Characteristics and Management of Chorioamnionitis at an Academic Centre in Ontario Before and After Implementation of an Order Set.

OBJECTIVES: Chorioamnionitis has implications for parturient and neonatal outcomes but is difficult to diagnose accurately. The particulars of management also differ between providers and between institutions. Clinical order sets have been shown to standardize and improve care. This study compares characteristics of chorioamnionitis and aspects of management before and after implementation of an order set. METHODS: Chart review facilitated comparison of 76 cases occurring prior to implementation of the order set and 66 cases occurring after. Characteristics of chorioamnionitis used for diagnosis and particulars of management were assessed. RESULTS: There was no significant difference in baseline characteristics between the groups. Parturient tachycardia was more prevalent in cases occurring after implementation of the order set but there was no difference in the percentage of cases meeting Gibb's criteria. Management of cases pre- and post-implementation of the order set differed only in antibiotic choice. Percentage of cases with blood cultures or placental examination performed did not differ. CONCLUSIONS: Overall, implementation of the order set did not significantly impact diagnosis of chorioamnionitis and altered management only with respect to antibiotic choice.

Single-domain antibodies applied as antiviral immunotherapeutics.

Viral infections have been the cause of high mortality rates throughout different periods in history. Over the last two decades, outbreaks caused by zoonotic diseases and transmitted by arboviruses have had a significant impact on human health. The emergence of viral infections in different parts of the world encourages the search for new inputs to fight pathologies of viral origin. Antibodies represent the predominant class of new drugs developed in recent years and approved for the treatment of various human diseases, including cancer, autoimmune and infectious diseases. A promising group of antibodies are single-domain antibodies derived from camelid heavy chain immunoglobulins, or VHHs, are biomolecules with nanometric dimensions and unique pharmaceutical and biophysical properties that can be used in the diagnosis and immunotherapy of viral infections. For viral neutralization to occur, VHHs can act in different stages of the viral cycle, including the actual inhibition of infection, to hindering viral replication or assembly. This review article addresses advances involving the use of VHHs in therapeutic propositions aimed to battle different viruses that affect human health.

Implementation of Entrustable Professional Activities assessments in a Canadian obstetrics and gynecology residency program: a mixed methods study.

Background: Since the implementation of competency-based medical education (CBME) across residency training programs in Canada, there has been limited research understanding how entrustable professional activity (EPA) assessments are used by faculty supervisors and residents. Objective: This study examines how EPA assessments are used in an Obstetrics and Gynecology residency program and the impact of implementation on both groups. Methods: A mixed methods study design was used. Part one involved the aggregation of descriptive data of EPA assessment completion for postgraduate year 1 and 2 residents from July 2019 to May 2020. Part two involved a thematic analysis of semi-structured interviews of residents and faculty. Results: There was significant uptake of EPA assessments across community and teaching hospitals with widespread contribution of assessment data from faculty. However, both residents and faculty reported that the intended design of EPA assessments as low-stakes assessments to provide formative feedback is not how EPA assessments are experienced. Residents and faculty noted the increased level of administrative burden and related perceived stress amongst the resident group. Conclusions: The implementation of EPA assessments is feasible across a variety of sites. However, previous measurement challenges remain. Neither residents nor faculty perceive the value of EPAs to improve feedback, despite their intended nature.

Contexte: Depuis l'implantation de l'éducation médicale fondée sur les compétences (EMFC) dans les programmes de résidence au Canada, peu de recherches ont été menées pour comprendre comment les évaluations des activités professionnelles confiables (APC) sont utilisées par les superviseurs et les résidents. Objectif: Cette étude examine l'utilisation des évaluations des APC dans un programme de résidence en obstétrique et gynécologie et les impacts de son implantation sur ces deux groupes. Méthodes: La première partie de cette étude à méthode mixte a consisté en l'agrégation des données descriptives sur les évaluations d'APC pour les résidents de première et deuxième année effectuées entre juillet 2019 et mai 2020. Dans un second temps, nous avons analysé thématiquement les entrevues semi-structurées de résidents et de membres du corps professoral. Résultats: Il y a eu une importante participation aux évaluations des APC dans les hôpitaux communautaires et universitaires, avec une contribution considérable de données d'évaluation de la part des professeurs. Toutefois, alors que les évaluations des APC sont considérées à faibles enjeux etvisent à fournir une rétroaction formative, ce n'est pas de cette façon qu'elles sont vécues Les résidents et le corps professoral ont tous les deux rapporté une augmentation de la charge administrative et du niveau de stress perçu chez les résidents. Conclusion: L'implantation des APC est réaliste dans plusieurs sites. Malgré l'intention qui a motivé la mise en place des APC, ni les résidents ni le corps professoral ne perçoivent leur valeur comme moyen d'améliorer la rétroaction.

