Stable ischemic heart disease in the older adults

Ischemic heart disease is caused by atherosclerotic and/or thrombotic obstruction of coronary arteries. Clinical spectrum of ischemic heart disease expands from asymptomatic atherosclerosis of coronary arteries to acute coronary syndromes (ACS) including unstable angina, acute myocardial infarction (non-ST elevation myocardial infarction and ST elevation myocardial infarction). Stable ischemic heart disease (SIHD) refers to patients with known or suspected SIHD who have no recent or acute changes in their symptomatic status, suggesting no active thrombotic process is underway. These patients include those with (1) recent-onset or stable angina or ischemic equivalent symptoms, such as dyspnea or arm pain with exertion; (2) post-ACS stabilized after revascularization or medical therapy; and (3) asymptomatic SIHD diagnosed by abnormal stress tests or imaging studies. This review summarizes clinical features and management of SIHD in the older adult. ACS in older adults is not considered in this review

CD4−CD8− T cells control intracellular bacterial infections both in vitro and in vivo

Memory T cells, including the well-known CD4+ and CD8+ T cells, are central components of the acquired immune system and are the basis for successful vaccination. After infection, CD4+ and CD8+ T cells expand into effector cells, and then differentiate into long-lived memory cells. We show that a rare population of CD4−CD8−CD3+αβ+γδ−NK1.1− T cells has similar functions. These cells potently and specifically inhibit the growth of the intracellular bacteria Mycobacterium tuberculosis (M. tb.) or Francisella tularensis Live Vaccine Strain (LVS) in macrophages in vitro, promote survival of mice infected with these organisms in vivo, and adoptively transfer immunity to F. tularensis LVS. Furthermore, these cells expand in the spleens of mice infected with M. tb. or F. tularensis LVS, and then acquire a memory cell phenotype. Thus, CD4−CD8− T cells have a role in the control of intracellular infection and may contribute to successful vaccination

Time for a European initiative for research to prevent cancer: A manifesto for Cancer Prevention Europe (CPE)

A landmark resolution on cancer prevention and control was adopted by Member States at the World Health Assembly 2017, noting that “risk reduction has the potential to prevent around half of all cancers” and urging “to promote cancer research to improve the evidence base for cancer prevention and control”. Public health oriented strategies for cancer prevention and their optimal application in effective real-life programmes will be vital to circumvent the dramatic health and economic implications of a strategy and healthcare expenditure based primarily on cancer treatment. The inter-disciplinary nature of cancer prevention stretches from the sub-microscopic study of cancer pathways through to the supra-macroscopic analysis of the “causes of the causes”, encompassing socio-economic and environmental factors. Research is required to provide new evidence-based preventive interventions and to understand the factors that hamper their implementation within health care systems and in the community. Successful implementation of cancer prevention requires long-term vision, a dedicated research agenda and funding, sustainable infrastructure and cooperation between countries and programmes. In order to develop world class prevention research in Europe that translates into effective cancer prevention guidelines and policies, we report on the creation of Cancer Prevention Europe. This international and multidisciplinary consortium of research institutes, organisations and networks of excellence with a common mission of reducing cancer morbidity and mortality in European populations through prevention, brings together different fields of expertise, from laboratory science through to policy research, as well as dissemination of the best evidence, the best quality indicators and the best practices used

Cancer Prevention Europe

The case for cancer prevention in Europe is the same as for all other parts of the world. The number of cancers is increasing, driven by demographic change and evolution in the exposure to risk factors, while the cost of treating patients is likewise spiralling. Estimations suggest that around 40% of cancers in Europe could be prevented if current understanding of risk and protective factors was translated into effective primary prevention, with further reductions in cancer incidence and mortality by screening, other approaches to early detection, and potentially medical prevention. However, the infrastructure for cancer prevention tends to be fragmented between and within different countries in Europe. This lack of a coordinated approach recently led to the foundation of Cancer Prevention Europe (Forman et al., 2018), a collaborative network with the main aims of strengthening cancer prevention in Europe by increasing awareness of the needs, the associated required resources and reducing inequalities in access to cancer prevention across Europe. This article showcases the need for strengthening cancer prevention and introduces the objectives of Cancer Prevention Europe and its foreseen future role in reducing the European cancer burden.</p

