Men's Preconception Health: A Primary Health-Care Viewpoint

The purpose of this article is to theoretically explore men’s preconception health as a mechanism to enhance fertility, as well as the health and well-being of the subject and his descendants. Premorbid risk factors and behaviors associated with stress, environmental toxins, excessive alcohol consumption, smoking, lack of exercise/obesity, and the use of illicit drugs are all known to affect fecundity. While there are many health clinics available to women, where advice in areas such as postnatal care of the newborn, family planning, and couples fertility is provided, there are few, if any, equivalent health clinics available to men. Additionally, getting men to attend primary health-care services has also been continuously problematic, even in the context of there being a clearly discernible need for treatment. It is argued in this article that an impetus is required to encourage men to focus on and improve their preconception health and to utilize primary health-care services to take action. An assertive men’s preconception health outlook can positively influence the conjugal relationship, fathering, male self-esteem, and continued good health. Using the sometimes complex concept of preconception health as a motivating factor for healthy lifestyle adaptation has the potential to improve male fertility outcomes and general health and well-being, as well as the health of future generations

Psychology and aggression

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68264/2/10.1177_002200275900300301.pd

The James Webb Space Telescope Mission

Twenty-six years ago a small committee report, building on earlier studies, expounded a compelling and poetic vision for the future of astronomy, calling for an infrared-optimized space telescope with an aperture of at least $4m$. With the support of their governments in the US, Europe, and Canada, 20,000 people realized that vision as the $6.5m$ James Webb Space Telescope. A generation of astronomers will celebrate their accomplishments for the life of the mission, potentially as long as 20 years, and beyond. This report and the scientific discoveries that follow are extended thank-you notes to the 20,000 team members. The telescope is working perfectly, with much better image quality than expected. In this and accompanying papers, we give a brief history, describe the observatory, outline its objectives and current observing program, and discuss the inventions and people who made it possible. We cite detailed reports on the design and the measured performance on orbit.Comment: Accepted by PASP for the special issue on The James Webb Space Telescope Overview, 29 pages, 4 figure

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival

The dynamic interplay between professional identity, threat and context within interprofessional health care teams

Research Doctorate - Doctor of Philosophy (PhD)Interprofessional practice has garnered widespread attention in the literature, yet current evidence does not elucidate the key mechanisms and contextual factors that determine its outcomes. This thesis by publication, arranged in the form of an overview, four core publications and two ancillary papers, addresses the question of how professional identity, identity threat and context interact to impact on interprofessional working. Professional identity underpins much of what occurs in interprofessional health care teams. Threats to valued professional identities can activate faultlines within teams and trigger tensions, conflict and underperformance, if not adequately managed. These threats can take the form of differential treatment of professional subgroups; divergent values and norms; and assimilation or devaluing of other professions. As the perception of threat is context dependent, this research focuses on rural settings where professional boundaries can be less distinct. This study was part of a larger project investigating the enablers of, and barriers to, effective interprofessional practice in an Australian rural health care context. Health practitioners representing various settings, functions, locations and professional backgrounds were interviewed to gather data on the contexts, mechanisms and outcomes of interprofessional practice. Independent content and thematic analyses were integrated to present the findings. The findings show that many rural clinicians were motivated to engage in interprofessional practice, and in doing so embraced flexible approaches and role overlap as a means to manage workforce pressures and overcome professional isolation. In contrast, interprofessional working was stymied by some practitioners who observed strict role boundaries and traditional hierarchies and who were reluctant to consider input from other health disciplines. However, workload sharing and role flexibility is limited in its application and cannot overcome continued skill deficits in rural health services. Moreover, extended role overlap or any hint of genericism is likely to provoke professional identity threat as individual professions need to maintain their distinctiveness and claims to unique expertise. Leadership strategies are required to balance a shared team identity with the salient professional identities characteristic of health care contexts. This is one of the first studies to examine the interplay between professional identity, professional identity threat and context, with particular reference to interprofessional practice in rural settings. By employing a sociological lens to examine the mechanisms and contexts of interprofessional practice, it advances our knowledge of the nature of collaboration between the professions and how interprofessional activities translate in the workplace

Interprofessional practice and professional identity threat

The implementation of interprofessional practice (IPP) within healthcare appears to be fraught with difficulties, despite the attention it has received in the literature. Although there are examples where IPP has reaped significant benefits, it has also been shown to impede team performance. We demonstrate that a key cause of failure in IPP can be attributed to interprofessional conflicts based on threats to professional identity, and provide insight into how professional identity faultlines have the potential to be activated and conflict induced when there is differential treatment of professional groups, different values between professions, assimilation, insult or humiliating action and simple contact within the team. This has significant implications for the management of interprofessional healthcare teams and provides information for team leaders and health managers

Antihypertensive medication use and blood pressure control among treated older adults

