Microbial colonisation of human follicular fluid and adverse in vitro fertilisation outcomes

This study, investigating 263 women undergoing trans-vaginal oocyte retrieval for in vitro fertilisation (IVF) found that microorganisms colonising follicular fluid contributed to adverse IVF (pre-implantation) and pregnancy (post-implantation) outcomes including poor quality embryos, failed pregnancy and early pregnancy loss (< 37 weeks gestation). Some microorganisms also showed in vitro growth patterns in liquid media that appeared to be enhanced by the hormonal stimulation protocol used for oocyte retrieval. Elaborated cytokines within follicular fluid were also associated with adverse IVF outcomes. This study is imperative because infertility affects 16% of the human population and the numbers of couples needing assistance continues to increase. Despite significant improvements in the technical aspects of assisted reproductive technologies (ART), the live birth rate has not increased proportionally. Overt genital tract infection has been associated with both infertility and adverse pregnancy outcomes (including miscarriage and preterm birth) as a direct result of the infection or the host response to it. Importantly, once inflammation had become established, medical treatment often failed to prevent these significant adverse outcomes. Current evaluations of fertility focus on the ovary as a site of steroid hormone production and ovulation. However, infertility as a result of subclinical colonisation of the ovary has not been reported. Furthermore, identification of the microorganisms present in follicular fluid and the local cytokine profile may provide clinicians with an early indication of the prognosis for IVF treatment in infertile couples, thus allowing antimicrobial treatment and/or counselling about possible IVF failure. During an IVF cycle, multiple oocytes undergo maturation in vivo in response to hormonal hyperstimulation. Oocytes for in vitro insemination are collected trans-vaginally. The follicular fluid that bathes the maturing oocyte in vivo, usually is discarded as part of the IVF procedure, but provides a unique opportunity to investigate microbial causes of adverse IVF outcomes. Some previous studies have identified follicular fluid markers that predict IVF pregnancy outcomes. However, there have not been any detailed microbiological studies of follicular fluid. For this current study, paired follicular fluid and vaginal secretion samples were collected from women undergoing IVF cycles to determine whether microorganisms in follicular fluid were associated with adverse IVF outcomes. Microorganisms in follicular fluid were regarded as either "colonisers" or "contaminants"; colonisers, if they were unique to the follicular fluid sample, and contaminants if the same microorganisms were detected in the vaginal and follicular fluid samples indicating that the follicular fluid was merely contaminated during the oocyte retrieval process. Quite unexpectedly, by these criteria, we found that follicular fluid from approximately 30% of all subjects was colonised with bacteria. Fertile and infertile women with colonised follicular fluid had decreased embryo transfer rates and decreased pregnancy rates compared to women with contaminated follicular fluids. The observation that follicular fluid was not always sterile, but contained a diverse range of microorganisms, is novel. Many of the microorganisms we detected in follicular fluid are known opportunistic pathogens that have been detected in upper genital tract infections and are associated with adverse pregnancy outcomes. Bacteria were able to survive for at least 28 weeks in vitro, in cultures of follicular fluid. Within 10 days of establishing these in vitro cultures, several species (Lactobacillus spp., Bifidobacterium spp., Propionibacterium spp., Streptococcus spp. and Salmonella entericus) had formed biofilms. Biofilms play a major role in microbial pathogenicity and persistence. The propensity of microbial species to form biofilms in follicular fluid suggests that successful treatment of these infections with antimicrobials may be difficult. Bifidobacterium spp. grew, in liquid media, only if concentrations of oestradiol and progesterone were similar to those achieved in vivo during an IVF cycle. In contrast, the growth of Streptococcus agalactiae and Escherichia coli was inhibited or abolished by the addition of these hormones to culture medium. These data suggest that the likelihood of microorganisms colonising follicular fluid and the species of bacteria involved is influenced by the stage of the menstrual cycle and, in the