The mediating effect of task presentation on collaboration and children's acquisition of scientific reasoning

There has been considerable research concerning peer interaction and the acquisition of children's scientific reasoning. This study investigated differences in collaborative activity between pairs of children working around a computer with pairs of children working with physical apparatus and related any differences to the development of children's scientific reasoning. Children aged between 9 and 10 years old (48 boys and 48 girls) were placed into either same ability or mixed ability pairs according to their individual, pre-test performance on a scientific reasoning task. These pairs then worked on either a computer version or a physical version of Inhelder and Piaget's (1958) chemical combination task. Type of presentation was found to mediate the nature and type of collaborative activity. The mixed-ability pairs working around the computer talked proportionally more about the task and management of the task; had proportionally more transactive discussions and used the record more productively than children working with the physical apparatus. Type of presentation was also found to mediated children's learning. Children in same ability pairs who worked with the physical apparatus improved significantly more than same ability pairs who worked around the computer. These findings were partially predicted from a socio-cultural theory and show the importance of tools for mediating collaborative activity and collaborative learning

Geriatric Cardiology: Coming of Age

Older adults with cardiovascular disease (CVD) contend with deficits across multiple domains of health due to age-related physiological changes and the impact of CVD. Multimorbidity, polypharmacy, cognitive changes, and diminished functional capacity, along with changes in the social environment, result in complexity that makes provision of CVD care to older adults challenging. In this review, we first describe the history of geriatric cardiology, an orientation that acknowledges the unique needs of older adults with CVD. Then, we introduce 5 essential principles for meeting the needs of older adults with CVD: 1) recognize and consider the potential impact of multicomplexity; 2) evaluate and integrate constructs of cognition into decision-making; 3) evaluate and integrate physical function into decision-making; 4) incorporate social environmental factors into management decisions; and 5) elicit patient priorities and health goals and align with care plan. Finally, we review future steps to maximize care provision to this growing population

SDSS-IV MaNGA: the spatial distribution of star formation and its dependence on mass, structure, and environment

We study the spatially resolved star formation of 1494 galaxies in the SDSS-IV MaNGA Survey. Star formation rates (SFRs) are calculated using a two-step process, using H α in star-forming regions and Dn4000 in regions identified as active galactic nucleus/low-ionization (nuclear) emission region [AGN/LI(N)ER] or lineless. The roles of secular and environmental quenching processes are investigated by studying the dependence of the radial profiles of specific star formation rate on stellar mass, galaxy structure, and environment. We report on the existence of ‘centrally suppressed’ galaxies, which have suppressed Specific Star Formation Rate (SSFR) in their cores compared to their discs. The profiles of centrally suppressed and unsuppressed galaxies are distributed in a bimodal way. Galaxies with high stellar mass and core velocity dispersion are found to be much more likely to be centrally suppressed than low-mass galaxies, and we show that this is related to morphology and the presence of AGN/LI(N)ER like emission. Centrally suppressed galaxies also display lower star formation at all radii compared to unsuppressed galaxies. The profiles of central and satellite galaxies are also compared, and we find that satellite galaxies experience lower specific star formation rates at all radii than central galaxies. This uniform suppression could be a signal of the stripping of hot halo gas in the process known as strangulation. We find that satellites are not more likely to be suppressed in their cores than centrals, indicating that the core suppression is an entirely internal process. We find no correlation between the local environment density and the profiles of star formation rate surface density

Students’ accounts of their participation in an intensive long-term learning community

