Management of elderly patients with breast cancer: updated recommendations of the International Society of Geriatric Oncology (SIOG) and European Society of Breast Cancer Specialists (EUSOMA)

As the mean age of the global population increases, breast cancer in older individuals will be increasingly encountered in clinical practice. Management decisions should not be based on age alone. Establishing recommendations for management of older individuals with breast cancer is challenging because of very limited level 1 evidence in this heterogeneous population. In 2007, the International Society of Geriatric Oncology (SIOG) created a task force to provide evidence-based recommendations for the management of breast cancer in elderly individuals. In 2010, a multidisciplinary SIOG and European Society of Breast Cancer Specialists (EUSOMA) task force gathered to expand and update the 2007 recommendations. The recommendations were expanded to include geriatric assessment, competing causes of mortality, ductal carcinoma in situ, drug safety and compliance, patient preferences, barriers to treatment, and male breast cancer. Recommendations were updated for screening, primary endocrine therapy, surgery, radiotherapy, neoadjuvant and adjuvant systemic therapy, and metastatic breast cancer.

The spectacle of modernity: blood, microscopes and mirrors in Colonial Tanganyika

The chapter focuses on attempts to change and improve the subjects of the colonial regime in what was the British Protectorate of Tanganyika, contemporary Tanzania. The colonial project in Africa was surrounded by technology, ideology, and representations of modernity based on the application of instrumental rationality. Through the example of colonial practices to control sleeping sickness, it examines how local forms of knowledge and livelihoods were negated and counter-tendencies people generated, offering explanations for the predicament of the human condition consequent upon the colonial experience.

Conspicuous redemption? Reflections on the promises and perils of the 'celebritization' of climate change

With rising public awareness of climate change, celebrities have become an increasingly important community of non nation-state ‘actors’ influencing discourse and action, thereby comprising an emergent climate science–policy–celebrity complex. Some feel that these amplified and prominent voices contribute to greater public understanding of climate change science, as well as potentially catalyze climate policy cooperation. However, critics posit that increased involvement from the entertainment industry has not served to influence substantive long-term advancements in these arenas; rather, it has instead reduced the politics of climate change to the domain of fashion and fad, devoid of political and public saliency. Through tracking media coverage in Australia, Canada, the United States, and United Kingdom, we map out the terrain of a ‘Politicized Celebrity System’ in attempts to cut through dualistic characterizations of celebrity involvement in politics. We develop a classification system of the various types of climate change celebrity activities, and situate movements in contemporary consumer- and spectacle-driven carbon-based society. Through these analyses, we place dynamic and contested interactions in a spatially and temporally-sensitive ‘Cultural Circuits of Climate Change Celebrities’ model. In so doing, first we explore how these newly ‘authorized’ speakers and ‘experts’ might open up spaces in the public sphere and the science/policy nexus through ‘celebritization’ effects. Second, we examine how the celebrity as the ‘heroic individual’ seeking ‘conspicuous redemption’ may focus climate change actions through individualist frames. Overall, this paper explores potential promises, pitfalls and contradictions of this increasingly entrenched set of ‘agents’ in the cultural politics of climate change. Thus, as a form of climate change action, we consider whether it is more effective to ‘plant’ celebrities instead of trees.

Targeting myocardial remodelling to develop novel therapies for heart failure: a position paper from the Working Group on Myocardial Function of the European Society of Cardiology

The failing heart is characterized by complex tissue remodelling involving increased cardiomyocyte death, and impairment of sarcomere function, metabolic activity, endothelial and vascular function, together with increased inflammation and interstitial fibrosis. For years, therapeutic approaches for heart failure (HF) relied on vasodilators and diuretics which relieve cardiac workload and HF symptoms. The introduction in the clinic of drugs interfering with beta-adrenergic and angiotensin signalling have ameliorated survival by interfering with the intimate mechanism of cardiac compensation. Current therapy, though, still has a limited capacity to restore muscle function fully, and the development of novel therapeutic targets is still an important medical need. Recent progress in understanding the molecular basis of myocardial dysfunction in HF is paving the way for development of new treatments capable of restoring muscle function and targeting specific pathological subsets of LV dysfunction. These include potentiating cardiomyocyte contractility, increasing cardiomyocyte survival and adaptive hypertrophy, increasing oxygen and nutrition supply by sustaining vessel formation, and reducing ventricular stiffness by favourable extracellular matrix remodelling. Here, we consider drugs such as omecamtiv mecarbil, nitroxyl donors, cyclosporin A, SERCA2a (sarcoplasmic/endoplasmic Ca(2 +) ATPase 2a), neuregulin, and bromocriptine, all of which are currently in clinical trials as potential HF therapies, and discuss novel molecular targets with potential therapeutic impact that are in the pre-clinical phases of investigation. Finally, we consider conceptual changes in basic science approaches to improve their translation into successful clinical applications.