Secondly, we aimed to quantify and benchmark Hungarian pediatric antibiotic use. First we intended to examine whether a correlation existed between dosage form data and the patient’s age. Therefore, issued prescriptions were analyzed in pharmacies. As a correlation was found between the share of liquid oral antibacterial products and the rate of pediatric antibiotic prescriptions (R=0.884; p<0.001), we extrapolated this finding to a large aggregated dataset and estimated that 34.6% of prescriptions were issued for pediatric cases (95% confidence interval: 19.7–60.0). Taking into account the demography of the population, children were exposed to antibiotics three times more often than adults with a corresponding annual prescription rate of 2.6. We demonstrated that simple drug-related data can be linked to a patient-related measure as we found strong associations between dosage form data and patients’ age. Based on this association, massive pediatric antibiotic exposure was found. Due to the general availability of dosage form data and the ease of the estimation method, the reported concept can be used to quantify pediatric antibiotic use in large aggregated datasets or when age stratification is absent