Taking matters into our own hands? Hierarchies of power and knowledge in online framings of IUD self-removal.

This article examines how intrauterine device (IUD) self-removal is framed in online sources containing the views of contraceptive providers. While research has explored power and knowledge hierarchies in clinical interactions between contraceptive users and providers, and has highlighted the safety of IUD self-removal, little is known about how self-removal is represented by providers in accessible online sources that may be relied upon by contraceptive users for information. A discourse analysis of 42 provider-generated online sources found that provider authority over contraception is reinforced through biomedical constructions of risk and safety in framings of self-removal. The data reveal how the sharing of self-removal experiences between IUD users via online platforms was perceived to threaten contraceptive provider expertise, resulting in the dismissal of users' experiential knowledge. While some sources were supportive, the framings of self-removal discussed in this paper typically mirror the unequal power relations of in-person contraceptive user/provider interactions. The sources analysed therefore demonstrate how power and knowledge hierarchies are reproduced and extend beyond clinical interactions to the digital context, reflecting broader socio-structural controls over bodies, knowledge, and reproductive decision-making.

IUD self-removal: A randomized controlled trial of a self-removal guide in clinical and nonclinical settings.

OBJECTIVES: Intrauterine device (IUD) users often encounter barriers to desired removal. Self-removal, while previously found to be successful only 19% of the time, may mitigate these obstacles. Our primary objective was to evaluate the effectiveness of our previously developed IUD self-removal guide. Our secondary objectives were to evaluate the acceptability of the guide and characterize the self-removal process. STUDY DESIGN: This was a randomized controlled trial comparing IUD self-removal success rates with and without a guide. Participants selected a clinical or nonclinical setting for self-removal. The primary outcome was the rate of successful IUD self-removal. Covariates of interest included demographic characteristics, parity, body mass index, and attempted removal setting. RESULTS: Of the 116 participants, 35 (30%) successfully removed their IUDs, 20 (32%) randomized to the guide, and 15 (28%) randomized to no guide (p = 0.7). While our guide was not associated with increased successful self-removal, the majority (97%) of those randomized to it reported it to be helpful. Those who selected a nonclinical setting (80%) were more successful at self-removal (35% vs 9%, p = 0.01). Most participants would recommend IUD self-removal to a friend (68%) and attempt again with a future IUD (80%). CONCLUSIONS: The proportion of participants who successfully removed their IUDs was higher than previously shown, with or without the use of our guide. Our inclusion of a nonclinical setting was novel, in which the proportion of successful self-removal was significantly higher. Providers should consider discussion of IUD self-removal, with a reasonable expectation about the likelihood of success, as a means of increasing reproductive autonomy. IMPLICATIONS: IUD self-removal was feasible and acceptable.

Waterwheel-inspired rotating evaporator for efficient and stable solar desalination even in saturated brine.

Solar desalination is one of the most promising technologies to address global freshwater shortages. However, traditional evaporators encounter the bottleneck of reduced evaporation rate or even failure due to salt accumulation in high-salinity water. Inspired by ancient waterwheels, we have developed an adaptively rotating evaporator that enables long-term and efficient solar desalination in brines of any concentration. The evaporator is a sulphide-loaded drum-type biochar. Our experiments and numerical simulations show that this evaporator, thanks to its low density and unique hydrophilic property, rotates periodically under the center-of-gravity shift generated by salt accumulation, achieving self-removal of salt. This allows it to maintain a high evaporation rate of 2.80 kg m-2 h-1 within 24 h even in saturated brine (26.47%), which was not achieved previously. This proof-of-concept work therefore demonstrates a concentration- and time-independent, self-rotation-induced solar evaporator.

Perspectives on sexual and reproductive health self-care among women, healthcare providers, and other key informants: a mixed-methods study in South Africa and Zambia.

