Continuous Rate Research Articles

Forecasting Sauter mean droplet size and examining the range of droplet sizes in a Tenova liquid–liquid extraction column

A new type of Tenova pulsed extraction column was introduced in 2017. It is the newest generation of pulsed columns. Due to the internal equipment of this column and the lack of moving parts and the simplicity and speed of repairs and maintenance, it has been the focus of researchers in recent years. No correlations for predicting the mean drop size and drop size distribution of the Tenova column have been reported. The Sauter mean drop diameter and drop size distribution are investigated for a Tenova pulsed column with a diameter and an active height of 7.4 and 73 cm, respectively. Three standard chemical systems of isobutyl acetate-water, isobutanol-water, and toluene-water have been used. The effects of pulse intensity, dispersed and continuous phase flow rates have been taken into account. In each experiment, 200–300 drops have been analyzed in a total of 10,000 drops. The investigation covered a spectrum of physical properties, notably surface tension (within a range of 1.75–36 mN/m). Operating conditions including pulse intensity (in the range of 0.2–2 cm/s) and the flow rate of continuous and dispersed phases (in the range of 8–30 L/h) have been investigated. Methods based on artificial intelligence (AI) such as multilayer perceptron neural networks and gene expression programming were combined with a dimensional analysis approach to provide a new approach to estimating the mean drop diameter (d32). Experimental results have been compared with the equations found by other researchers in similar columns. The variation of drop size distribution has also been experimentally obtained.Methods based on artificial intelligence (AI) such as multilayer perceptron neural networks and gene expression programming were combined with a dimensional analysis approach to provide a new approach to estimating the mean drop diameter (d32). Experimental results have been compared with the equations found by other researchers in similar columns. The variation of drop size distribution has also been experimentally obtained.

Altered emotional mind-body coherence in older adults.

Coherence between subjective experience and bodily responses in emotion is assumed to have a positive influence on well-being, which might be particularly valuable in late adulthood. Previous studies of young adults' continuous subjective, behavioral, and physiological responses to emotional films reported emotional mind-body coherence. In contrast, research regarding emotional coherence in older adults has been scarce. In this study, we examined emotional coherence in older adults between continuous valence ratings and behavioral responses (facial electromyography [EMG] of the corrugator supercilii and zygomatic major muscles), as well as between continuous arousal ratings and physiological measures (electrodermal activity [EDA] and fingertip temperature), in response to four emotion-eliciting film clips (anger, sadness, contentment, and amusement) film clips and an emotionally neutral clip. Intraindividual cross-correlation analyses revealed that the coherence between valence ratings and corrugator EMG activity for the anger-eliciting film was weaker in older adults than in young adults, who completed an identical experiment. Age differences also emerged in the coherence of arousal ratings with EDA and fingertip temperature measures, respectively, while participants watched the anger-eliciting and contentment-eliciting films; while negative correlations were found for older adults, positive correlations were found for young adults. These results indicate that emotional mind-body coherence somewhat differs quantitatively and qualitatively between older and young adults. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Enhanced Scheduling to Improve Resident Continuity in a Family Medicine Teaching Clinic.

Continuity of care is a core concept at the heart of primary care practices. Increased patient-provider continuity of care is associated with better satisfaction scores, better clinical outcomes, decreased hospitalizations and emergency department utilization, improved completion of preventive health services, adherence to medical treatment plans, and improved show rates. Compared to traditional outpatient practices, resident teaching clinics traditionally have lower rates of continuity and face unique challenges in improving continuity given the curricular demands, complex scheduling, and high turnover of providers. The objective of our study was to assess the impact of front office training and new electronic medical record (EMR) scheduling protocols on resident continuity in a family medicine teaching clinic. From July 2021 through May 2022, optimized scheduling through a provider search function in the EMR was implemented in a family medicine teaching clinic. We compared the monthly continuity rates between corresponding months in the prior year and the intervention year. Over an 11-month implementation process, continuity for resident physicians increased from 36.4% to 64.6% (χ2=675.41, P<.001) using EMR tools and scheduling search functions to improve and sustain continuity over the study period. This intervention to enhance continuity in a family medicine residency clinic led to rapid and sustained improvement in provider continuity. This result demonstrates that optimization of EMR scheduling with tools and protocols can improve overall continuity. This scheduling process can likely be applied to clinical sites for residency programs across disciplines.