Rapid Cycle Deliberate Practice Versus Traditional Simulation to Improve Resident Performance in Forceps Deliveries.

This study aimed to assess the effectiveness of rapid cycle deliberate practice (RCDP) in improving obstetrics and gynaecology residents' performance and skill retention in forceps-assisted vaginal deliveries. Thirty-three residents were randomly assigned to RCDP or traditional debriefing. Performance was evaluated using an objective structured assessment of technical skills (OSATS) tool. There were no significant differences in immediate performance scores between groups (P = 0.082). At 4-6 months, both groups demonstrated improved performance scores (traditional, P = 0.001; RCDP, P = 0.001). Seventy-six percent of residents in the RCDP group indicated "real-time" feedback was advantageous. Three residents suggested this method was less beneficial at a senior level.

Informing the Spectrum of Approaches: Institutional Review of Placenta Accreta Spectrum Disorders Management.

OBJECTIVE: Placenta accreta spectrum (PAS) is a condition defined by abnormal adherence of the placenta. Cesarean hysterectomy is the preferred management, but practice patterns vary based on local resources and expertise. We retrospectively reviewed the clinical course of patients diagnosed antenatally with PAS who underwent surgical management in our centre. METHODS: We conducted a retrospective records review involving patients with an antenatal diagnosis of PAS between 2014 and 2019. The primary outcome was a composite score of maternal morbidity, and secondary outcomes were total estimated blood loss and composite neonatal morbidity. Patients were stratified based on the presence or absence of PAS on final pathology. Antenatal diagnosis by ultrasound and magnetic resonance imaging (MRI) was compared with final histologic diagnosis. RESULTS: A total of 34 patients were diagnosed with PAS antenatally and managed at our institution. Final histology confirmed PAS in 29 patients. The overall composite morbidity rate was 44%, with no significant difference between patients with and without PAS on pathology (P = 0.355). Intraoperative blood loss was similar between the 2 groups (2374 ± 2212 mL vs. 1080 ± 852 mL; P = 0.232). The rate of composite neonatal morbidity was 47%. Ultrasound achieved a high positive predictive value in the diagnosis of PAS (96%) and more accurately predicted pathology than MRI. CONCLUSIONS: PAS is associated with high rates of morbidity. Dissemination of our local experience serves to inform best practices in the management of this complex condition.

Tranexamic Acid Use in the Postpartum Period Since the WOMAN Trial: A Retrospective Chart Review.

OBJECTIVE: To analyze the use of tranexamic acid (TXA) in postpartum patients since the World Maternal Antifibrinolytic (WOMAN) trial. METHODS: A retrospective chart review was conducted from May 2017 to March 2020 at a tertiary care centre to identify all patients who received TXA for postpartum bleeding. The primary outcome was to identify the proportion of patients who received TXA as per World Health Organization guidelines created using results of the World Maternal Antifibrinolytic trial. RESULTS: A total of 231 patients were included in our analysis. Use increased over time with 18 patients in 2017, 51 in 2018, and 134 in 2019 receiving TXA. In all, 203 patients (87.9%) received TXA within recommended guidelines, and these patients were less likely to require surgery or interventional radiology (12.3% vs. 42.9%, P < 0.001) or blood transfusion (23.6% vs. 42.9%, P = 0.030), and they had a lower likelihood of overall adverse outcomes (1.62 (1.6) vs. 2.60 (2.0), P = 0.024). TXA was commonly used as the first-line agent for postpartum bleeding (48.9% of patients), more likely administered at cesarean section (77.0%) and when estimated blood loss did not meet criteria for "true" postpartum hemorrhage (41.6% of patients). Use of TXA as the first medication was associated with fewer overall adverse outcomes than misoprostol (P = 0.035). A shorter time to administration of the first medication was associated with shorter postpartum admission time (P = 0.042). CONCLUSIONS: The majority of patients received TXA within guidelines and experienced fewer adverse outcomes. Further study is needed to identify the best order of TXA administration with additional uterotonics and whether TXA should be used prophylactically in some groups for postpartum bleeding.