BACKGROUND: "Self-care" for sexual and reproductive health (SRH) includes contraceptive methods and other supplies that people can use with or without the support of a healthcare provider. Self-administered tests, self-injection of injectable contraception, or self-removal of intrauterine devices (IUDs) can increase people's access to and autonomy over their own SRH. Objectives of this study were to assess women's current interest in and use of SRH self-care and explore key informants' (KI) opinions of self-care, especially during the COVID-19 pandemic. METHODS: Data for this study came from female participants in the longitudinal Contraceptive Use Beyond ECHO (CUBE) study, and KIs, including healthcare providers, in South Africa and Zambia between September 2020 and June 2021. For this analysis, we used data from a participant phone survey (n = 537), and from in-depth interviews (IDIs) completed with a sub-sample of women (n = 39) and KIs (n = 36). Survey data were analyzed with descriptive statistics, and IDI data were analyzed using applied thematic analysis. RESULTS: Female survey participants in South Africa were more interested in learning about emergency contraceptive pills, subcutaneous injectable contraception, and CycleBeads, while Zambian participants wanted more information and access to condoms. However, in IDIs in both countries, women described minimal experience with self-care beyond condom use. In the Zambian KI IDIs, COVID-19 led to increased self-care counseling on subcutaneous injectable contraception and HIV self-testing. KIs who do not counsel on self-care were concerned that women may harm themselves or blame the provider for difficulties. Two KIs thought that women could possibly self-remove IUDs, but most expressed concerns. Reported barriers to self-care included COVID movement restrictions, transport costs, lack of accessible pharmacies, women's low awareness, and possible stigma. CONCLUSIONS: Women surveyed reported interest in learning more about SRH self-care methods and resources, but in IDIs did not report extensive previous use besides condoms. KIs described some concerns about women's ability to use self-care methods. Counseling on and provision of self-care methods and supplies may have increased during the COVID-19 pandemic, but ensuring that self-care is more than just a temporary measure in health systems has the potential to increase access to SRH care and support women's autonomy and healthcare needs.

BACKGROUND: "Self-care" refers to healthcare that does not have to be given by a provider, but that people can use themselves. In sexual and reproductive health (SRH), this includes medicines or supplies like pills and injections that people can use to prevent or test for pregnancy or sexually transmitted infections. This study wanted to better understand women's interest in and use of SRH self-care and explore key informants' opinions of self-care, especially during the COVID-19 pandemic. METHODS: We surveyed 537 women in KwaZulu-Natal province, South Africa and Lusaka, Zambia in 2020­2021. We also conducted interviews with 39 women and 36 key informants, including healthcare providers, government officials, and community advocates. RESULTS: Women surveyed in South Africa were more interested than those in Zambia in learning more about self-care contraception, especially daily pills, emergency pills, and injections they could give themselves. In interviews, some key informants said that they do not tell women about self-care because they worried that women could hurt themselves or blame the provider if they experienced problems. COVID movement restrictions, transport costs, and inaccessible pharmacies were all barriers that key informants mentioned to accessing tests, tools, or contraceptive methods that women could give or use themselves. CONCLUSIONS: Women surveyed were interested in learning more about self-care and those interviewed reported minimal previous use of self-care methods besides condoms. Providers also have some concerns about women's ability to use self-care methods. Counseling on and providing self-care methods and supplies may have increased during COVID-19, but increasing access to self-care could help more women take care of their own sexual and reproductive healthcare.

Intrauterine device self-removal practices during the COVID-19 pandemic among family planning clinics.

OBJECTIVES: To explore the prevalence of intrauterine device self-removal practices before and during the COVID-19 pandemic among family planning clinics. STUDY DESIGN: This is a secondary analysis of data from a descriptive, longitudinal study using a clinic-based convenience sample from the Abortion Clinical Research Network assessing baseline and pandemic-adaptive family planning practices. RESULTS: Of the 63 sites that provided contraception, 5 (7.9%) reported providing guidance on intrauterine device self-removal at baseline. Sixteen sites (25.4%) provided guidance on self-removal by the end of the study period. Self-removal counseling was associated with being an academic center and reporting a median lower number of monthly contraceptive encounters. CONCLUSIONS: Endorsement of IUD self-removal increased to one-quarter of sites by the final timepoint. IMPLICATIONS: Twenty-five percent of family planning clinics reported provision of intrauterine device self-removal guidance by eight months into the COVID-19 pandemic, a three-fold increase from baseline; these findings suggest clinician support for patient autonomy in contraceptive self-management and limited concern for safety issues with self-removal during a public health emergency.

Fabrication of Metallic Superhydrophobic Surfaces with Tunable Condensate Self-Removal Capability and Excellent Anti-Frosting Performance.