Mortality and hyperkalaemia-associated hospitalisation in patients with chronic kidney disease: comparison of sodium zirconium cyclosilicate and sodium/calcium polystyrene sulfonate.

Sodium zirconium cyclosilicate (SZC), a novel drug used for treating hyperkalaemia, is effective in reducing serum potassium levels. The effects of potassium adsorbents on the mortality and hyperkalaemia-associated hospitalisation rates remain unclear. We aimed to examine how mortality and hyperkalaemia-associated hospitalisation rates vary with usage of various potassium adsorbents. This retrospective study used patients' data between April 2008 and August 2021 obtained from a large-scale Japanese medical claims database. Consecutive patients with chronic kidney disease (CKD) prescribed potassium adsorbents were enrolled and divided into three groups according to the adsorbent type [SZC, calcium polystyrene sulfonate (CPS), and sodium polystyrene sulfonate (SPS)] and were observed for 1 year. The primary outcome was a composite of mortality and hyperkalaemia-associated hospitalisation. In total, 234, 54 183, and 18 692 patients were prescribed SZC, CPS, and SPS, respectively. The SZC group showed a higher event-free survival rate than the other two groups. The hazard ratio for the primary outcome in the CPS and SPS groups was similar in the analyses of the subgroups of patients who did not receive renal replacement therapy and those who received haemodialysis. The SZC group had a higher renin-angiotensin-aldosterone system inhibitors (RAASi) continuation rate compared to CPS and SPS groups, the difference being especially significant for SPS. This real-world study demonstrated the therapeutic effect of SZC in reducing mortality and hyperkalaemia-associated hospitalisations. The high RAASi continuation rate in the SZC group might be a contributing factor for improvement of the primary outcome.

Preliminary Experience With Remimazolam for Procedural Sedation and as an Adjunct to General Anesthesia During Diagnostic and Interventional Cardiac Procedures.

Remimazolam is a benzodiazepine which, like midazolam, has sedative, anxiolytic, and amnestic properties. Ester metabolism results in a half-life of 5 - 10 min, a limited context sensitive half-life, and rapid recovery when the infusion is discontinued. Following the Institutional Review Board (IRB) approval, we performed a retrospective chart review of patients who received remimazolam in the cardiac catheterization, cardiac magnetic resonance imaging (MRI), and electrophysiology suites. The primary objective was to assess efficacy and safety. The secondary objective was to describe bolus and infusion dosing of remimazolam and the need for adjunctive agents to optimize procedural sedation conditions. The study cohort included 26 patients with a median age of 18 years and a total of 33 anesthetic encounters. The most common procedures were endomyocardial biopsy or isolated hemodynamic assessment (right or left heart catheterization). Remimazolam was the primary agent for sedation in 82% of the procedures. The majority of cases (25 encounters, 76%) included a bolus dose of remimazolam prior to the start of an infusion. For those patients who received a starting bolus dose, dosing typically ranged between 30 and 110 µg/kg. Continuous infusion rates of remimazolam varied from 5 to 20 µg/kg/min. No adverse hemodynamic or respiratory effects were noted. Midazolam, fentanyl, and dexmedetomidine were the most frequently used adjunctive agents. One patient required transition to general anesthesia due to the need for a surgical intervention based on the findings of the cardiac catheterization. All other patients were effectively sedated. Our preliminary experience demonstrates that remimazolam effectively provided sedation for diagnostic and therapeutic cardiovascular procedures. Future studies are needed to further define dosing parameters for both bolus dosing and continuous infusion as well as to compare remimazolam to other commonly used for procedural sedation in patients with congenital and acquired heart disease.

738 - Validation of a novel, low-cost continuous newborn respiratory rate monitor

738 - Validation of a novel, low-cost continuous newborn respiratory rate monitor

Unraveling the interplay of circadian rhythm and sleep deprivation on mood: A Real-World Study on first-year physicians.