Maternal Vitamin B12 Levels During Pregnancy and Their Effects on Maternal Neurocognitive Symptoms: A Systematic Review.

OBJECTIVE: Vitamin B12 deficiency has been linked to neurocognitive symptoms. Vitamin B12 deficiency in pregnancy may be associated with antenatal or postpartum depression along with other neurocognitive symptoms including restless leg syndrome. The objective of this study was to systematically review the literature regarding vitamin B12 deficiency and insufficiency in pregnancy and its effects on maternal neurocognitive symptoms. DATA SOURCES: MEDLINE, Embase, and SCOPUS were searched from inception to October, 2020. STUDY SELECTION: Observational studies and randomized controlled trials of singleton pregnancies involving vitamin B12 deficiency and reporting maternal neurocognitive outcomes were identified. DATA EXTRACTION AND SYNTHESIS: Data were synthesized and are presented narratively. CONCLUSIONS: The 5 studies included in the analysis did not demonstrate a statistically significant link between vitamin B12 deficiency or insufficiency and either restless leg syndrome or depression in pregnancy. To date, evidence is lacking that would support a causal link between suboptimal vitamin B12 serum levels and maternal restless leg syndrome or depression.

Cervical Length as a Predictor of Latency to Labour in Twin Pregnancies Complicated by Preterm Pre-Labour Rupture of Membranes: A Retrospective Study.

OBJECTIVE: Preterm pre-labour rupture of membranes (PPROM), one of the leading causes of preterm delivery, represents a serious economic and psychosocial health care burden. The unpredictability of the interval between PPROM and labour, also known as the latency period, can be unsettling for patients and clinicians alike. In singleton pregnancies, the literature supports the use of ultrasound-determined cervical length to estimate the latency period. METHODS: With this retrospective cohort study, we sought to determine whether a shorter cervical length (≤25 vs. >25 mm) is associated with a shorter latency period in twin pregnancies complicated by PPROM. At McMaster University Medical Centre, a tertiary care centre, we used the Better Outcomes Registry Network (BoRN) database to identify patient records that met our criteria for inclusion over a 5-year period. RESULTS: Forty-three records were included in our analysis. On average, shorter cervical length was statistically significantly associated with a 6-day shorter latency period (P = 0.035). Confounders were controlled for using ANCOVA statistical analysis. A moderate, positive correlation between cervical length and latency period was also identified (r = 0.4). CONCLUSION: Understanding that a shorter cervical length is associated with a shorter latency period can assist clinicians in optimizing maternal counselling and patient care, including triaging transfers to tertiary care centres.

Mode of Delivery: Development and Implementation of an Obstetrical In Situ Simulation Program.

OBJECTIVE: Simulation is increasingly valued as a learning tool in obstetrical practice. In situ simulation assesses the hands-on and critical thinking skills of a health care team within their clinical setting. We aimed to create an in situ simulation program to promote skills acquisition, enhance teamwork, and identify system limitations. METHODS: Key obstetrical emergencies were identified through a needs assessment. In situ simulations were developed to address these clinical presentations. During simulations, organizers and participants identified latent safety threats. Medical management was evaluated through comprehensive emergency-specific checklists. Leadership attitudes were assessed using the modified Perinatal Emergency Team Response Assessment tool. Following each simulation, team members were debriefed, and qualitative and quantitative feedback was solicited and aggregated by specialty and discipline. RESULTS: Simulations were conducted monthly at two academic centers over 14 months. Participation was interdisciplinary, including learners, staff physicians, nursing, and allied health team members from the departments of obstetrics, anesthesia, emergency medicine, and neonatology. Participants reported their involvement was enjoyable. Participants reported improvements in communication skills, content knowledge, and procedural knowledge. Participants favourably rated the spontaneity of simulations, clinically relevant scenarios, safe environment, and use of realistic equipment. Latent safety threats, related to equipment, medication, personnel, resources, and technical skills, were identified. CONCLUSION: We present the successful implementation of a comprehensive in situ simulation program. In situ simulation allows for deliberate practice of obstetrical emergencies and promotes a culture of patient safety. Lessons learned provide valuable data to identify limitations within our current practices and inform future policy change.

