Multiple sclerosis in the elderly: a retrospective cohort study.

BACKGROUND: There is a lack of knowledge of disease course, prognosis, comorbidities and potential treatments of elderly MS patients. OBJECTIVE: To characterize the disease course including disability progression and relapses, to quantify the use of DMTs and to identify comorbidities and risk factors for progression in elderly multiple sclerosis (MS) patients. METHODS: This is a retrospective study of 1200 Austrian MS patients older than 55 years as of May 1st, 2017 representing roughly one-third of all the MS patients of this age in Austria. Data were collected from 15 MS centers including demographics, first symptom at onset, number of relapses, evolvement of disability, medication, and comorbidities. RESULTS: Median observation time was 17.1 years with 957 (80%) relapsing and 243 (20%) progressive onsets. Average age at diagnosis was 45 years with a female predominance of 71%. Three-hundred and twenty-six (27%) patients were never treated with a DMT, while most treated patients received interferons (496; 41%) at some point. At last follow-up, 420 (35%) patients were still treated with a DMT. No difference was found between treated and never-treated patients in terms of clinical outcome; however, patients with worse disability progression had significantly more DMT switches. Pyramidal onset, number of comorbidities, dementia, epilepsy, and psychiatric conditions as well as a higher number of relapses were associated with worse outcome. The risk of reaching EDSS 6 rose with every additional comorbidity by 22%. In late and very-late-onset MS (LOMS, VLOMS) time to diagnosis took nearly twice the time compared to adult and early onset (AEOMS). The overall annualized relapse rate (ARR) decreased over time and patients with AEOMS had significantly higher ARR compared to LOMS and VLOMS. Four percent of MS patients had five medications or more fulfilling criteria of polypharmacy and 20% of psychiatric drugs were administered without a matching diagnosis. CONCLUSIONS: In this study, we identified number of comorbidities, pyramidal and cerebellar signs, and a higher number of relapses as unfavorable prognostic factors in elderly MS patients filling gaps of knowledge in patients usually underrepresented in clinical trials and may guide future therapeutic studies.

Reproducible research and GIScience: an evaluation using AGILE conference papers.

The demand for reproducible research is on the rise in disciplines concerned with data analysis and computational methods. Therefore, we reviewed current recommendations for reproducible research and translated them into criteria for assessing the reproducibility of articles in the field of geographic information science (GIScience). Using this criteria, we assessed a sample of GIScience studies from the Association of Geographic Information Laboratories in Europe (AGILE) conference series, and we collected feedback about the assessment from the study authors. Results from the author feedback indicate that although authors support the concept of performing reproducible research, the incentives for doing this in practice are too small. Therefore, we propose concrete actions for individual researchers and the GIScience conference series to improve transparency and reproducibility. For example, to support researchers in producing reproducible work, the GIScience conference series could offer awards and paper badges, provide author guidelines for computational research, and publish articles in Open Access formats.

Object view in spatial system dynamics: a grassland farming example.

Spatial system dynamics (SSD) models are typically implemented by linking stock variables to raster grids while the use of object representations of human artefacts such as buildings or ownership has been limited. This limitation is addressed by this article, which demonstrates the use of object representations in SSD. The objects are parcels of land that are attributed to grassland farms. The model simulates structural change in agriculture, i.e., change in the size of farms. The aim of the model is to reveal relations between structural change, farmland fragmentation and variable farmland quality. Results show that fragmented farms tend to become consolidated by structural change, whereas consolidated initial conditions result in a significant increase of fragmentation. Consolidation is reinforced by a dynamic land market and high transportation costs. The example demonstrates the capabilities of the object-based approach for integrating object geometries (parcel shapes) and relations between objects (distances between parcels) dynamically in SSD.

Spatial sensitivity of grassland yields to weather variations in Austria and its implications for the future.

Agricultural production fulfills economic, ecological and structural functions. Despite technological advances, agricultural production remains sensitive to climate variations. In central Europe, climate change is predicted to bring more rainfall in winter, less rainfall in summer, and increased drought risk among other effects. Grassland agriculture, which is the dominant land use in Alpine regions, may be significantly affected by these climatic changes in the future. Motivated by this issue, the susceptibility of grassland yields to weather variations in Austria is empirical evaluated as a case study. The major objective of this study is to derive spatially distributed indications for climate change exposure by assessing the impacts of weather variations on past yield. It is assumed that reduced water supply during summer constitutes a threat to grassland productivity in regions that are warmer and drier already today. On the contrary, increased spring temperatures may improve grassland productivity in cooler regions like Alpine valleys, since the earlier snow melt leads to an extension of the growth period. Regression analyses are used for evaluating the relation between yearly yields and spring temperatures or water supply in summer, respectively. Water supply is thereby expressed by aggregated precipitation sums and the Climatic Water Balance (CWB). Input data are a meteorological time series as well as yearly yields available for 25 years between 1970 and 2010 and 99 districts in Austria. Yearly yields show a significant (P < 0.05) and positive dependency on water supply in summer for the eastern Austrian lowlands. The combination of temperature in spring and CWB in summer is only significant for six districts in the east of Austria. The positive impact of higher spring temperatures could not be verified. Generally, the regression coefficients are not very high, which indicates that temperature and water supply do not fully describe grassland productivity. Projected climate change may increasingly constitute a risk to yield reliability in the east of the country. That in turn, requires consideration in agricultural development plans and a quantification of these impacts from a social-economic perspective.