The interplay between circadian rhythms, time awake, and mood remains poorly understood in the real-world. Individuals in high-stress occupations with irregular schedules or nighttime shifts are particularly vulnerable to depression and other mood disorders. Advances in wearable technology have provided the opportunity to study these interactions outside of a controlled laboratory environment. Here, we examine the effects of circadian rhythms and time awake on mood in first-year physicians using wearables. Continuous heart rate, step count, sleep data, and daily mood scores were collected from 2,602 medical interns across 168,311 days of Fitbit data. Circadian time and time awake were extracted from minute-by-minute wearable heart rate and motion measurements. Linear mixed modeling determined the relationship between mood, circadian rhythm, and time awake. In this cohort, mood was modulated by circadian timekeeping (p<0.001). Furthermore, we show that increasing time awake both deteriorates mood (p<0.001) and amplifies mood's circadian rhythm nonlinearly. These findings demonstrate the contributions of both circadian rhythms and sleep deprivation to underlying mood and show how these factors can be studied in real-world settings using Fitbits. They underscore the promising opportunity to harness wearables in deploying chronotherapies for psychiatric illness.

Development of a directional continuous joint adjustment rating for the rock mass rating system

Development of a directional continuous joint adjustment rating for the rock mass rating system

Receipt survey of prescription continuation rates for patients with onychomycosis and web-based survey of dermatologists on prescribing policies for onychomycosis therapeutics.

Onychomycosis can be treated with topical and oral medications. However, it is important to appropriately select these medications according to the type and severity of the disease and ensure treatment is continued for the recommended duration. In Japan, treatment options for onychomycosis have increased in recent years. Moreover, in 2019, the guidelines for dermatomycosis treatment were revised. In this study, we conducted a receipt survey to clarify the actual treatment status of onychomycosis cases as indicated by the continuation rates of prescribed treatment drugs, together with a web-based survey to ascertain the prescribing policy of dermatologists regarding drugs for onychomycosis treatment. In agreement with past surveys, this receipt survey showed that the prescription continuation rate for oral medications was higher than that for topical medications. The 1-year prescription continuation rate for topical onychomycosis medications was found to be low (<10%). The web-based survey showed that the percentage of physicians who prescribed oral medications as their first choice increased by approximately 10% for each disease type, compared with the results of the previous survey conducted around 7 years ago. However, the study also confirmed that topical drugs are still prescribed for some disease types for which oral drugs are better suited. To ensure complete cure without patient drop-out, oral drugs with a high probability of achieving complete cure and a high continuation rate should be prescribed for patients with onychomycosis.

Laboratory profile of scrub typhus in children admitted at Bankura Sammilani medical college, India: a cross-sectional study

Background: An in-depth evaluation of routine baseline investigations is required in clinically suspected cases of scrub typhus fever due to the unavailability and/or delayed arrival of serological testing in all remote health care facilities. This may assist medical professionals diagnose and promptly administer anti-scrub medication. Methods: A cross-sectional research was conducted on 105 children who had scrub typhus fever admitted in a tertiary healthcare facility. The children were selected one after the other till desired sample size was achieved. Basic demographic information, clinical symptoms, and test results were all recorded. Software called EpiInfo 3.5.1 was used for analysing the collected information. For continuous variables, rate and ratio were used to express them, whereas standard deviation and mean were used for categorical variables. Once more, ANOVA was used for analysing association between categorical variables. P-values of &lt;.05 were considered statistically significant. Results: Of the 105 children, 90.48% were from country-side and 56.19% were male. The most common haematological abnormalities were anaemia (84.76%), leucocytosis (42.86%), and, thrombocytopenia (46.67%). The biochemical changes include hypoproteinaemia (28.57%), hypoalbuminemia (23.81%), hyponatremia (50.48%), and elevated serum levels of ALT (66.67%) and AST (84.76%). An extended duration of fever was shown to be related with a statistically significant (P value =&lt; 0.05) association between mean haemoglobin concentration, leucocyte and thrombocyte count, and serum levels of sodium. Conclusions: Early recognition and management of scrub typhus fever may be aided by the presence of anaemia, thrombocytopenia, leucocytosis, hypoproteinaemia, albuminemia, hyponatremia, and elevated serum levels of alanine and aspartate amino transferase.