Hysterectomy with Fetus In Situ for Uterine Rupture at 21-Week Gestation due to a Morbidly Adherent Placenta.

BACKGROUND: Uterine rupture due to a morbidly adherent placenta is a rare obstetrical cause of acute abdominal pain in the pregnant patient. We present a case to add to the small body of published literature describing this diagnosis. CASE: A 32-year-old G5T2P1A1L2 with multiple prior cesarean sections presented at 21+3 weeks' gestation with abdominal pain and presyncope. Ultrasound showed a large volume of complex intraabdominal free fluid and a heterogenous placenta with irregular lacunae and increased vascularity extending to the posterior bladder wall. Exploratory laparotomy identified a uterine defect and a hysterectomy was performed due to significant bleeding. Pathology confirmed a diagnosis of placenta percreta. CONCLUSION: Early recognition and management of uterine rupture due to a morbidly adherent placenta are essential to prevent catastrophic hemorrhage.

On the Effects of Artificial Feeding on Bee Colony Dynamics: A Mathematical Model.

This paper proposes a new mathematical model to evaluate the effects of artificial feeding on bee colony population dynamics. The proposed model is based on a classical framework and contains differential equations that describe the changes in the number of hive bees, forager bees, and brood cells, as a function of amounts of natural and artificial food. The model includes the following elements to characterize the artificial feeding scenario: a function to model the preference of the bees for natural food over artificial food; parameters to quantify the quality and palatability of artificial diets; a function to account for the efficiency of the foragers in gathering food under different environmental conditions; and a function to represent different approaches used by the beekeeper to feed the hive with artificial food. Simulated results are presented to illustrate the main characteristics of the model and its behavior under different scenarios. The model results are validated with experimental data from the literature involving four different artificial diets. A good match between simulated and experimental results was achieved.

Neonatal Outcomes in Women With Untreated Antenatal Depression Compared With Women Without Depression: A Systematic Review and Meta-analysis.

IMPORTANCE: Despite the prevalence of antenatal depression and the fact that only one-third of pregnant women with depression consider it acceptable to take antidepressants, the effect of untreated depression on neonatal outcomes remains to be addressed thoroughly. OBJECTIVE: To undertake a systematic review and meta-analysis to understand the effect of untreated depression on neonatal outcomes. DATA SOURCES: We executed our search strategy, with emphasis on its exhaustiveness, in MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health, Cochrane Central Register of Controlled Trials, and Web of Science. The search was conducted in July, 2015. STUDY SELECTION: We included randomized and nonrandomized studies that examined neonatal outcomes in women with depression receiving neither pharmacological nor nonpharmacological treatment compared with women without depression. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently screened titles and abstracts, assessed full-text articles, extracted data, and assessed their quality using a modified version of the Newcastle-Ottawa Scale. We pooled data using random-effects meta-analyses, quantified heterogeneity using the I2 statistic, and explored it with subgroup analyses by type of assessment of depression, severity, reported conflicts of interest, and study quality. MAIN OUTCOMES AND MEASURES: Primary outcomes were preterm birth before 37 weeks and before 32 weeks, small and large for gestational age, low birth weight, and neonatal intensive care unit admission. RESULTS: Of the 6646 titles initially identified, 23 studies met inclusion criteria, all observational, with a total of 25 663 women. Untreated depression was associated with significantly increased risks of preterm birth (odds ratio [OR], 1.56; 95% CI, 1.25-1.94; 14 studies; I2, 39%) and low birth weight (OR, 1.96; 95% CI, 1.24-3.10; 8 studies; I2, 48%), with a trend toward higher risks for exposure to more severe depression. While the odds of preterm birth more than doubled in studies reporting conflicts of interest (OR, 2.50; 95% CI, 1.70-3.67; 5 studies; I2, 0%), studies not reporting such conflicts showed more moderate results (OR, 1.34; 95% CI, 1.08-1.66; 9 studies; I2, 30%). CONCLUSIONS AND RELEVANCE: Our results contrast with what is, to our knowledge, the only previous systematic review that examined the question of untreated depression because we found significant risks of 2 key perinatal outcomes, preterm birth and low birth weight. These are important results for pregnant women and clinicians to take into account in the decision-making process around depression treatment.