case of IVF, the nature and dose of steroid hormones administered for the maturation of multiple oocytes in vivo. Our findings indicate that the elevated levels of steroid hormones during an IVF cycle may influence the microbial growth within follicular fluid, suggesting that the treatment itself will impact on the microflora present in the female upper genital tract during pre-conception and early post-conception phases of the cycle. The effect of the host immune response on colonising bacteria and on the outcomes of IVF also was investigated. White blood cells reportedly compose between 5% and 15% of the cell population in follicular fluid. The follicular membrane is semi-permeable and cells are actively recruited as part of the normal menstrual cycle and in response to microorganisms. A previous study investigated follicular fluid cytokines from infertile women and fertile oocyte donors undergoing IVF, and concluded that there were no significant differences in the cytokine concentrations between the two groups. However, other studies have reported differences in the follicular fluid cytokine levels associated with infertile women with endometriosis or polycystic ovary syndrome. In this study, elevated levels of interleukin (IL)-1 á, IL-1 â and vascular endothelial growth factor (VEGF) in vaginal fluid were associated with successful fertilisation, which may be useful marker for successful fertilisation outcomes for women trying to conceive naturally or prior to oocyte retrieval for IVF. Elevated levels of IL-6, IL-12p40, granulocyte colony stimulating factor (GCSF) and interferon-gamma (IFN ã) in follicular fluid were associated with successful embryo transfer. Elevated levels of pro-inflammatory IL-18 and decreased levels of anti-inflammatory IL-10 were identified in follicular fluid from women with idiopathic infertility. Successful fertilisation and implantation is dependent on a controlled pro-inflammatory environment, involving active recruitment of pro-inflammatory mediators to the genital tract as part of the menstrual cycle and early pregnancy. However, ongoing pregnancy requires an enhanced anti-inflammatory environment to ensure that the maternal immune system does not reject the semi-allergenic foetus. The pro-inflammatory skew in the follicular fluid of women with idiopathic infertility, correlates with normal rates of fertilisation, embryo discard and embryo transfer, observed for this cohort, which were similar to the outcomes observed for fertile women. However, their pregnancy rate was reduced compared to fertile women. An altered local immune response in follicular fluid may provide a means of explaining infertility in this cohort, previously defined as 'idiopathic'. This study has found that microorganisms colonising follicular fluid may have contributed to adverse IVF and pregnancy outcomes. Follicular fluid bathes the cumulus oocyte complex during the in vivo maturation process, and microorganisms in the fluid, their metabolic products or the local immune response to these microorganisms may result in damage to the oocytes, degradation of the cumulus or contamination of the IVF culture system. Previous studies that have discounted bacterial contamination of follicular fluid as a cause of adverse IVF outcomes failed to distinguish between bacteria that were introduced into the follicular fluid at the time of trans-vaginal oocyte retrieval and those that colonised the follicular fluid. Those bacteria that had colonised the fluid may have had time to form biofilms and to elicit a local immune response. Failure to draw this distinction has previously prevented consideration of bacterial colonisation of follicular fluid as a cause of adverse IVF outcomes. Several observations arising from this study are of significance to IVF programs. Follicular fluid is not always sterile and colonisation of follicular fluid is a cause of adverse IVF and pregnancy outcomes. Hormonal stimulation associated with IVF may influence whether follicular fluid is colonised and enhance the growth of specific species of bacteria within follicular fluid. Bacteria in follicular fluid may form biofilms and literature has reported that this may influence their susceptibility to antibiotics. Monitoring the levels of selected cytokines within vaginal secretions may inform fertilisation outcomes. This study has identified novel factors contributing to adverse IVF outcomes and that are most likely to affect also natural conception outcomes. Early intervention, possibly using antimicrobial or immunological therapies may reduce the need for ART and improve reproductive health outcomes for all women.

