Diagnosing "his" infertility : men's experiences and reflections on the diagnosis of azoospermia

M.D. ThesisBackground: A male cause is the main or a contributing factor in up to 50% of couples presenting with infertility. Azoospermia (lack of sperm in the semen) is present in approximately 15% of infertile men. Unlike psychosocial aspects of female infertility, male attitudes to their own infertility are poorly understood. Male infertility can potentially have a significant impact on psychological and social aspects of men’s lives, impacting negatively on self-image, relationships and causing psychological distress. Objective data in this area is lacking. Aim: The aim of this study was to assess the impact of the diagnosis of azoospermia on men’s psychological and social functioning. Method: This was a qualitative interview study, involving fifteen men with azoospermia attending a fertility clinic. All men were over twenty three years of age and suffering from primary infertility for more than a year. Participants gave their own account of how they perceived the experience of receiving the diagnosis, undergoing further investigations and having treatment. Data were collected between June 2013 and November 2013. The interviews were fully transcribed and analysed thematically using NVivo® software. Results: Major themes that emerged from the interviews included ‘reaction to the initial diagnosis’, ‘lack of cause and explanation’, ‘effect on interpersonal relationships’, ‘disclosure of the diagnosis’, ‘support seeking’ and ‘decisions regarding fertility treatment’. Key findings highlighted a feeling of shock and disbelief as a prominent part of men’s experience. Many men said that they never expected to be told of a ‘completely zero’ sperm count. Finding out was described as ‘heartbreaking’, ‘devastating’, ‘confusing’ and ‘sad’. The possibility of biological fatherhood was perceived as non-existent by some, with one commenting: ‘It felt as it was the end of the world’. One third of participants felt the diagnosis to be a threat to their masculinity, and to have a negative impact on their sense of self-confidence. Men found the lack of a precise aetiology frustrating and distressing. Most men were reluctant to share the diagnosis beyond close family members. The diagnosis brought partners closer together in most cases. Most men did not feel the need to seek external psychological support following the diagnosis and were satisfied with the support provided by clinic staff and their partners. A sperm retrieval operation was in most cases the only hope for establishing biological fatherhood. Decision- v making with regards to this and donor sperm treatment took into account multiple factors, including the risk of potential complications and side effects, their partner’s influence, and attitudes towards using donor sperm. Conclusion: Male infertility impacts substantially on men’s quality of life and healthcare professionals should be aware of this when investigating and treating patients with azoospermia. An improved understanding of men’s experiences is important for the provision of optimal clinical and psychosocial care. Better education and publicity about male factor infertility will reduce stigma and encourage men to seek help sooner. Men find the lack of specific aetiology frustrating and therefore further research is required into the aetiology of male infertility.Newcastle Fertility Centre Research Fun

Evolving missions to create game spaces

This paper describes a search-based generative method which creates game levels by evolving the intended sequence of player actions rather than their spatial layout. The proposed approach evolves graphs where nodes representing player actions are linked to form one or more ways in which a mission can be completed. Initially simple graphs containing the mission’s starting and ending nodes are evolved via mutation operators which expand and prune the graph topology. Evolution is guided by several objective functions which capture game design patterns such as exploration or balance; experiments in this paper explore how these objective functions and their combinations affect the quality and diversity of the evolved mission graphs.peer-reviewe

Pairing character classes in a deathmatch shooter game via a deep-learning surrogate model

This paper introduces a surrogate model of gameplay that learns the mapping between different game facets, and applies it to a generative system which designs new content in one of these facets. Focusing on the shooter game genre, the paper explores how deep learning can help build a model which combines the game level structure and the game's character class parameters as input and the gameplay outcomes as output. The model is trained on a large corpus of game data from simulations with artificial agents in random sets of levels and class parameters. The model is then used to generate classes for specific levels and for a desired game outcome, such as balanced matches of short duration. Findings in this paper show that the system can be expressive and can generate classes for both computer generated and human authored levels.peer-reviewe

Learning the patterns of balance in a multi-player shooter game

A particular challenge of the game design process is when the designer is requested to orchestrate dissimilar elements of games such as visuals, audio, narrative and rules to achieve a specic play experience. Within the domain of adversarial rst person shooter games, for instance, a designer must be able to comprehend the dierences between the weapons available in the game, and appropriately cra a game level to take advantage of strengths and weaknesses of those weapons. As an initial study towards computationally orchestrating dissimilar content generators in games, this paper presents a computational model which can classify a matchup of a team-based shooter game as balanced or as favoring one or the other team. e computational model uses convolutional neural networks to learn how game balance is aected by the level, represented as an image, and each team’s weapon parameters. e model was trained on a corpus of over 50,000 simulated games with articial agents on a diverse set of levels created by 39 dierent generators. e results show that the fusion of levels, when processed by a convolutional neural network, and weapon parameters yields an accuracy far above the baseline but also improves accuracy compared to articial neural networks or models which use partial information, such as only the weapon or only the level as input.peer-reviewe