AVDOS-VR: Affective Video Database with Physiological Signals and Continuous Ratings Collected Remotely in VR

Investigating emotions relies on pre-validated stimuli to evaluate induced responses through subjective self-ratings and physiological changes. The creation of precise affect models necessitates extensive datasets. While datasets related to pictures, words, and sounds are abundant, those associated with videos are comparatively scarce. To overcome this challenge, we present the first virtual reality (VR) database with continuous self-ratings and physiological measures, including facial EMG. Videos were rated online using a head-mounted VR device (HMD) with attached emteqPRO mask and a cinema VR environment in remote home and laboratory settings with minimal setup requirements. This led to an affective video database with continuous valence and arousal self-rating measures and physiological responses (PPG, facial-EMG (7x), IMU). The AVDOS-VR database includes data from 37 participants who watched 30 randomly ordered videos (10 positive, neutral, and negative). Each 30-second video was assessed with two-minute relaxation between categories. Validation results suggest that remote data collection is ecologically valid, providing an effective strategy for future affective study designs. All data can be accessed via: www.gnacek.com/affective-video-database-online-study.

P1004 Proportion of agents for refractory ulcerative colitis and the efficacy of immunomodulator in 5-aminosalicylic acid intolerance

Abstract Background 5-Aminosalicylic acid (5-ASA) is effective for ulcerative colitis (UC), yet several patients exhibit intolerance to this medication. Although biologics and immunomodulators are often employed in cases of 5-ASA intolerance in UC, reports on their induction rates and effectiveness are sparse. This study aims to ascertain the proportion of therapeutic agents for refractory UC and evaluate the efficacy of immunomodulators in patients intolerant to 5-ASA. Methods We conducted a retrospective chart review of 182 consecutive UC patients treated for refractory UC at our tertiary referral hospital from 2014 to 2023. The 5-ASA intolerance group comprised patients who initiated oral 5-ASA therapy, discontinued one or more oral 5-ASA treatments within 6 months due to adverse effects, and were unable to continue oral 5-ASA therapy for over 6 months. Those who had been on oral 5-ASA for more than 6 months were categorised as the 5-ASA tolerance group. We compared the types of agents for refractory UC (immunomodulators, calcineurin inhibitors, anti-TNF-α agents, vedolizumab, ustekinumab, JAK inhibitors), disease duration, and clinical background (age at diagnosis, history of acute severe UC [ASUC], disease extent) between the groups. Additionally, we examined the discontinuation rates due to adverse effects and the continuation rate of immunomodulators. Results Among the patients treated with agents for refractory UC, 19 belonged to the 5-ASA intolerance group and 163 to the 5-ASA tolerance group. The time to initiation of treatment for refractory UC was significantly shorter in the 5-ASA intolerance group compared to the 5-ASA tolerance group (median 69 days vs 1431 days, p &amp;lt; 0.001). The induction of immunomodulators occurred in 78.9% of the 5-ASA intolerance group, versus 38.0% in the 5-ASA tolerance group (p = 0.001). Anti-TNF-α agents was not used in the 5-ASA intolerance group, while 33.7% of the 5-ASA tolerance group received it (p = 0.001). 15 patients in the 5-ASA intolerance group and 53 in the 5-ASA tolerance group were introduced to immunomodulators to maintain remission. Discontinuations due to adverse effects were noted in 33.3% of the 5-ASA intolerance group and 18.9% in the 5-ASA tolerance group, but the differences were not significant. The one-year cumulative continuation rate of immunomodulators, excluding patients who discontinued due to adverse effects, was 93.3% in the 5-ASA intolerance group and 77.4% in the 5-ASA tolerance group, with no significant difference observed. Conclusion Immunomodulators are frequently introduced in cases of 5-ASA intolerance. No significant difference was found in the discontinuation rate of immunomodulators, with a high cumulative continuation rate observed in the 5-ASA intolerance group.

