Referral Center Experience With Nonpalpable Contraceptive Implant Removals.

ObjectiveTo describe our experience with office removal of nonpalpable contraceptive implants at our referral center.MethodsWe performed a retrospective cohort study by reviewing the charts of patients referred to our family planning specialty center for nonpalpable or complex contraceptive implant removal from January 2015 through December 2018. We localized nonpalpable implants using high-frequency ultrasonography and skin mapping in radiology, followed by attempted removal in the office using local anesthesia and a modified vasectomy clamp. We abstracted information on demographics, implant location, and outcomes.ResultsOf 61 referrals, 55 patients attended their scheduled appointments. Seven patients had palpable implants; six elected removal. The other 48 patients had ultrasound localization, which identified 47 (98%) of the implants; the remaining patient had successful localization with computed tomography imaging. Nonpalpable implants were suprafascial (n=22), subfascial (n=25) and intrafascial (n=1); four of these patients opted to delay removal. Of 50 attempted office removals, all palpable (n=6), all nonpalpable suprafascial (n=21 [100%, 95% CI 83-100%]), and 19 out of 23 (83%, 95% CI 67-98%) subfascial implants were successful. Three of the four patients with failed subfascial implant office removal had successful operating room removal with a collaborative orthopedic surgeon; the other patient sought removal elsewhere. Transient postprocedure neuropathic complaints were noted in 7 out of 23 (30%, 95% CI 12-49%) subfascial and 1 out of 21 (5%, 95% CI 0-13%) suprafascial removals (P=.048). Nonpalpable implants were more likely to be subfascial in nonobese patients (24/34, 71%) as compared with obese (1/13, 8%) patients (P<.001). Seven (28%) of the 25 subfascially located implants had been inserted during a removal-reinsertion procedure through the same incision.ConclusionMost nonpalpable contraceptive implants can be removed in the office by an experienced subspecialty health care provider after ultrasound localization. Some patients may experience transient postprocedure neuropathic pain. Nonpalpable implants in thinner women are more likely to be in a subfascial location

The functional role of producer diversity in ecosystems

Over the past several decades, a rapidly expanding field of research known as biodiversity and ecosystem functioning has begun to quantify how the world\u27s biological diversity can, as an independent variable, control ecological processes that are both essential for, and fundamental to, the functioning of ecosystems. Research in this area has often been justified on grounds that (1) loss of biological diversity ranks among the most pronounced changes to the global environment and that (2) reductions in diversity, and corresponding changes in species composition, could alter important services that ecosystems provide to humanity (e.g., food production, pest/disease control, water purification). Here we review over two decades of experiments that have examined how species richness of primary producers influences the suite of ecological processes that are controlled by plants and algae in terrestrial, marine, and freshwater ecosystems. Using formal meta-analyses, we assess the balance of evidence for eight fundamental questions and corresponding hypotheses about the functional role of producer diversity in ecosystems. These include questions about how primary producer diversity influences the efficiency of resource use and biomass production in ecosystems, how primary producer diversity influences the transfer and recycling of biomass to other trophic groups in a food web, and the number of species and spatial /temporal scales at which diversity effects are most apparent. After summarizing the balance of evidence and stating our own confidence in the conclusions, we outline several new questions that must now be addressed if this field is going to evolve into a predictive science that can help conserve and manage ecological processes in ecosystems

Absorption cross section in Lifshitz black hole

We derive the absorption cross section of a minimally coupled scalar in the Lifshitz black hole obtained from the new massive gravity. The absorption cross section reduces to the horizon area in the low energy and massless limit of s-wave mode propagation, indicating that the Lifshitz black hole also satisfies the universality of low energy absorption cross section for black holes.Comment: 13 pages, 1 figure, version to appear in EPJ