Diffusion determinants for passive building technologies

This summary is based on an international review of leading peer reviewed journals, in both technical and management fields. It draws on highly cited articles published between 2000 and 2009 to investigate the research question, "What are the diffusion determinants for passive building technologies in Australia?". Using a conceptual framework drawn from the innovation systems literature, this paper synthesises and interprets the literature to map the current state of passive building technologies in Australia and to analyse the drivers for, and obstacles to, their optimal diffusion. The paper concludes that the government has a key role to play through its influence over the specification of building codes.

An object oriented road asset information model

Preservation and enhancement of transportation infrastructure is critical to continuous economic development in Australia. Of particular importance are the road assets infrastructure, due to their high costs of setting up and their social and economic impact on the national economy. Continuous availability of road assets, however, is contingent upon their effective design, condition monitoring, maintenance, and renovation and upgrading. However, in order to achieve this data exchange, integration, and interoperability is required across municipal boundaries. On the other hand, there are no agreed reference frameworks that consistently describe road infrastructure assets. As a consequence, specifications and technical solutions being chosen to manage road assets do not provide adequate detail and quality of information to support asset lifecycle management processes and decisions taken are based on perception not reality. This paper presents a road asset information model, which works as reference framework to, link other kinds of information with asset information; integrate different data suppliers; and provide a foundation for service driven integrated information framework for community infrastructure and asset management.

Status of current research on the implication of climate change on built environment

The cycling interaction between climate change and building performance is of dynamic nature and both are essentially the cause and the effect of each other. On one hand, buildings contribute significantly to the global warming process. On the other hand, climate change is also expected to impact on many aspects of building performance. In this paper, the status of current research on the implication of climate change on built environment is reviewed. It is found that although the present research has covered broad areas of research, they are generally only limited to the qualitative analyses. It is also highlighted that although it is widely realized that reducing greenhouse gas emissions from the building sector is very important, the adoption of complementary adaptation strategy to prepare the building for a range of climate change scenarios is also necessary. Due to the lack of holistic approach to generate future hourly weather data, various approaches have been used to generate different key weather variables. This ad hoc situation has seriously hindered the application of building simulation technique to the climate change impact study, in particular, to provide quantitative information for policy and design development.

Impact of global warming on the design and performance of air-conditioned office buildings in Australia

As global warming entails new conditions for the built environment, the thermal behavior of existing air conditioned office buildings, which are typically designed based on current weather data, may also change. Through building computer simulations, this paper evaluates the impact of global warming on the design and performance of air-conditioned office buildings in Australia, including the increased cooling loads imposed by potential global warming and probable indoor temperature increases due to possible undersized air-conditioning system, as well as the possible change in energy use and CO2 emission of Australian office buildings. It is found that the existing office buildings would generally be able to adapt to the increasing warmth of 2030 year Low and High scenarios projections and 2070 year Low scenario projection. However, for the 2070 year High scenario, the study indicates that the existing office buildings, in all capital cities except for Hobart, will suffer from overheating problems. If the energy source is assumed to be the electricity, it is found that in comparison with current weather scenario, the increased energy uses would translate into the increase of CO2 emissions by 0 to 34.6 kg CO2 equivalent/m2, varying with different future weather scenarios and with different locations.

Analysis of ten years historical weather data in Australia

Typical reference year (TRY) weather data is often used to represent the long term weather pattern for building simulation and design. Through the analysis of ten year historical hourly weather data for seven Australian major capital cities using the frequencies procedure of descriptive statistics analysis (by SPSS software), this paper investigates: • the closeness of the typical reference year (TRY) weather data in representing the long term weather pattern; • the variations and common features that may exist between relatively hot and cold years. It is found that for the given set of input data, in comparison with the other weather elements, the discrepancy between TRY and multiple years is much smaller for the dry bulb temperature, relative humidity and global solar irradiance. The overall distribution patterns of key weather elements are also generally similar between the hot and cold years, but with some shift and/or small distortion. There is little common tendency of change between the hot and the cold years for different weather variables at different study locations.

Overview of Australian Civil UAS Regulations and Supporting Research

This presentation provides a review of current civil unmanned aircraft system operations and applications, the operational environment and aviation safety regulations in Australia. A summary of current regulatory reform efforts is also provided. The presentation includes new and existing research programs established to address the technical and social issues facing the unmanned aircraft systems industry and aid the regulatory reform process.

