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.

Book review of Donald, S.H., & Gammack, J.G. 2007. Tourism and the Branded City : Film and Identity in the Pacific Rim. Aldershot : Ashgate.

In the decade since the destination branding literature emerged (see for example Pritchard & Morgan 1998, Dosen & Vransevic 1998), only a few books have been published. These are Morgan et al.’s (2002, 2004) edited volumes of international case studies and conceptual papers, and Baker’s (2007) practitioner perspective on branding small cities in the USA. This work by Stephanie Donald and John Gammack is the first research-based text related to destination branding, and is a welcome and timely addition to the field. In the foreword to the first issue of Place Branding and Public Policy, editor Simon Anholt (2004, p. 4) suggested “almost nobody agrees on what, exactly, branding means”, when he described place branding practice as akin to the Wild West. Indeed, this lack of theory was one of the motivators for the authors of this text. Tourism and the Branded City is part of Ashgate’s New Directions in Tourism Analysis series, edited by Dimitri Ioannides. The aim of the series is to address the gap in published theory underpinning the study of tourism, with a particular interest in non-business disciplines such as Sociology, Social Anthropology, Human and Social Geography, and Cultural Studies...

Give and take in major gift relationships

This article investigates the complex phenomenon of major gift giving to charitable institutions. Drawing on empirical evidence from interviews with 16 Australian major donors (who gave a single gift of at least AU$10,000 in 2008 or 2009), we seek to better understand donor expectations and (dis)satisfaction. Given growing need for social services, and the competition among nonprofit organisations (NPOs) to secure sustainable funding, this research is particularly timely. Currently, little is known about major donors’ expectations, wants and needs. Equity theory, with the concept of reciprocity at its core, was found to provide a useful framework for understanding these phenomena. A model of equitable major gift relationships was developed from the data, which portrays balanced relationships and identifies potential areas of dissatisfaction for major donors. We conclude by offering suggestions for NPOs seeking to understand the complexities of major gift relationships, with practical implications for meeting donors’ needs.

MRI study of the changes in crystalline lens shape with accommodation and ageing in humans

Magnetic Resonance Imaging was used to study changes in the crystalline lens and ciliary body with accommodation and aging. Monocular images were obtained in 15 young (19-29 years) and 15 older (60-70 years) emmetropes when viewing at far (6m) and at individual near points (14.5 to 20.9 cm) in the younger group. With accommodation, lens thickness increased (mean±95% CI: 0.33±0.06mm) by a similar magnitude to the decrease in anterior chamber depth (0.31±0.07mm) and equatorial diameter (0.32±0.04mm) with a decrease in the radius of curvature of the posterior lens surface (0.58±0.30mm). Anterior lens surface shape could not be determined due to the overlapping region with the iris. Ciliary ring diameter decreased (0.44±0.17mm) with no decrease in circumlental space or forward ciliary body movement. With aging, lens thickness increased (mean±95% CI: 0.97±0.24mm) similar in magnitude to the sum of the decrease in anterior chamber depth (0.45±0.21mm) and increase in anterior segment depth (0.52±0.23mm). Equatorial lens diameter increased (0.28±0.23mm) with no change in the posterior lens surface radius of curvature. Ciliary ring diameter decreased (0.57±0.41mm) with reduced circumlental space (0.43±0.15mm) and no forward ciliary body movement. Accommodative changes support the Helmholtz theory of accommodation including an increase in posterior lens surface curvature. Certain aspects of aging changes mimic accommodation.

‘Show Me Your Wiki and I’ll Show you Mine’: Using Online Interactive Media to Improve Academic Writing and Research in a Public Health Under-Graduate Cohort

The number of Internet users in Australia has been steadily increasing, with over 10.9 million people currently subscribed to an internet provider (ABS, 2011). Over the past year, the most avid users of the Internet were 15 – 24 year olds, with approximately 95% accessing the internet on a regular basis (ABS, Social Trends, 2011). While the internet has been described as fundamental to higher education students, social and leisure internet tools are also increasingly being used by these students to generate and maintain their social and professional networks and interactions (Duffy & Bruns 2006). Rapid technological advancements have enabled greater and faster access to information for learning and education (Hemmi et al, 2009; Glassman and Kang, 2011). As such, we sought to integrate interactive, online social media into the assessment profile of a Public Health undergraduate cohort at the Queensland University of Technology (QUT). The aim of this exercise was to engage students to both develop and showcase their research on a range of complex, contemporary health issues within the online forum of Wikispaces (http://www.wikispaces.com/) for review and critique by their peers. We applied Bandura’s Social Learning Theory (SLT) to analyse the interactive processes from which students developed deeper and more sustained learning, and via which their overall academic writing standards were raised. This paper outlines the assessment task, and the students’ feedback on their learning outcomes in relation to the Attentional, Retentional, Motor Reproduction, and Motivational Processes outlined by Bandura in SLT. We conceptualise the findings in a theoretical model, and discuss the implications for this approach within the broader tertiary environment.

Learning and acting in project situations through a meta-method (MAP) a case study : contextual and situational approach for project management governance in management education

The paper introduces the underlying principles and the general features of a meta-method (MAP method) developed as part of and used in various research, education and professional development programmes at ESC Lille. This method aims at providing effective and efficient structure and process for acting and learning in various complex, uncertain and ambiguous managerial situations (projects, programmes, portfolios). The paper is developed around three main parts. First, I suggest revisiting the dominant vision of the project management knowledge field, based on the assumptions they are not addressing adequately current business and management contexts and situations, and that competencies in management of entrepreneurial activities are the sources of creation of value for organisations. Then, grounded on the former developments, I introduce the underlying concepts supporting MAP method seen as a ‘convention generator’ and how this meta method inextricably links learning and practice in addressing managerial situations. Finally, I briefly describe an example of application, illustrating with a case study how the method integrates Project Management Governance, and give few examples of use in Management Education and Professional Development.

