Effect of Baseline Menstrual Bleeding Pattern on Copper Intrauterine Device Continuation

Background Heavy menstrual bleeding is a leading cause of copper intrauterine device (IUD) discontinuation. Thus, women with heavy baseline menstrual bleeding may be at increased risk for early copper IUD discontinuation. Our objective was to assess if there was an association between baseline menstrual bleeding pattern prior to IUD insertion and discontinuation rate at 12 months among study participants who chose copper IUD at baseline. Study Design We performed a secondary analysis of the Contraceptive CHOICE Project, a prospective observational cohort study of 9,256 women offered no cost contraception for 2-3 years. Included in our study were participants who chose copper IUD for contraception and for whom method continuation data at 12 months were available. Prior to contraception initiation, participants were asked to qualify their menstrual bleeding over the past year as: light, moderate, moderately heavy or heavy. Light bleeding corresponded to using 10 or fewer pads/tampons per period. Moderate, moderately heavy and heavy bleeding corresponded to 11-20 pads/tampons, 21-30 pads/tampons, and more than 30 pads/tampons per period, respectively. Subjects were then categorized into either a “heavy” baseline group (those reporting moderately heavy or heavy bleeding at baseline), or a “not heavy” group (those reporting light or moderate bleeding). The 12-month continuation rate for each group was then calculated using Kaplan-Meier survival function, and hazard ratio for risk of discontinuation was evaluated using a Cox proportional hazard model to determine if moderately heavy or heavy bleeding at baseline was associated with early discontinuation. Results Of the 918 women meeting the inclusion criteria for this analysis, 165 were in the heavy baseline bleeding group, while 753 were in the not heavy bleeding group. The 12-month continuation rates for groups were similar: 80.2% (heavy) and 85.0% (not heavy; P=0.24). Patients reporting either moderately heavy or heavy baseline bleeding were not at increased risk for early discontinuation of copper IUD (hazard ratio 1.21, 95% CI 0.88, 1.66). Our sample size provided greater than 90% power to detect a clinically important difference of 15% (assuming 20% discontinuation rate in not heavy bleeding group and a 35% discontinuation rate in the heavy bleeding group). Conclusions We did not find that women who reported baseline moderately heavy or heavy menstrual bleeding were at increased risk for early discontinuation. Thus, we do not believe that women with heavy menstrual bleeding should be discouraged from using this safe and highly-effective form of contraception

The fennec automatic weather station (AWS) network: Monitoring the Saharan climate system

The Fennec automatic weather station (AWS) network consists of eight stations installed across the Sahara, with four in remote locations in the central desert, where no previous meteorological observations have existed. The AWS measures temperature, humidity, pressure, wind speed, wind direction, shortwave and longwave radiation (upwelling and downwelling), ground heat flux, and ground temperature. Data are recorded every 3 min 20 s, that is, at 3 times the temporal resolution of the World Meteorological Organization's standard 10-min reporting for winds and wind gusts. Variations in wind speeds on shorter time scales are recorded through the use of second- and third-order moments of 1-Hz data. Using the Iridium Router- Based Unrestricted Digital Internetworking Connectivity Solutions (RUDICS) service, data are transmitted in near-real time (1-h lag) to the United Kingdom, where calibrations are applied and data are uploaded to the Global Telecommunications System (GTS), for assimilation into forecast models. This paper describes the instrumentation used and the data available from the network. Particular focus is given to the engineering applied to the task of making measurements in this remote region and challenging climate. The communications protocol developed to operate over the Iridium RUDICS satellite service is described. Transmitting the second moment of the wind speed distribution is shown to improve estimates of the dust-generating potential of observed winds, especially for winds close to the threshold speed for dust emission of the wind speed distribution. Sources of error are discussed and some preliminary results are presented, demonstrating the system's potential to record key features of this region

Scapula fractures: interobserver reliability of classification and treatment

OBJECTIVES:There is substantial variation in the classification and the management of scapula fractures. The first purpose of this study was to analyze the interobserver reliability of the OTA/AO and the New International Classification of scapula fractures. The second purpose was to assess the proportion of agreement among orthopaedic surgeons on operative or nonoperative treatment. DESIGN:: Web-based reliability study SETTING:: Independent orthopaedic surgeons from several countries were invited to classify scapular fractures in an online survey. PARTICIPANTS:One-hundred and three orthopaedic surgeons evaluated 35 movies of 3DCT-reconstruction of selected scapular fractures, representing a full spectrum of fracture patterns. MAIN OUTCOME MEASUREMENTS:Fleiss' kappa (κ) was used to assess the reliability of agreement between the surgeons. RESULTS:: The overall agreement on the OTA/AO Classification was moderate for the types (A, B, and C, κ = 0.54) with a 71% proportion of rater agreement (PA) as well as for the nine groups (A1 to C3, κ = 0.47) with a 57% PA. For the New International Classification, the agreement about the intra-articular extension of the fracture (Fossa (F), κ = 0.79) was substantial, the agreement about a fractured body (Body (B), κ = 0.57) or process was moderate (Process (P), κ = 0.53), however PAs were more than 81%. The agreement on the treatment recommendation was moderate (κ = 0.57) with a 73% PA. CONCLUSIONS:The New International Classification was more reliable. Body and process fractures generated more disagreement than intra-articular fractures and need further clear definitions