Some reflections about P2M : the place of the mirror

The purpose of this paper is to provide some insights about P2M, and more specifically, to develop some thoughts about Project Management seen as a Mirror, a place for reflection…, between the Mission of organisation and its actual creation of Values (with s: a source of value for people, organisations and society). This place is the realm of complexity, of interactions between multiple variables, each of them having a specific time horizon and occupying a specific place, playing a specific role. Before developing this paper I would like to borrow to my colleague and friend, Professor Ohara, the following, part of a paper going to be presented at IPMA World Congress, in New Delhi later this year in November 2005. “P2M is the Japanese version of project & program management, which is the first standard guide for education and certification developed in 2001. A specific finding of P2M is characterized by “mission driven management of projects” or a program which harness complexity of problem solving observed in the interface between technical system and business model.” (Ohara, 2005, IPMA Conference, New Delhi) “The term of “mission” is a key word in the field of corporate strategy, where it expresses raison d’être or “value of business”. It is more specifically used for expressing “the client needs” in terms of a strategic business unit. The concept of mission is deemed to be a useful tool to share essential content of value and needs in message for complex project.” (Ohara, 2005, IPMA Conference, New Delhi) “Mission is considered as a significant “metamodel representation” by several reasons. First, it represents multiple values for aspiration. The central objective of mission initiative is profiling of ideality in the future from reality, which all stakeholders are glad to accept and share. Second, it shall be within a stretch of efforts, and not beyond or outside of the realization. Though it looks like unique, it has to depict a solid foundation. The pragmatic sense of equilibrium between innovation and adaptation is required for the mission. Third, it shall imply a rough sketch for solution to critical issues for problems in reality.” (Ohara, 2005, IPMA Conference, New Delhi) “Project modeling” idea has been introduced in P2M program management. A package of three project models of “scheme”, “system” and “service” are given as a reference type program. (Ohara, 2005, IPMA Conference, New Delhi) If these quotes apply to P2M, they are fully congruent with the results of the research undertaken and the resulting meta-model & meta-method developed by the CIMAP, ESC Lille Research Centre in Project & Program Management, since the 80’s. The paper starts by questioning the common Project Management (PM) paradigm. Then discussing the concept of Project, it argues that an alternative epistemological position should be taken to capture Page 2 / 11 the very nature of the PM field. Based on this, a development about “the need of modelling to understand” is proposed grounded on two theoretical roots. This leads to the conclusion that, in order to enables this modelling, a standard approach is necessary, but should be understood under the perspective of the Theory of Convention in order to facilitate a situational and contextual application.

Processpedia : an ecological environment for BPM stakeholders' collaboration

Purpose: The purpose of this paper is to clarify how end-users’ tacit knowledge can be captured and integrated in an overall business process management (BPM) approach. Current approaches to support stakeholders’ collaboration in the modelling of business processes envision an egalitarian environment where stakeholders interact in the same context, using the same languages and sharing the same perspectives on the business process. Therefore, such stakeholders have to collaborate in the context of process modelling using a language that some of them do not master, and have to integrate their various perspectives. Design/methodology/approach: The paper applies the SECI knowledge management process to analyse the problems of traditional top-down BPM approaches and BPM collaborative modelling tools. Besides, the SECI model is also applied to Wikipedia, a successful Web 2.0-based knowledge management environment, to identify how tacit knowledge is captured in a bottom-up approach. Findings – The paper identifies a set of requirements for a hybrid BPM approach, both top-down and bottom-up, and describes a new BPM method based on a stepwise discovery of knowledge. Originality/value: This new approach, Processpedia, enhances collaborative modelling among stakeholders without enforcing egalitarianism. In Processpedia tacit knowledge is captured and standardised into the organisation’s business processes by fostering an ecological participation of all the stakeholders and capitalising on stakeholders’ distinctive characteristics.