Preferred strategy for euploid single embryo transfer in advanced maternal age: Fresh versus frozen.

The purpose of this study was to compare fresh and frozen-thawed euploid blastocyst transfer protocols following preimplantation genetic screening (PGS) in cases of advanced maternal age. A total of 330 patients were examined retrospectively. PGS was performed on the embryos of 146 patients for whom fresh transfers were chosen. In contrast, frozen-thawed euploid single embryo transfer (ET) was selected after PGS for 184 patients, and their embryos were vitrified. The percentage of euploid embryos and rates of implantation, pregnancy, and pregnancy continuity, as well as clinical and biochemical abortion rates, were compared. The numbers of retrieved oocytes, metaphase II oocytes, and fertilized ova were greater in the frozen-thawed group. The percentages of euploid embryos were comparable between the fresh and frozen-thawed groups (32% vs. 34.8%, respectively). The rates of implantation (46.6%vs. 62.5%), pregnancy (50% vs. 66.8%), ongoing pregnancy (38.4% vs. 53.8%), and live birth percentage (37.0% vs. 53.8%) were significantly higher in the frozen-thawed group. However, no significant differences were found in the clinical and biochemical abortion rates. The use of frozen-thawed single euploid ET is associated with increased implantation and pregnancy rates compared to fresh single euploid ET with PGS.

When can a population spreading across sink habitats persist?

We consider populations with time-varying growth rates living in sinks. Each population, when isolated, would become extinct. Dispersal-induced growth (DIG) occurs when the populations are able to persist and grow exponentially when dispersal among the populations is present. We provide a mathematical analysis of this surprising phenomenon, in the context of a deterministic model with periodic variation of growth rates and non-symmetric migration which are assumed to be piecewise continuous. We also consider a stochastic model with random variation of growth rates and migration. This work extends existing results of the literature on the DIG effects obtained for periodic continuous growth rates and time independent symmetric migration.

Surgeon fatigue in robot-assisted and laparoscopic gastrectomy for gastric cancer: Exploratory prospective observational study ancillary to JCOG1907 randomized controlled trial (JCOG1907A1).

TPS422 Background: Fatigue is being increasingly recognized as an important factor in surgical procedures, because it leads to errors in surgeons' decisions and reduced operating efficiency. In comparison to laparoscopic surgery, robot-assisted surgery is expected to reduce surgeon fatigue due to ergonomic adjustments, comfortable sitting positions, minimal restriction of instrument movement, and stable visualization. The aim of this study is to assess surgeon fatigue and explore the superiority of robot-assisted gastrectomy over laparoscopic gastrectomy in surgeon fatigue. Methods: This study is conducted as a prospective observational study ancillary to a randomized controlled phase III trial investigating the superiority in safety of robot-assisted gastrectomy over laparoscopic gastrectomy for clinical stage T1-4aN0-3 gastric cancer (JCOG1907: UMIN000039825). The lead surgeon and the first assistant performing surgeries as protocol treatment in JCOG1907 were included. Surgeon fatigue is quantitatively assessed using multiple assessment tools. The primary endpoint is the average NASA-Task Load Index (NASA-TLX) value for the lead surgeons. Secondary endpoints include six individual parameters of NASA-TLX, visual analog scale assessments for fatigue, advanced trail-making tests, and continuous heart rate variability measurements for lead surgeons and first assistants. The primary analysis compares surgeon fatigue between robot-assisted and laparoscopic surgery. Secondary analyses examine the association between surgeon fatigue and various factors, such as surgeon and patient background, and surgical findings, as well as cross-correlations among measures of surgical fatigue. In addition, the association between surgeon fatigue and postoperative complications and its impact on long-term survival outcomes is also evaluated. The sample size is 500 surgical cases, with a planned accrual period of 2 years. This study was initiated in April 2023 and registered at the University Hospital Medical Information Network as UMIN000052120. As of August 2023, 52 cases (10.4% of the planned accrual) have been enrolled in the study. Clinical trial information: UMIN000052120 .