The association of different antihypertensive regimens with blood pressure (BP) control is not well-described among community-dwelling older adults with low comorbidity. We examined antihypertensive use and BP control in 10,062 treated hypertensives from Australia and the United States (U.S.) using baseline data from the ASPirin in Reducing Events in the Elderly (ASPREE) trial. Renin-angiotensin system (RAS) drugs were the most prevalently used antihypertensive in both countries (Australia: 81.7% of all regimens; U.S.: 62.9% of all regimens; P<0.001). Diuretics were the next most commonly used antihypertensive in both countries, but were more often included in regimens of U.S. participants (48.9%, vs. 33.3% of regimens in Australia; P<0.001). Among all antihypertensive classes and possible combinations, monotherapy with a RAS drug was the most common regimen in both countries, but with higher prevalence in Australian than U.S. participants (35.9% vs 20.9%; P<0.001). For both monotherapy and combination users, BP control rates across age, ethnicity, and sex were consistently lower in Australian than U.S. participants. After adjustment for age, sex, ethnicity, and BMI, significantly lower BP control rates remained in Australian compared to U.S. participants for the most commonly used classes and regimens (RAS blocker monotherapy: BP control=45.5% vs 54.2%; P=0.002; diuretic monotherapy: BP control=45.2% vs 64.5%; P=0.001; RAS blocker/diuretic combo: BP control=50.2% vs 65.6%; P=0.001). Our findings highlight variation in antihypertensive use in older adults treated for hypertension, with implications for BP control. Differences in BP control that were observed may be influenced, in part, by reasons other than choice of specific regimens

Major GI bleeding in older persons using aspirin: Incidence and risk factors in the ASPREE randomised controlled trial

Objective: There is a lack of robust data on significant gastrointestinal bleeding in older people using aspirin. We calculated the incidence, risk factors and absolute risk using data from a large randomised, controlled trial. Design: Data were extracted from an aspirin versus placebo primary prevention trial conducted throughout 2010-2017 ('ASPirin in Reducing Events in the Elderly (ASPREE)', n=19 114) in community-dwelling persons aged ≥70 years. Clinical characteristics were collected at baseline and annually. The endpoint was major GI bleeding that resulted in transfusion, hospitalisation, surgery or death, adjudicated independently by two physicians blinded to trial arm. Results: Over a median follow-up of 4.7 years (88 389 person years), there were 137 upper GI bleeds (89 in aspirin arm and 48 in placebo arm, HR 1.87, 95% CI 1.32 to 2.66, p Conclusion: Aspirin increases overall GI bleeding risk by 60%; however, the 5-year absolute risk of serious bleeding is modest in younger, well individuals. These data may assist patients and their clinicians to make informed decisions about prophylactic use of aspirin

Effect of aspirin on disability-free survival in the healthy elderly

Background: Information on the use of aspirin to increase healthy independent life span in older persons is limited. Whether 5 years of daily low-dose aspirin therapy would extend disabilityfree life in healthy seniors is unclear. Methods: From 2010 through 2014, we enrolled community-dwelling persons in Australia and the United States who were 70 years of age or older (or =65 years of age among blacks and Hispanics in the United States) and did not have cardiovascular disease, dementia, or physical disability. Participants were randomly assigned to receive 100 mg per day of enteric-coated aspirin or placebo orally. The primary end point was a composite of death, dementia, or persistent physical disability. Secondary end points reported in this article included the individual components of the primary end point and major hemorrhage. Results: A total of 19,114 persons with a median age of 74 years were enrolled, of whom 9525 were randomly assigned to receive aspirin and 9589 to receive placebo. A total of 56.4% of the participants were women, 8.7% were nonwhite, and 11.0% reported previous regular aspirin use. The trial was terminated at a median of 4.7 years of follow-up after a determination was made that there would be no benefit with continued aspirin use with regard to the primary end point. The rate of the composite of death, dementia, or persistent physical disability was 21.5 events per 1000 person-years in the aspirin group and 21.2 per 1000 person-years in the placebo group (hazard ratio, 1.01; 95% confidence interval [CI], 0.92 to 1.11; P = 0.79). The rate of adherence to the assigned intervention was 62.1% in the aspirin group and 64.1% in the placebo group in the final year of trial participation. Differences between the aspirin group and the placebo group were not substantial with regard to the secondary individual end points of death from any cause (12.7 events per 1000 person-years in the aspirin group and 11.1 events per 1000 person-years in the placebo group), dementia, or persistent physical disability. The rate of major hemorrhage was higher in the aspirin group than in the placebo group (3.8% vs. 2.8%; hazard ratio, 1.38; 95% CI, 1.18 to 1.62; P&lt;0.001). Conclusions: Aspirin use in healthy elderly persons did not prolong disability-free survival over a period of 5 years but led to a higher rate of major hemorrhage than placebo