Project 2.7 Leveraging R&D Investment for the Australian built environment : Phase 2 Case Study Report Part 4 - CADD, BIM and IPD

This report discusses findings of a case study into "CADD, BIM and IPD" undertaken as a part of the retrospective analysis component of Sustainable Built Environment National Research Centre (SBEnrc) Project 2.7 Leveraging R&D investment for the Australian Built Environment. This case study investigated the evolution that has taken place in the Queensland Department of Public Works Division of Project Services during the last 20 years from: the initial implementation of computer aided design and documentation(CADD); to the experimentation with building information modelling (BIM) from the mid 2000’s; embedding integrated practice (IP); to current steps towards integrated project delivery (IPD) with the integration of contractors in the design/delivery process. This case study should be read in conjunction with Part 1 of this suite of reports.

Project 2.7 Leveraging R&D Investment for the Australian built environment : Phase 2 Case Study Report Part 2 - Road Construction Safety

This report discusses findings of a case study into "Road Construction Safety" undertaken as a part of the retrospective analysis component of Sustainable Built Environment National Research Centre (SBEnrc) Project 2.7 Leveraging R&D investment for the Australian Built Environment. The Queensland Department of Transport and Main Roads (QTMR) has taken a leadership role in developing a safer working environment for road construction workers. In the past decades, a range of initiatives have been introduced to contribute to improved performance in this area. Several initiatives have been undertaken by QTMR as part of their overarching commitment to safety. Three such initiatives form the basis for this case study investigation, in order to better illustrate the nature of R&D investment and its impact on day-to-day operations and the supply chain. These are the development and implementation of: (i) the Mechanical Traffic Aid: (ii) the Thermal Imaging Camera; and (iii) the Trailer-based CCTV (camera). This case study should be read in conjunction with Part 1 of this suite of reports.

Project 2.7 Leveraging R&D Investment for the Australian built environment : Phase 2 Case Study Report Part 3 - Green Buildings

This report discusses findings of a case study into "Green Buildings" undertaken as a part of the retrospective analysis component of Sustainable Built Environment National Research Centre (SBEnrc) Project 2.7 Leveraging R&D investment for the Australian Built Environment. The Western Australian Government (WAG) has taken a leadership role for a number of decades in developing more environmentally responsive buildings. In the past decade, considerable initiatives have been introduced to contribute to: (i) greening the stock of government buildings; and (ii) providing leadership in the development of other non-residential buildings developed commercially. This role has been informed by global, national and internal initiatives and research in this area. This case study investigates: (i) the nature of this leadership; and (ii) the role of R&D policy development; and (iii) the dissemination and impact of outcomes in the broader industry. This case study should be read in conjunction with Part 1 of this suite of reports.

Productivity, technical and efficiency change in Singapore’s services sector, 2005 to 2008

The current study was motivated by statements made by the Economic Strategies Committee that Singapore’s recent productivity levels in services were well below countries such as the US, Japan and Hong Kong. Massive employment of foreign workers was cited as the reason for poor productivity levels. To shed more light on Singapore’s falling productivity, a nonparametric Malmquist productivity index was employed which provides measures of productivity change, technical change and efficiency change. The findings reveal that growth in Total Factor Productivity (TFP) was attributed to technical change with no improvement in efficiency change. Such results suggest that gains from TFP were input-driven rather than from a ‘best-practice’ approach such as improvements in operations or better resource allocation.

The impact of organisational culture on project selection : what is the appropriate culture type?

Project selection is a complex decision making process that is not merely influenced by the technical aspects of the project. Selection of road infrastructure projects in the Indonesian public sector is generally conducted at an organisational level, which involves multiple objectives, constraints and stakeholders. Hence, a deeper understanding of the various organisational drivers that impact on such decisions, in particular organisational culture, is much needed for improving decision-making processes as it has been posited by some researchers that organisational culture can become either an enabler, or a barrier, to the process. One part of the cultural assessment undertaken as part of the research, identifies and analyses the cultural types of relevant and involved organisations in the decision making process. The organisational culture assessment instrument (OCAI) of Cameron and Quinn (2011) was utilized in this study and the data was taken from three selected provinces in Indonesia. The results can facilitate the surveyed (and similar) organisations to improve their performance by moving towards a more appropriate cultural typology that is arguably better suited to their operations and to improving their organisational processes to more closely align with their organisational vision, mission and objectives.