Phase transitions for the Lifshitz black holes

We study possibility of phase transitions between Lifshitz black holes and other configurations by using free energies explicitly. A phase transition between Lifshitz soliton and Lifshitz black hole might not occur in three dimensions. We find that a phase transition between Lifshitz and BTZ black holes unlikely occurs because they have different asymptotes. Similarly, we point out that any phase transition between Lifshitz and black branes unlikely occurs in four dimensions since they have different asymptotes. This is consistent with a necessary condition for taking a phase transition in the gravitational system, which requires the same asymptote.Comment: 19 pages, 7 figures, a revised version to appear in EPJ

Geometry and BMS Lie algebras of spatially isotropic homogeneous spacetimes

Simply-connected homogeneous spacetimes for kinematical and aristotelian Lie algebras (with space isotropy) have recently been classified in all dimensions. In this paper, we continue the study of these "maximally symmetric" spacetimes by investigating their local geometry. For each such spacetime and relative to exponential coordinates, we calculate the (infinitesimal) action of the kinematical symmetries, paying particular attention to the action of the boosts, showing in almost all cases that they act with generic non-compact orbits. We also calculate the soldering form, the associated vielbein and any invariant aristotelian, galilean or carrollian structures. The (conformal) symmetries of the galilean and carrollian structures we determine are typically infinite-dimensional and reminiscent of BMS Lie algebras. We also determine the space of invariant affine connections on each homogeneous spacetime and work out their torsion and curvature.Comment: 62 pages, 3 figures, 4 tables, v2: Matches published version, mistake corrected in Section 4.1.3., 10.2, 10.3, other minor improvements, added reference

Asymptotically Lifshitz wormholes and black holes for Lovelock gravity in vacuum

Static asymptotically Lifshitz wormholes and black holes in vacuum are shown to exist for a class of Lovelock theories in d=2n+1>7 dimensions, selected by requiring that all but one of their n maximally symmetric vacua are AdS of radius l and degenerate. The wormhole geometry is regular everywhere and connects two Lifshitz spacetimes with a nontrivial geometry at the boundary. The dynamical exponent z is determined by the quotient of the curvature radii of the maximally symmetric vacua according to n(z^2-1)+1=(l/L)^2, where L corresponds to the curvature radius of the nondegenerate vacuum. Light signals are able to connect both asymptotic regions in finite time, and the gravitational field pulls towards a fixed surface located at some arbitrary proper distance to the neck. The asymptotically Lifshitz black hole possesses the same dynamical exponent and a fixed Hawking temperature given by T=z/(2^z pi l). Further analytic solutions, including pure Lifshitz spacetimes with a nontrivial geometry at the spacelike boundary, and wormholes that interpolate between asymptotically Lifshitz spacetimes with different dynamical exponents are also found.Comment: 19 pages, 1 figur

What Price Recreation in Finland?—A Contingent Valuation Study of Non-Market Benefits of Public Outdoor Recreation Areas

Basic services in Finnish national parks and state-owned recreation areas have traditionally been publicly financed and thus free of charge for users. Since the benefits of public recreation are not captured by market demand, government spending on recreation services must be motivated in some other way. Here, we elicit people’s willingness to pay (WTP) for services in the country’s state-owned parks to obtain an estimate of the value of outdoor recreation in monetary terms. A variant of the Tobit model is used in the econometric analysis to examine the WTP responses elicited by a payment card format. We also study who the current users of recreation services are in order to enable policymakers to anticipate the redistribution effects of a potential implementation of user fees. Finally, we discuss the motives for WTP, which reveal concerns such as equity and ability to pay that are relevant for planning public recreation in general and for the introduction of fees in particular

Limits of JT gravity

We construct various limits of JT gravity, including Newton-Cartan and Carrollian versions of dilaton gravity in two dimensions as well as a theory on the three-dimensional light cone. In the BF formulation our boundary conditions relate boundary connection with boundary scalar, yielding as boundary action the particle action on a group manifold or some Hamiltonian reduction thereof. After recovering in our formulation the Schwarzian for JT, we show that AdS-Carroll gravity yields a twisted warped boundary action. We comment on numerous applications and generalizations.Comment: 41 pages, 3 figures, 1 table; v2: Matches published version + Footnote 11; v3: Corrected typo in Carrollian/Galilean generalized dilaton potentia