Learning and acting in project situations through a meta-method (MAP) : a case study : contextual and situational approach for project management governance in management education

The paper introduces the underlying principles and the general features of a meta-method (MAP method – Management & Analysis of Projects) developed as part of and used in various research, education and professional development programmes at ESC Lille. This method aims at providing effective and efficient structure and process for acting and learning in various complex, uncertain and ambiguous managerial situations (projects, programmes, portfolios). The paper is organized in three parts. In a first part, I propose to revisit the dominant vision of the project management knowledge field, based on the assumptions they are not addressing adequately current business and management contexts and situations, and that competencies in management of entrepreneurial activities are the sources of creation of value for organisations. Then, grounded on the new suggested perspective, the second part presents the underlying concepts supporting MAP method seen as a ‘convention generator' and how this meta-method inextricably links learning and practice in addressing managerial situations. The third part describes example of application, illustrating with a brief case study how the method integrates Project Management Governance, and gives few examples of use in Management Education and Professional Development.

Leading the transformation of learning and praxis in science classrooms

Individual science teachers who have inspired colleagues to transform their classroom praxis have been labelled transformational leaders. As the notion of distributed leadership became more accepted in the educational literature, the focus on the individual teacher-leader shifted to the study of leadership praxis both by individuals (whoever they might be) and by collectives within schools and science classrooms. This review traces the trajectory of leadership research, in the context of learning and teaching science, from an individual focus to a dialectical relationship between individual and collective praxis. The implications of applying an individual-collective perspective to praxis for teachers, students and their designated leaders are discussed.

Risk, uncertainty and complexity in science education

Increasingly societies and their governments are facing important social issues that have science and technology as key features. A number of these socio-scientific issues have two features that distinguish them from the restricted contexts in which school science has traditionally been presented. Some of their science is uncertain and scientific knowledge is not the only knowledge involved. As a result, the concepts of uncertainty, risk and complexity become essential aspects of the science underlying these issues. In this chapter we discuss the nature and role of these concepts in the public understanding of science and consider their links with school science. We argue that these same concepts and their role in contemporary scientific knowledge need to be addressed in school science curricula. The new features for content, pedagogy and assessment of this urgent challenge for science educators are outlined. These will be essential if the goal of science education for citizenship is to be achieved with our students, who will increasingly be required to make personal and collective decisions on issues involving science and technology.

Deliberation and empowerment in Rio de Janeiro's favelas

In modern day Brazil, new media initiatives centred in local communities are attempting to change the face of mainstream ideas about favelas and their inhabitants. One of these initiatives is Viva Favela which is ideologically and physically supported by the NGO Viva Rio that is based in Rio de Janeiro. This non-government organisation runs projects that provide favela residents with skills to take, edit and print their own(photo)journalism contents that enable a community-based framing and documentation of favela life, personalities and issues. The NGO furthermore has developed a range of public venues for displaying these works of (photo)journalism, thus minimising the invisibility that favela dwellers feel in Brazilian political life. This paper takes a discursive and ethnographic approach to investigating how community media might contribute with the aims of empowering people and supporting deliberation within Rio de Janeiro’s favelas.

The younger audience : children and broadcasting in New Zealand

The role and influence of media in the lives of children are ongoing sources of public, political and academic debates. These debates move back and forth along a care-control continuum (Cohen, 1997), and reflect a commitment both to educate children and to regulate their media experiences. Rapid advancements in computer technologies have vastly expanded the range of media experiences available to children. The development of Internet information and the rapid expansion of channels as a result of digital television have created increasingly accessible and diverse sources of media for children. These media are instantaneous and, in some circumstances, constantly available. As a result, a substantial body of international research has emerged that examines the influence of media consumption on children. How much time do children spend interacting with media? What sorts of media do they access? Are media harmful or beneficial to children? If so, in which contexts? Do media influence children�s personal development? And what role should governments, broadcasters and independent producers play in the regulation of the media? These questions remain central to contemporary debates about children and the media.

Crime is in the air : air pollution and regulation in the UK

This latest briefing by Professor Reece Walters in the What is crime? series, draws attention to an area of harm that is often absent from criminological debate. He highlights the human costs of air pollution and failed attempts to adequately regulate and control such harm. Arguing for a cross disciplinary ‘eco-crime’ narrative, the author calls for greater understanding of the far-reaching consequences of air pollution which could set in train changes which may lead to a ‘more robust and meaningful system of justice’. Describing current arrangements in place to control and regulate air pollution, Walters draws attention to the lack of neutrality in current arrangements and the bias ‘towards the economic imperatives of free trade over and above the centrality of environmental protection’. While attention is often given to direct and individualised instances of ‘crime’, the serious consequences of air pollution are frequently neglected. The negative effects of pollution on health and well-being are often borne by people already experiencing a range of other disadvantages. In a global and national context, it is often the poor who are affected most. Ultimately, political and economic imperatives have historically helped to shape legal and regulatory regimes. Whether this is an inherent flaw in current systems or something that can be overcome in favour of dealing with more wide-ranging harms is an area that requires further discussion and debate.