Inhibition of the Myotoxicity Induced by Bothrops jararacussu Venom and Isolated Phospholipases A2 by Specific Camelid Single-Domain Antibody Fragments.

Antivenoms, produced using animal hyperimmune plasma, remains the standard therapy for snakebites. Although effective against systemic damages, conventional antivenoms have limited efficacy against local tissue damage. Additionally, the hypersensitivity reactions, often elicited by antivenoms, the high costs for animal maintenance, the difficulty of producing homogeneous lots, and the instability of biological products instigate the search for innovative products for antivenom therapy. In this study, camelid antibody fragments (VHH) with specificity to Bothropstoxin I and II (BthTX-I and BthTX-II), two myotoxic phospholipases from Bothrops jararacussu venom, were selected from an immune VHH phage display library. After biopanning, 28 and 6 clones recognized BthTX-I and BthTX-II by ELISA, respectively. Complementarity determining regions (CDRs) and immunoglobulin frameworks (FRs) of 13 VHH-deduced amino acid sequences were identified, as well as the camelid hallmark amino acid substitutions in FR2. Three VHH clones (KF498607, KF498608, and KC329718) were capable of recognizing BthTX-I by Western blot and showed affinity constants in the nanomolar range against both toxins. VHHs inhibited the BthTX-II phospholipase A2 activity, and when tested for cross-reactivity, presented specificity to the Bothrops genus in ELISA. Furthermore, two clones (KC329718 and KF498607) neutralized the myotoxic effects induced by B. jararacussu venom, BthTX-I, BthTX-II, and by a myotoxin from Bothrops brazili venom (MTX-I) in mice. Molecular docking revealed that VHH CDRs are expected to bind the C-terminal of both toxins, essential for myotoxic activity, and to epitopes in the BthTX-II enzymatic cleft. Identified VHHs could be a biotechnological tool to improve the treatment for snake envenomation, an important and neglected world public health problem.

Engenharia de anticorpos na busca por fragmentos funcionais para insumos de diagnóstico e aplicações terapêuticas / Antibody engineering in the search for functional fragments for diagnostic inputs and therapeutic applications

Anticorpos, agentes empregados no desenvolvimento de pesquisas biomédicas, no diagnóstico e na terapêutica, possuem elevada capacidade de interação aos mais variados ligantes, Estruturalmente são heterotetrameros constituídos por duas cadeias leves e duas cadeias pesadas com massa molecular de aproximadamente 150 kDa, Visando melhorar as características farmacocinéticas e minimizar possíveis reações adversas desencadeadas por imunoglobulinas de origem não humana, a engenharia molecular de anticorpos vem obtendo fragmentos de anticorpos como porções Fab, F(ab?)2, scFv e Fv, Em adição aos anticorpos convencionais, camelídeos produzem imunoglobulinas funcionais desprovidas de cadeia leve, onde o domínio variável da cadeia pesada, denominado VHH ou nanocorpo, é responsável pelo reconhecimento antigênico, Apresentando características adequadas ao desenvolvimento de fármacos com alta capacidade de neutralização, fragmentos VHHs vêm sendo propostos para uso em imunoterapia passiva ou em drug-delivery, No diagnóstico esses fragmentos podem ser aplicados na construção de biosensores ou na imagiologia, atuando na detecção de células cancerígenas, no monitoramento de tumores ou em alterações celulares...

Antibodies, agents employed for the development of biomedical research, diagnostic and therapeutic, have high ability to interact with different ligands. Structurally are heterotetramers constituted by two light and two heavy chains, with molecular weight of approximately 150 kDa. Aiming to improve the pharmacokinetic properties and minimize possible adverse reactions triggered by immunoglobulins of non-human origin, the molecular engineering of antibodies has been obtaining fragments of antibodies, such as Fab, F(ab?)2, Fv and scFv. In addition to the conventional antibodies, camelids produce functional immunoglobulins devoid of light chain, in which the variable domain, named VHH or nanocorpo, is able to recognize the antigen. With appropriate characteristics for the development of drugs with high neutralizing capacity, VHH fragments have been proposed for use in passive immunotherapy or drug-delivery. To the diagnosis, these fragments can be used to construct biosensors, in the imagiology , acting in the detection of cancer cells, tumor monitoring or cell changes...

Novel camelid antibody fragments targeting recombinant nucleoprotein of Araucaria hantavirus: a prototype for an early diagnosis of Hantavirus Pulmonary Syndrome.

