Vaginal delivery simulation in the Obstetrics and Gynaecology clerkship.

BACKGROUND: Although simulation is now used in other areas of obstetrics and gynaecology, its utility in the training of an uncomplicated vaginal delivery is surprisingly under-explored. Here we describe our experience integrating simulation into the third-year Obstetrics and Gynaecology (OB/GYN) clerkship. METHODS: In 2013/14, at the start of each 4-week OB/GYN clerkship, each third-year student participated in a 90-minute vaginal delivery simulation session using the Noelle(®) simulator. Upon completion of the clerkship, they were surveyed using a five-point Likert scale questionnaire (1, inferior; 5, superior) to assess self-perceived training adequacy, clinical preparedness and number of deliveries performed during the clerkship. Students who completed the clerkship in 2012/13, before the introduction of the simulation, were also surveyed to serve as a comparison group. Survey scores and number of deliveries performed were compared between the two cohorts of students. RESULTS: The 2013/14 cohort (n = 98) who received simulation training gave their training in vaginal deliveries an average rating of 4.1, versus 2.7 for the 2012/13 cohort that did not receive the simulation (n = 80; p < 0.001). Self-perceived preparedness to perform a vaginal delivery was 4.0 in the 2013/14 cohort, versus 3.0 in the 2012/13 cohort (p < 0.001). There was no difference in the number of deliveries performed between the cohorts. DISCUSSION: Students that received simulation rated their training adequacy and readiness to perform a vaginal delivery higher than students that did not receive training. Simulation did not increase participation in real-life deliveries. The utility of simulation in the training of an uncomplicated vaginal delivery is under-explored.

Predator-induced renesting and reproductive effort in indigo buntings: more work for less pay?

Renesting after nest predation is ultimately an adaptive response to increase productivity in birds. However, renesting also increases reproductive effort to replace lost clutches. We investigated the consequences of this increased reproductive effort by determining whether renesting in female indigo buntings (Passerina cyanea) is associated with a decline in body condition (size-corrected mass) and haematocrit and an increase in stress hormones and whether renesting or maternal body condition is associated with a decline in productivity (clutch size, nestling body condition). Next, because a consequence of multiple renesting attempts is a prolonged breeding season and later timing, we predicted that a population of post-breeding females and juveniles would have lower body condition in fragmented forest than in contiguous forest owing to higher nest predation and frequency of renesting. Both forest types were settled by females of similar condition. Nest survival was lower in fragmented forest, where a higher proportion of females failed their first attempt and the breeding season was 2 weeks longer. Compared with females on their first attempt, renesting females had lower body condition and haematocrit and higher corticosterone concentrations. Lower maternal body condition was associated with higher concentrations of corticosterone, lower nestling body condition and smaller clutches. Clutch size was lower in renests and in fragmented forest. Nestling condition was lower in renests but did not vary greatly with forest type. Despite a prolonged breeding season in the fragmented forest, post-breeding females and hatch-year birds were in similar condition in both forest types. Our results suggest that the indirect effects of nest predation on maternal and offspring condition pose additional individual-level costs that have not been considered in the context of fragmentation studies. We discuss how predator-induced renesting could have additional demographic consequences by prolonging the breeding season and prompting seasonal interactions or carry-over effects that could impact populations.

Pneumonia outbreak associated with group a Streptococcus species at a military training facility.

BACKGROUND: Although group A streptococci (GAS) infections are a major cause of morbidity and mortality, outbreaks of associated pneumonia are rare. We report an outbreak of GAS pneumonia that occurred at a US military training camp. METHODS: Standard epidemiologic and laboratory procedures were used to characterize the outbreak and causative organism(s). A case-control study and determination of the prevalence of GAS infection among camp personnel were also performed. RESULTS: A total of 162 of 4500 Marine Corps personnel were hospitalized for respiratory symptoms during the period of 1 November and 20 December 2002, and 127 (78%) had radiographically confirmed pneumonia. The attack rate was 1.6 cases per 100 person-months. Thirty-four (27%) of 127 patients with pneumonitis had definite or probable GAS pneumonia; an additional 22 (17.3%) were coinfected with GAS and another pathogen. Pathogens, in addition to GAS, included Chlamydia pneumoniae (27 patients), Mycoplasma pneumoniae (19), adenovirus (5), and Streptococcus pneumoniae (2). A survey revealed that the pharyngeal carriage rate of GAS among camp personnel was 16%. Molecular characterization of the GAS isolates found emm type 3, multilocus sequence type 15. The epidemic ended after administration of additional prophylaxis with a single dose of intramuscular benzathine penicillin (1.2 million U) or azithromycin (1 g orally). Because the number of days from the last penicillin injection was correlated with a positive throat culture result and the occurrence of pneumonia, the dosing interval of benzathine penicillin was shortened from every 28-35 days to every 21 days. CONCLUSIONS: This is the largest outbreak of GAS pneumonia reported in >30 years. This outbreak emphasizes the potential for GAS to cause epidemics of severe infection and demonstrates the need for surveillance and consideration of appropriate antibiotic prophylaxis among particularly high-risk populations.