Adrenaline modulates the global transcriptional profile of Salmonella revealing a role in the antimicrobial peptide and oxidative stress resistance responses

<p>Abstract</p> <p>Background</p> <p>The successful interaction of bacterial pathogens with host tissues requires the sensing of specific chemical and physical cues. The human gut contains a huge number of neurons involved in the secretion and sensing of a class of neuroendocrine hormones called catecholamines. Recently, in <it>Escherichia coli </it>O157:H7, the catecholamines adrenaline and noradrenaline were shown to act synergistically with a bacterial quorum sensing molecule, autoinducer 3 (AI-3), to affect bacterial virulence and motility. We wished to investigate the impact of adrenaline on the biology of <it>Salmonella </it>spp.</p> <p>Results</p> <p>We have determined the effect of adrenaline on the transcriptome of the gut pathogen <it>Salmonella enterica </it>serovar Typhimurium. Addition of adrenaline led to an induction of key metal transport systems within 30 minutes of treatment. The oxidative stress responses employing manganese internalisation were also elicited. Cells lacking the key oxidative stress regulator OxyR showed reduced survival in the presence of adrenaline and complete restoration of growth upon addition of manganese. A significant reduction in the expression of the <it>pmrHFIJKLM </it>antimicrobial peptide resistance operon reduced the ability of <it>Salmonella </it>to survive polymyxin B following addition of adrenaline. Notably, both phenotypes were reversed by the addition of the β-adrenergic blocker propranolol. Our data suggest that the BasSR two component signal transduction system is the likely adrenaline sensor mediating the antimicrobial peptide response.</p> <p>Conclusion</p> <p><it>Salmonella </it>are able to sense adrenaline and downregulate the antimicrobial peptide resistance <it>pmr </it>locus through the BasSR two component signalling system. Through iron transport, adrenaline may affect the oxidative stress balance of the cell requiring OxyR for normal growth. Both adrenaline effects can be inhibited by the addition of the β-adrenergic blocker propranolol. Adrenaline sensing may provide an environmental cue for the induction of the <it>Salmonella </it>stress response in anticipation of imminent host-derived oxidative stress. However, adrenaline may also serve in favour of the host defences by lowering antimicrobial peptide resistance and hence documenting for the first time such a function for a hormone.</p

Peptides as quorum sensing molecules : measurement techniques and obtained levels in vitro and in vivo

The expression of certain bacterial genes is regulated in a cell-density dependent way, a phenomenon called quorum sensing. Both Gram-negative and Gram-positive bacteria use this type of communication, though the signal molecules (auto-inducers) used by them differ between both groups: Gram-negative bacteria use predominantly N-acyl homoserine lacton (AHL) molecules (autoinducer-1, AI-1) while Gram-positive bacteria use mainly peptides (autoinducer peptides, AIP or quorum sensing peptides). These quorum sensing molecules are not only involved in the inter-microbial communication, but can also possibly cross-talk directly or indirectly with their host. This review summarizes the currently applied analytical approaches for quorum sensing identification and quantification with additionally summarizing the experimentally found in vivo concentrations of these molecules in humans

Staphylococcus aureus Manganese Transport Protein C Is a Highly Conserved Cell Surface Protein That Elicits Protective Immunity Against S. aureus and Staphylococcus epidermidis

Staphylococcus aureus and other staphylococci cause severe human disease, and there are currently no vaccines available. We evaluated whether manganese transport protein C (MntC), which is conserved across the staphylococcal species group, could confer protection against S. aureus and Staphylococcus epidermidis. In vivo analysis of S. aureus MntC expression revealed that expression occurs very early during the infectious cycle. Active immunization with MntC was effective at reducing the bacterial load associated with S. aureus and S. epidermidis infection in an acute murine bacteremia model. Anti-MntC monoclonal antibodies have been identified that can bind S. aureus and S. epidermidis cells and are protective in an infant rat passive protection model and induce neutrophil respiratory burst activity. This is the first description of a protein that has the potential to provide protection across the staphylococcal species group