In addition to conventional antibodies, camelids produce immunoglobulins G composed exclusively of heavy chains in which the antigen binding site is formed only by single domains called VHH. Their particular characteristics make VHHs interesting tools for drug-delivery, passive immunotherapy and high-throughput diagnosis. Hantaviruses are rodent-borne viruses of the Bunyaviridae family. Two clinical forms of the infection are known. Hemorrhagic Fever with Renal Syndrome (HFRS) is present in the Old World, while Hantavirus Pulmonary Syndrome (HPS) is found on the American continent. There is no specific treatment for HPS and its diagnosis is carried out by molecular or serological techniques, using mainly monoclonal antibodies or hantavirus nucleoprotein (N) to detect IgM and IgG in patient serum. This study proposes the use of camelid VHHs to develop alternative methods for diagnosing and confirming HPS. Phage display technology was employed to obtain VHHs. After immunizing one Lama glama against the recombinant N protein (prNΔ85) of a Brazilian hantavirus strain, VHH regions were isolated to construct an immune library. VHHs were displayed fused to the M13KO7 phage coat protein III and the selection steps were performed on immobilized prNΔ85. After selection, eighty clones recognized specifically the N protein. These were sequenced, grouped based mainly on the CDRs, and five clones were analyzed by western blot (WB), surface plasmon resonance (SPR) device, and ELISA. Besides the ability to recognize prNΔ85 by WB, all selected clones showed affinity constants in the nanomolar range. Additionaly, the clone KC329705 is able to detect prNΔ85 in solution, as well as the native viral antigen. Findings support the hypothesis that selected VHHs could be a powerful tool in the development of rapid and accurate HPS diagnostic assays, which are essential to provide supportive care to patients and reduce the high mortality rate associated with hantavirus infections.

Hygienic Behavior of Africanized Honey Bees Apis mellifera Directed towards Brood in Old and New Combs during Diurnal and Nocturnal Periods.

Hygienic behavior in honey bees, Apis mellifera, is measured by determining the rate at which the bees uncap and remove dead sealed brood. We analyzed individual behavior of house-cleaning Africanized honey bees in order to focus on some poorly understood aspects of hygienic behavior. Two observation hives, each with approximately 3,000 individually marked bees, were used in this study. The efficiency of hygienic behavior was evaluated in hygienic and non-hygienic strains of bees using two types of combs (new and old), as well as at different periods of the day (night and day). We also recorded the age of workers that performed this task of removing dead brood. In both strains, the workers that performed tasks related to hygienic behavior were within the same age cohort; we found no influence of age on the amount of time dedicated to the task, independent of the type of comb or period of the day. The total time from perforation of the cell capping until the dead brood had been completely removed, and was significantly shorter during daytime than at night. Hygienic behavior directed towards dead brood in new combs was also significantly more efficient (faster) than for brood in old combs. The type of comb had significantly more effect than did the time of day. We conclude that the type of comb and time of day should be taken into consideration when evaluating hygienic behavior in honey bees.

Comparative morphology of reproductive and trophic eggs in melipona bees (Apidae, Meliponini)

The process of cell provisioning and oviposition (POP) in stingless bees involves highly complex interactionsbetween the queen and workers. During this process, workers can usually lay two types of eggs, referred toas reproductive and trophic. Reproductive worker-laid eggs are unfertilized but develop into males whereastrophic worker-laid eggs are eaten by the queen immediately after oviposition. Although the egg-layingactivity of reproductive workers varies considerably among species, the laying of trophic eggs appears to bethe rule in Melipona bees. In this work, we examined whether the morphology of eggs laid by workers andqueens of M. scutellaris, M. compressipes fasciculata and M. asilvai was similar to that of other Meliponaspecies. Egg morphology was examined by scanning electron microscopy whereas egg size was measured bylight microscopy. In all of the species studied, the chorion of queen and worker reproductive eggs showed acharacteristic reticulate pattern. The surface of trophic eggs was not reticulate and had an irregular appearancefollowing fixation. Trophic eggs were also invariably smaller than queen-laid eggs and were sometimessmaller than worker-laid reproductive eggs. These findings indicate that trophic eggs can be smaller than theeggs of functional workers, which suggests that the development of this type of egg is probably associatedwith different physiological adaptations.