Laser fabrication of metallic superhydrophobic surfaces (SHSs) for anti-frosting has recently attracted considerable attention. Effective anti-frosting SHSs require the efficient removal of condensed microdroplets through self-propelled droplet jumping, which is strongly influenced by the surface morphology. However, detailed analyses of the condensate self-removal capability of laser-structured surfaces are limited, and guidelines for laser processing parameter control for fabricating rationally structured SHSs for anti-frosting have not yet been established. Herein, a series of nanostructured copper-zinc alloy SHSs are facilely constructed through ultrafast laser processing. The surface morphology can be properly tuned by adjusting the laser processing parameters. The relationship between the surface morphologies and condensate self-removal capability is investigated, and a guideline for laser processing parameterization for fabricating optimal anti-frosting SHSs is established. After 120 min of the frosting test, the optimized surface exhibits less than 70% frost coverage because the remarkably enhanced condensate self-removal capability reduces the water accumulation amount and frost propagation speed (<1 µm/s). Additionally, the material adaptability of the proposed technique is validated by extending this methodology to other metals and metal alloys. This study provides valuable and instructive insights into the design and optimization of metallic anti-frosting SHSs by ultrafast laser processing.

Developing an intrauterine device self-removal guide: a mixed methods qualitative and small pilot study.

BACKGROUND: The intrauterine device (IUD) is a highly effective form of long-acting reversible contraception (LARC) with few contraindications. Users, however, often encounter barriers to desired removal. IUD self-removal may mitigate these obstacles. We sought to develop a guide for IUD self-removal with the aim of increasing user control over the method. METHODS: This was a two-phase mixed-methods qualitative and small pilot study with the aim of developing an IUD self-removal guide. We conducted an online content analysis of advice for IUD self-removal as well as interviews with expert key informants to develop an IUD self-removal guide. We next recruited IUD-users who had previously attempted self-removal to participate in focus group discussion and individual interviews to further refine the guide. In the second phase of the study, we piloted the guide among eight IUD-users seeking removal interested in attempting self-removal. RESULTS: Expert key informants agreed that IUD self-removal was safe and low risk. The primary components of successful IUD self-removal elicited were ability to feel and grasp the strings, a crouched down position, and multiple attempts. A preference for presenting IUD self-removal as safe was emphasized. In the second phase, participants in the clinical pilot suggested more information for non-palpable strings, but liked the style and information provided. One participant successfully removed their IUD. CONCLUSIONS: IUD-users reported satisfaction with our guide. In our small pilot, the majority were unable to remove their own IUD. A larger study is needed to assess acceptability, feasibility, and efficacy in increasing successful self-removal.

Fe and As geochemical self-removal dynamics in mineral waters: evidence from the Ferrarelle groundwater system (Riardo Plain, Southern Italy).

A theoretical pattern for Fe and As co-precipitation was tested directly in a groundwater natural system. Several monitoring wells were sampled to identify the different endmembers that govern the hydrodynamics of the Ferrarelle Groundwater System in the Riardo Plain (Southern Italy). In agreement with recent investigations, we found a mix of a deep and a shallow component in different proportions, resulting in a specific chemical composition of groundwater in each well depending on the percentages of each component. The shallow component was characterized by EC ~ 430 µS/cm, Eh ~ 300 mV, Fe ~ 0.06 µmol/L and As ~ 0.01-0.12 µmol/L, while the deep component was characterized by EC ~ 3400 µS/cm, Eh ~ 170 mV, Fe ~ 140 µmol/L and As ~ 0.59 µmol/L. A general attenuation of As and Fe concentration that was not due to a simple dilution effect was observed in the mixing process. The oxidation of Fe(II) to Fe(III) produces solid precipitates which adsorb As from solution and then co-precipitate. The reactions pattern of Fe(II) oxidation and As adsorption gave a linear function between [As] and [Fe], where the angular coefficient depends on the [O2]/[H+] ratio. Chemical data obtained from our samples showed a very good agreement with this theoretical relationship. The investigated geochemical dynamics represented a natural process of attenuation of Fe and As, two undesirable elements that usually affect groundwater quality in volcanic aquifers in central-southern Italy, which are exploited to supply drinking water.

Exploring the experience of IUD self-removal in the United States through posts on internet forums.

