Simulation-based bronchoscopy training: Randomized trial comparing worked example to video introduction.

INTRODUCTION: Learning the complex skill of bronchoscopy involves the integration of cognitive domains and motor skills. The development of simulators has opened up new possibilities in bronchoscopy training. This study aimed at evaluating how effective the modeling example methodology is in training this skill and assessed its effect on cognitive load in learning. METHODS: Forty-seven medical students participating in a simulator-based bronchoscopy training program were randomly allocated to a control group, receiving a video lesson, and the modeling example group. They were evaluated by the simulator's metrics at different time points: pre-, posttest, and 15 days and 12 months after training. Cognitive load was assessed with the modified Paas scale. RESULTS: Simulation-based training was effective for both groups, based on simulator metrics (p < .05). The modeling example group outperformed the control group in all measures at posttest and after 15 days (p < .001). After 12 months, there was a decline in skill in both groups, but the modeling example group performed better (p < .001). Simulation-based training reduced cognitive load, more strongly so in the modeling example group (p < .001). CONCLUSION: The modeling example group showed substantial benefits over the control group, both in reducing the cognitive load in learning and in retaining knowledge and skill after 15 days and 12 months.

Use of embryo transfer to alleviate infertility caused by heat stress.

Heat stress (HS) has a pronounced deleterious effect on fertility in dairy herds throughout the world, especially in hot and humid summer months in tropical and subtropical areas. Summer HS reduces feed intake and increases negative energy balance, induces changes in ovarian follicular dynamics, reduces estrus detection rates and alters oviductal function leading to fertilization failure and early embryonic death. Furthermore, oocytes harvested from lactating cows during summer HS have a decreased ability to develop to the blastocyst stage after in vitro fertilization when compared with oocytes harvested during winter. The present manuscript describes the detrimental effect of HS on reproduction, with emphasis on preovulatory oocytes and carry over effects of HS on embryo development and P/AI. Embryo transfer (ET) has been an effective tool to reestablish fertility during HS because it bypasses the damage to the oocyte and early embryo caused by hyperthermia. Therefore, a management strategy to maintain increased fertility throughout the year would be to produce embryos during the cooler months, when oocyte quality is greater, and use them to produce pregnancies during the periods of HS, when oocyte quality is compromised. However, this strategy only can be implemented using cryopreserved embryos, what is still limiting. During the warmer months, the use of heifers or non-lactating cows as oocyte or embryo donors may facilitate embryo production, mainly because of the lesser deleterious effects of HS comparing to lactating cows. Also, genetic selection of donors for thermoregulation ability is one potential strategy to mitigate effects of HS and increase embryo production during the warmer months. These alternatives enable the transference of fresh embryos with more efficiency during HS periods. Additionally, the application of timed ET protocols, which avoid the need for estrus detection in recipients, has facilitated management and improved the efficiency of ET programs during HS.

Anti-Mullerian hormone and its relationship to ovulation response and fertility in timed AI Bos indicus heifers.

This study evaluated the association between plasma anti-Mullerian hormone (AMH) concentration and fertility in Nelore (Bos indicus) heifers submitted to timed artificial insemination (TAI). At the onset of the synchronization protocol, heifers (n = 289) received a subcutaneous P4 ear implant (3 mg) and 2 mg of oestradiol benzoate. Eight days later, the P4 implant was removed and 0.5 mg of oestradiol cypionate, prostaglandin (0.265 mg, i.m.) and equine chorionic gonadotropin (300 UI, i.m.) was administered, and TAI was performed 48 hr after ear implant removal. Ovarian ultrasound evaluations were performed to measure number of ovarian follicles, dominant follicle size and ovulation response. Pregnancy diagnosis was performed by ultrasound 30 days after AI. Heifers with greater circulating AMH had more antral follicles, a smaller dominant follicle near timed ovulation and lower ovulation response to the timed AI protocol compared to heifers with lower circulating AMH. Although AMH and pregnancy outcome had a quadratic-shaped pattern, AMH was not significantly associated with fertility. In conclusion, heifers with lower AMH had larger follicles towards the end of the synchronization protocol and greater ovulation responses, whereas greater circulating AMH was unrelated to conception success.

Effects of propylene glycol or elevated luteinizing hormone during follicle development on ovulation, fertilization, and early embryo development.

Seventeen nonlactating Holstein cows were superovulated in a Latin-square designed experiment to determine the effects of increased propylene glycol (PROP) and luteinizing hormone (LH) during antral follicle development on ovarian function, fertilization, and early embryo quality. PROP was orally drenched every 4 h for 7 days to induce hyperinsulinemia and associated metabolic changes. LH concentrations were altered by increasing LH (3-fold) during last 2 days of superovulation. Treatment groups were as follows: (1) control-oral drenching with water plus low-LH preparation; (2) high LH(HLH)-water plus HLH preparation; (3) PROP-drenching with PROP plus low LH; (4) PROP/HLH-PROP plus HLH. PROP increased glucose (P < 0.05) and insulin (P < 0.02) concentrations at all time points analyzed. Neither PROP nor LH affected numbers of follicles > 9 mm at time of gonadotropin-releasing hormone-induced LH surge, although percentage of these follicles that ovulated was decreased by both PROP (P = 0.002) and LH (P = 0.048). In addition, PROP tended (P = 0.056) to decrease total number of ovulations. PROP reduced (P = 0.028) fertilization rate, while LH tended (P = 0.092) to increase fertilization rate. There was no effect of either PROP or LH on any measure of embryo quality including percentage of embryos that were degenerate, quality 1, or quality 1 and 2 of total structures collected or fertilized structures. These results indicate that acute elevation in insulin during the preovulatory follicular wave can decrease percentage of large follicles that ovulate, particularly when combined with increased LH, and reduce fertilization of ovulated oocytes.