TenseMusic: An automatic prediction model for musical tension.

The perception of tension and release dynamics constitutes one of the essential aspects of music listening. However, modeling musical tension to predict perception of listeners has been a challenge to researchers. Seminal work demonstrated that tension is reported consistently by listeners and can be accurately predicted from a discrete set of musical features, combining them into a weighted sum of slopes reflecting their combined dynamics over time. However, previous modeling approaches lack an automatic pipeline for feature extraction that would make them widely accessible to researchers in the field. Here, we present TenseMusic: an open-source automatic predictive tension model that operates with a musical audio as the only input. Using state-of-the-art music information retrieval (MIR) methods, it automatically extracts a set of six features (i.e., loudness, pitch height, tonal tension, roughness, tempo, and onset frequency) to use as predictors for musical tension. The algorithm was optimized using Lasso regression to best predict behavioral tension ratings collected on 38 Western classical musical pieces. Its performance was then tested by assessing the correlation between the predicted tension and unseen continuous behavioral tension ratings yielding large mean correlations between ratings and predictions approximating r = .60 across all pieces. We hope that providing the research community with this well-validated open-source tool for predicting musical tension will motivate further work in music cognition and contribute to elucidate the neural and cognitive correlates of tension dynamics for various musical genres and cultures.

Conversion of Z-Scheme to type-II in dual-defective V2O5/C3N4 heterostructure for durable hydrogen evolution

The carbon nitride (C3N4) materials and hybrids have been acknowledged as promising photocatalysts for decades. The precise design and modulation of C3N4-based photocatalyst in defects and energy bands for further promotion is of importance but less investigated. In this work, a type of defective V2O5/C3N4 heterojunction with dual oxygen and carbon vacancy on interface is designed through simple annealing and plasma etching. The incorporation of V2O5 enables to promote the separation efficiency for photo-induced carriers and enhance built-in electric field (BIEF) at junction boundary to accelerate charge transport. The designed double defects in V2O5/C3N4 further results in a type-II heterojunction and switch of redox reaction sites, preventing photocatalytic corrosion of unstable V2O5. As a result, owing to the integrated advantages of such composite photocatalyst, the defective V2O5/C3N4 heterojunction exhibits a comparable hydrogen evolution rate of 0.90 mmol·g−1·h−1 to V2O5/C3N4, and dramatically improved regeneration with a continuous hydrogen evolution rate of 0.83 mmol·g−1·h−1 for 5 cycles. Our study is envisaged to provide a toolbox for rationally designing compositive nanomaterials toward high-efficiency photocatalytic systems.

Individual honey bee tracking in a beehive environment using deep learning and Kalman filter

The honey bee is the most essential pollinator and a key contributor to the natural ecosystem. There are numerous ways for thousands of bees in a hive to communicate with one another. Individual trajectories and social interactions are thus complex behavioral features that can provide valuable information for an ecological study. To study honey bee behavior, the key challenges that have resulted from unreliable studies include complexity (high density of similar objects, small objects, and occlusion), the variety of background scenes, the dynamism of individual bee movements, and the similarity between the bee body and the background in the beehive. This study investigated the tracking of individual bees in a beehive environment using a deep learning approach and a Kalman filter. Detection of multiple bees and individual object segmentation were performed using Mask R-CNN with a ResNet-101 backbone network. Subsequently, the Kalman filter was employed for tracking multiple bees by tracking the body of each bee across a sequence of image frames. Three metrics were used to assess the proposed framework: mean average precision (mAP) for multiple-object detection and segmentation tasks, CLEAR MOT for multiple object tracking tasks, and MOTS for multiple object tracking and segmentation tasks. For CLEAR MOT and MOTS metrics, accuracy (MOTA and MOTSA) and precision (MOTP and MOTSP) are considered. By employing videos from a custom-designed observation beehive, recorded at a frame rate of 30 frames per second (fps) and utilizing a continuous frame rate of 10 fps as input data, our system displayed impressive performance. It yielded satisfactory outcomes for tasks involving segmentation and tracking of multiple instances of bee behavior. For the multiple-object segmentation task based on Mask R-CNN, we achieved a 0.85 mAP. For the multiple-object-tracking task with the Kalman filter, we achieved 77.48% MOTA, 79.79% MOTSP, and 79.56% recall. For the overall system for multiple-object tracking and segmentation tasks, we achieved 77.00% MOTSA, 75.60% MOTSP, and 80.30% recall.

