Use of effective contraception following provision of the progestogen-only pill for women presenting to community pharmacies for emergency contraception (Bridge-It): a pragmatic cluster-randomised crossover trial

BACKGROUND: Unless women start effective contraception after oral emergency contraception, they remain at risk of unintended pregnancy. Most women in the UK obtain emergency contraception from community pharmacies. We hypothesised that pharmacist provision of the progestogen-only pill as a bridging interim method of contraception with emergency contraception plus an invitation to a sexual and reproductive health clinic, in which all methods of contraception are available, would result in increased subsequent use of effective contraception. METHODS: We did a pragmatic cluster-randomised crossover trial in 29 UK pharmacies among women receiving levonorgestrel emergency contraception. Women aged 16 years or older, not already using hormonal contraception, not on medication that could interfere with the progestogen-only pill, and willing to give contact details for follow-up were invited to participate. In the intervention group, women received a 3-month supply of the progestogen-only pill (75 μg desogestrel) plus a rapid access card to a participating sexual and reproductive health clinic. In the control group, pharmacists advised women to attend their usual contraceptive provider. The order in which each pharmacy provided the intervention or control was randomly assigned using a computer software algorithm. The primary outcome was the use of effective contraception (hormonal or intrauterine) at 4 months. This study is registered, ISRCTN70616901 (complete). FINDINGS: Between Dec 19, 2017, and June 26, 2019, 636 women were recruited to the intervention group (316 [49·6%], mean age 22·7 years [SD 5·7]) or the control group (320 [50·3%], 22·6 years [5·1]). Three women (one in the intervention group and two in the control group) were excluded after randomisation. 4-month follow-up data were available for 406 (64%) participants, 25 were lost to follow-up, and two participants no longer wanted to participate in the study. The proportion of women using effective contraception was 20·1% greater (95% CI 5·2-35·0) in the intervention group (mean 58·4%, 48·6-68·2), than in the control group (mean 40·5%, 29·7-51·3 [adjusted for recruitment period, treatment group, and centre]; p=0·011).The difference remained significant after adjusting for age, current sexual relationship, and history of effective contraception use, and was robust to the effect of missing data (assuming missingness at random). No serious adverse events occurred. INTERPRETATION: Provision of a supply of the progestogen-only pill with emergency contraception from a community pharmacist, along with an invitation to a sexual and reproductive health clinic, results in a clinically meaningful increase in subsequent use of effective contraception. Widely implemented, this practice could prevent unintended pregnancies after use of emergency contraception. FUNDING: National Institute for Health Research (Health Technology Assessment Programme project 15/113/01)

Flattening effect of four wave mixing on multiwavelength Brillouin-erbium fiber laser.

A multiwavelength Brillouin-erbium fiber laser with enhanced output uniformity is demonstrated and its performance with and without the assistance of four wave mixing (FWM) is compared. The presence of FWM effect is proven by the generation of anti-Stokes wave and higher-order Stokes wave. This scheme is successful in flattening the multiwavelength output. At Brillouin pump wavelength of 1,550 nm, between the first and the last output channel, peak power differences of 4.59 and 8.32 dB are recorded for the scheme with and without the assistance of FWM, respectively. This represents 3.73 dB improvement in the multiwavelength output power uniformity

Performance characteristics of single frequency Er³⁺:Yb³⁺ codoped fiber laser

The performance of Er3+:Yb3+ single frequency fiber lasers is reported. With lasing powers up to 60mW, they are shown to have excellent specifications in terms of optical linewidth, signal-to-noise ratio, RIN, SMSR and polarisation purity

High performance single frequency fiber grating-based Erbium:Ytterbium-codoped fiber lasers

The device characteristics of Er3+:Yb3+ single frequency fiber lasers are reported. A 5cm long 1550 nm distributed feedback fiber laser with 4 mW output power is shown to have excellent specifications in terms of optical linewidth, signal-to-noise ratio, relative intensity noise, side-mode suppression and polarisation purity. For higher power applications, a 1.5cm single frequency Er3+:Yb3+ grating-based fiber laser with 60 mW output power and a net efficiency of 12% is demonstrated

Maximising follow-up participation rates in a large scale 45 and Up cohort study in Australia.

Background The issue of poor response rates to population surveys has existed for some decades, but few studies have explored methods to improve the response rate in follow-up population cohort studies. Methods A sample of 100,000 adults from the 45 and Up Study, a large population cohort in Australia, were followed up 3.5 years after the baseline cohort was assembled. A pilot mail-out of 5000 surveys produced a response rate of only 41.7 %. This study tested methods of enhancing response rate, with three groups of 1000 each allocated to (1) receiving an advance notice postcard followed by a questionnaire, (2) receiving a questionnaire and then follow-up reminder letter, and (3) both these strategies. Results The enhanced strategies all produced an improved response rate compared to the pilot, with a resulting mean response rate of 53.7 %. Highest response was found when both the postcard and questionnaire reminder were used (56.4 %) but this was only significantly higher when compared to postcard alone (50.5 %) but not reminder alone (54.1 %). The combined approach was used for recruitment among the remaining 92,000 participants, with a resultant further increased response rate of 61.6 %. Conclusions Survey prompting with a postcard and a reminder follow-up questionnaire, applied separately or combined can enhance follow-up rates in large scale survey-based epidemiological studies