Collaborative learning environments have been analysed extensively, yet we know relatively little about how students experience their participation in long-term learning communities where learners work together over extended periods of time. This study aims to understand pre-service teacher–students’ experiences and accounts of their participation in a university-based long-term learning community. The study investigates issues of change and stability, with respect to the students’ perceptions of participation over the first 2 years of their work within the learning community. The study also addresses the relations between the students’ accounts of participation and their learning experiences in terms of ‘teachership’. A teacher–trainee group of nine students, who had studied for 3 years within a Masters level teacher education programme which had adopted an intensive community-based approach, individually appraised their participation and learning within the programme. Using empirical data derived from the learners’ own evaluations of their learning experiences, the study draws on the accounts given by students concerning their orientations to and positions within the learning community. Videotaped recordings of some of the student's seminars were used as resources to support the giving of appraisals using questionnaires which contained both closed- and open-ended questions. Results showed that the students’ qualitative accounts of their participation revealed great differences in their orientations to group activities. Considerable differences in orientations could be found with respect to: students’ relation to power; to socio-emotional involvement; to the degree of participation; to the subject-matter and to theoretical interests. These were related to the quantitatively evaluated level of participation. Based on the analysis of students’ perceived trajectories of participation over 2 years, three qualitatively different trajectories could be identified: highly involved participation, increased participation and decreased or marginal participation. A comparison of the perceived learning experiences arising from these different kinds of participation revealed considerable diversity in the students’ major learning objectives and in the social and affective aspects of their learning. The most impressive and comprehensive learning took place among those reporting increased participation. For those reporting highly involved participation, the group functioned first and foremost as a source of motivation. However, those group-members who reported decreased and marginal participation found the learning experience to be emotionally and affectively very negative. The results suggest that if students cannot have an active participatory role in the community, they are in danger of being marginalized and this in turn has consequences for learning

Sarcopenia and Cardiovascular Diseases

Sarcopenia is the loss of muscle strength, mass, and function, which is often exacerbated by chronic comorbidities including cardiovascular diseases, chronic kidney disease, and cancer. Sarcopenia is associated with faster progression of cardiovascular diseases and higher risk of mortality, falls, and reduced quality of life, particularly among older adults. Although the pathophysiologic mechanisms are complex, the broad underlying cause of sarcopenia includes an imbalance between anabolic and catabolic muscle homeostasis with or without neuronal degeneration. The intrinsic molecular mechanisms of aging, chronic illness, malnutrition, and immobility are associated with the development of sarcopenia. Screening and testing for sarcopenia may be particularly important among those with chronic disease states. Early recognition of sarcopenia is important because it can provide an opportunity for interventions to reverse or delay the progression of muscle disorder, which may ultimately impact cardiovascular outcomes. Relying on body mass index is not useful for screening because many patients will have sarcopenic obesity, a particularly important phenotype among older cardiac patients. In this review, we aimed to: (1) provide a definition of sarcopenia within the context of muscle wasting disorders; (2) summarize the associations between sarcopenia and different cardiovascular diseases; (3) highlight an approach for a diagnostic evaluation; (4) discuss management strategies for sarcopenia; and (5) outline key gaps in knowledge with implications for the future of the field

Life\u27s Essential 8: Optimizing Health in Older Adults

The population worldwide is getting older as a result of advances in public health, medicine, and technology. Older individuals are living longer with a higher prevalence of subclinical and clinical cardiovascular disease (CVD). In 2010, the American Heart Association introduced a list of key prevention targets, known as Life\u27s Simple 7 to increase CVD-free survival, longevity, and quality of life. In 2022, sleep health was added to expand the recommendations to Life\u27s Essential 8 (eat better, be more active, stop smoking, get adequate sleep, manage weight, manage cholesterol, manage blood pressure, and manage diabetes). These prevention targets are intended to apply regardless of chronologic age. During this same time, the understanding of aging biology and goals of care for older adults further enhanced the relevance of prevention across the range of functions. From a biological perspective, aging is a complex cellular process characterized by genomic instability, telomere attrition, loss of proteostasis, inflammation, deregulated nutrient-sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion, and altered intercellular communication. These aging hallmarks are triggered by and enhanced by traditional CVD risk factors leading to geriatric syndromes (eg, frailty, sarcopenia, functional limitation, and cognitive impairment) which complicate efforts toward prevention. Therefore, we review Life\u27s Essential 8 through the lens of aging biology, geroscience, and geriatric precepts to guide clinicians taking care of older adults