Long-term continuations rate of ring pessary use for symptomatic pelvic organ prolapse.

To evaluate long-term continuation rates, adverse events of ring pessary use at a minimum of 5years follow-up, and factors associated with discontinuation in symptomatic pelvic organ prolapse (POP). Women with symptomatic POP who were treated with vaginal ring pessary and had successful fittings were included. Adverse events and reasons for discontinuation of pessary use were recorded. Patients who were lost to follow-up were defined as discontinuation. During 12year-period, 239 of 329 POP patients (72.6%) had successful fittings with ring pessary. The mean age was 67.8 ± 8.9years (range 27-86) and 70% of patients had advanced stage. The cumulative probability of continued ring pessary use was 84.1%, 64.4%, 49.3%, and 33.5%, at 1, 3, 5, and 10years, respectively. Most common reason for discontinuation was frequent expulsion (21.6%), followed by vaginal erosion (16.5%), no prolapse improvement (12.4%), and inability or inconvenience to do self-care (9.3%). However, 9 patients (9.3%) had improvement of prolapse and were able to discontinue pessary insertion. Age above 70years, wide introitus, and incapability of self-care are independent factors associated with long-term discontinuation. Adverse events occurred in 23.4% of patients, 18.8% of them had vaginal erosion, 11.7% vaginal discharge/infection, and 18.4% de novo SUI. However, no statistical significance existed between those who continued and discontinued pessary use due to these adverse events. Ring pessary is an effective treatment in symptomatic POP, with acceptable long-term continuation rates and minor adverse events. Self-care of pessary is very important aiming to minimize adverse events. Advanced age, wide introitus and incapability of self-care were associated factors for long-term discontinuation.

Uptake, discontinuation, and continuation rate of long-acting contraceptive methods when offered at no cost in Campinas, Brazil

ObjectivesThis study aimed to compare the uptake, reasons for discontinuation, continuation, and satisfaction of long-acting contraceptive methods (LARC) when offered at no cost in Campinas, Brazil. Study designThis was a prospective cohort study conducted at University of Campinas, Campinas, São Paulo, Brazil, including women aged 18 to 48 years, who adopted one of three methods. Participants underwent telephone follow-up every 3 months for up to 24 months after insertion. Satisfaction was assessed at the end of 2 years of use through the Likert scale. ResultsWe invited 1222 women, and among the 971 women who volunteered to participate in follow-up, 414 (42.6%) chose the levonorgestrel 52-mg intrauterine device (IUD), 358 (36.9%) chose the etonogestrel (ENG) implant, and 199 (20.5%) chose the TCu380A IUD. Discontinuation due to bothersome bleeding was higher among users of the ENG implant (10/358; 2.4%) and the TCu380A IUD (32/199; 8.9%), and expulsion was higher for the TCu380A IUD (30/199; 15.1%). Women continued at 24 months were 340/414 (82.1%), 270/358 (75.4%), and 119/199 (59.8%) among users of the levonorgestrel 52-mg IUD, ENG implant, and TCu380A IUD, respectively. The users of the levonorgestrel 52-mg IUD (301/339, 88.8%), the ENG-implant (222/270, 82.2%), and the TCu380A IUD (105/119, 88.2%) were satisfied or very satisfied by 24 months of follow-up. ConclusionsThe three LARC methods had great uptake, high continuation, and discontinuation due to bothersome bleeding was higher among users of the ENG implant and the TCu380A IUD, and expulsion was higher for the TCu380A IUD compared to the 52-mg levonorgestrel IUD. Most of the participants reported being very satisfied. ImplicationsWhen the LARC methods were offered at no cost in a Brazilian public clinic the uptake, satisfaction and continuation were high by 24 months after device placement, and high level of satisfaction was reported by most of the participants.