Reducing Perineal Lacerations Through Team-Based Simulation.

INTRODUCTION: Vaginal deliveries that result in perineal trauma involve significant morbidity to women. Multiple strategies have been identified to reduce the risk of severe perineal lacerations. The objective of this study was to evaluate the effectiveness of an interprofessional simulation-based teams-training program aimed at reducing severe perineal lacerations during childbirth. METHODS: A quasi-experimental pre-post single-group design was used to examine the performance of labor and delivery personnel at a large multihospital system after participating in a mixed-modality simulation program for reducing perineal lacerations. Multiple educational strategies aimed at management of second stage of labor (including laboring down, warm compresses, coaching, positioning, perineal support, controlled delivery of fetal head, and mediolateral episiotomy techniques) were taught using patients, task trainers, and a standardized curriculum during interprofessional educational sessions. Primary study outcomes were as follows: (a) pre-post differences in knowledge; (b) pre-post differences in team performance assessments; and (c) pre-post differences in safety culture. Secondary outcomes were severe perineal laceration rates. RESULTS: During an 18-month period, 675 personnel in 4 hospitals participated in the program. Significant improvement was noted in pre-post scores of knowledge (59.86%, 93.87%, P < 0.0001), performance (36.54%, 93.45%, P < 0.0001), and safety culture (3.24, 1.45, 1 = high, 5 = low, P < 0.0001). Severe perineal laceration rates decreased by 33.38% since initiation. Rates fluctuated with the addition of new personnel and renewed educational programs. CONCLUSIONS: A multimodal interprofessional simulation program of strategies to prevent severe perineal lacerations significantly improved knowledge, skills, and attitudes in labor and delivery personnel within a healthcare system. Severe perineal laceration rates were reduced.

Measles outbreak in a refugee settlement in Calais, France: January to February 2016.

We report a measles outbreak in a refugee settlement in Calais, France, between 5 January and 11 February 2016. In total, 13 confirmed measles cases were identified among migrants, healthcare workers in hospital and volunteers working on site. A large scale vaccination campaign was carried out in the settlement within two weeks of outbreak notification. In total, 60% of the estimated target population of 3,500 refugees was vaccinated during the week-long campaign.

Mixing of two co-directional Rayleigh surface waves in a nonlinear elastic material.

The mixing of two co-directional, initially monochromatic Rayleigh surface waves in an isotropic, homogeneous, and nonlinear elastic solid is investigated using analytical, finite element method, and experimental approaches. The analytical investigations show that while the horizontal velocity component can form a shock wave, the vertical velocity component can form a pulse independent of the specific ratios of the fundamental frequencies and amplitudes that are mixed. This analytical model is then used to simulate the development of the fundamentals, second harmonics, and the sum and difference frequency components over the propagation distance. The analytical model is further extended to include diffraction effects in the parabolic approximation. Finally, the frequency and amplitude ratios of the fundamentals are identified which provide maximum amplitudes of the second harmonics as well as of the sum and difference frequency components, to help guide effective material characterization; this approach should make it possible to measure the acoustic nonlinearity of a solid not only with the second harmonics, but also with the sum and difference frequency components. Results of the analytical investigations are then confirmed using the finite element method and the experimental feasibility of the proposed technique is validated for an aluminum specimen.

Baseline susceptibility to Cry1Ac insecticidal protein in Heliothis virescens (Lepidoptera: Noctuidae) populations in Brazil.

The tobacco budworm, Heliothis virescens (F.), is one of the target pests of genetically modified cotton expressing Cry1Ac insecticidal protein (Bt cotton) derived from Bacillus thuringiensis Berliner. This study was conducted to evaluate the susceptibility of field-collected populations of H. virescens to Cry1Ac to establish a baseline for use in an insect resistance management program for Bt cotton in Brazil. Insects were sampled from the main Brazilian cotton-growing regions (Bahia, Mato Grosso, Mato Grosso do Sul, and Goiás) during the cropping seasons of 2007/08 and 2008/09. Cry1Ac susceptibility was estimated by using diet incorporation bioassays. H. virescens was highly susceptible to Cry1Ac protein. The estimated LC50 values varied from 0.18 to 0.66 microg of Cry1Ac/ml of diet among the 2007-2008 populations (approximately 3.7-fold variation). Similarly, the EC50 values based on growth inhibition ranged from 0.0053 to 0.0161 microg of Cry1Ac/ml of diet for the 2007-2008 populations (approximately 3.0-fold variation). A joint analysis of the mortality data across all tested populations was used to develop and validate the diagnostic concentrations of 3.1 and 5.6 microg of Cry1Ac/ml of diet, the upper bound of the confidence interval and twice the LC99 were selected, for resistance monitoring programs of H. virescens to Cry1Ac protein in Brazil.

Pregnancy-associated breast cancer.

Breast cancer is the second most common malignancy affecting pregnancy. Pregnancy-associated breast cancer (PABC) is defined as breast cancer diagnosed during pregnancy or in the first postpartum year. Because PABC is a relatively rare event surrounded by multiple variables, few studies address the best management and treatment options. We present a case of PABC to illustrate and highlight some of the recommendations for treatment, obstetric care, delivery management, and cancer surveillance.

Reconstituted human corneal epithelium: a new alternative to the Draize eye test for the assessment of the eye irritation potential of chemicals and cosmetic products.

The aim of this study was to evaluate the interest of a new three-dimensional epithelial model cultivated from human corneal cells to replace animal testing in the assessment of eye tolerance. To this end, 65 formulated cosmetic products and 36 chemicals were tested by means of this in vitro model using a simplified toxicokinetic approach. The chemicals were selected from the ECETOC data bank and the EC/HO International validation study list. Very satisfactory results were obtained in terms of concordance with the Draize test data for the formulated cosmetic products. Moreover, the response of the corneal model appeared predictive of human ocular response clinically observed by ophthalmologists. The in vitro scores for the chemicals tested strongly correlated with their respective scores in vivo. For all the compounds tested, the response of the corneal model to irritants was similar regardless of their chemical structure, suggesting a good robustness of the prediction model proposed. We concluded that this new three-dimensional epithelial model, developed from human corneal cells, could be promising for the prediction of eye irritation induced by chemicals and complex formulated products, and that these two types of materials should be tested using a similar protocol. A simple shortening of the exposure period was required for the chemicals assumed to be more aggressively irritant to the epithelial tissues than the cosmetic formulae.