OBJECTIVE: Some intrauterine devices (IUD) users self-remove their IUDs, and these experiences are not well understood. This study examines what IUD users post in internet forums about their experience, as well as advice and questions shared among IUD users about self-removal. STUDY DESIGN: This study uses qualitative analysis of internet health and parenting forum postings about IUD self-removal identified from an internet search engine. We analyzed the data using inductive and deductive content analyses. RESULTS: Twenty-eight sites, containing 1742 posts by 1197 unique users, satisfied our eligibility criteria. Users reported successful IUD self-removal attempts as "quick," "easy," and "painless"; it was rare to encounter IUD users describing complications of their self-removal attempts. Users described unsuccessful attempts as failure to find or grasp strings. Many IUD users described their successful removal techniques and gave advice to other users who were struggling with self-removal. Users frequently utilized the forum to ask questions about IUD self-removal methods and timing, pain, when to seek medical intervention, and the effects on future fertility. CONCLUSIONS: Posts describing successful IUD self-removal report positive experiences. IUD users who have difficulty with self-removal may utilize internet forums to learn from others' experiences. IMPLICATIONS: Exploring IUD users' experiences with and questions about self-removal may inform strategies to develop better resources for those who desire self-removal.

Self-removal of long-acting reversible contraception: A content analysis of YouTube videos.

OBJECTIVE: To explore publicly available information about the self-removal of long-acting reversible contraception (LARC) on a popular video-sharing website. STUDY DESIGN: We conducted a comprehensive keyword search of YouTube videos related to self-removal of LARC-namely intrauterine devices and implants. We analyzed video content to explore demographic characteristics, method and duration of LARC use, and motivations and experiences of self-removal. RESULTS: Our keyword search identified 58 videos that met the criteria for inclusion, including 48 videos that featured individuals who removed an intrauterine device and 10 who removed an implant. Collectively, videos had over 4 million views. We identified most video creators as white (53%), 31% as Black, and 14% as Latinx. Users were motivated to remove their own device by both preferences and barriers to formal care. Most individuals in our sample (n = 56/58) successfully removed their device and described their experience in positive terms related to the ease of removal. Reasons for LARC discontinuation included negative side effects, fear of potential side effects, and desire for pregnancy. CONCLUSION: This study builds upon prior research by describing publicly available information about LARC self-removal. The over representation of Black women in our sample may reflect a higher prevalence of LARC self-removal among this population. Positive experiences of self-removal and high levels of viewer engagement with online videos suggest a need for provider counseling on LARC removal at the time of insertion. IMPLICATIONS: Prior to LARC insertion, patients should be made aware of any financial requirements for discontinuation. Provider counseling for self-removal at the time of insertion will likely minimize health risks and affirm patient reproductive autonomy.

Awareness of the option of IUC self-removal among US adolescents.

OBJECTIVE: To assess adolescent awareness of the safety of self-removal of intrauterine contraception (IUC) and explore associations with sociodemographic characteristics, IUC knowledge, and personal experience using an IUC. STUDY DESIGN: We recruited women aged 15 to 20 years from 21 U.S. states and Washington, D.C. Participants completed an online survey assessing their communication with peers about contraception and knowledge and use of IUCs. RESULTS: Few (11%, 95% CI 9%-13%) adolescents knew that IUC self-removal is safe, whether or not they had personally used an IUC (14% vs 8%, p = 0.01). Knowledge that IUCs do not protect users from sexually transmitted infections (99% vs 91%, p < 0.001) and that IUCs can be removed early (99% vs 88%, p < 0.001) was higher among adolescents who had used an IUC than those who had not. Knowledge that IUC use does not adversely affect fertility after IUC removal (86% vs 63%, p < 0.001) and that IUCs are more effective than birth control pills (82% vs 50%, p < 0.001) also differed by personal experience with an IUC. Awareness of the safety of IUC self-removal was not associated with overall knowledge of IUCs. However, adolescents who knew that IUCs are more effective than birth control pills were more likely to be aware of the safety of IUC self-removal (OR = 1.85, 95% CI 1.12-3.05). CONCLUSIONS: Adolescent women in the U.S. possess incomplete knowledge of many important aspects of IUC use, and awareness of the safety of IUC self-removal is particularly low, even among those who have used an IUC. IMPLICATIONS: Efforts to increase adolescent knowledge of IUC should include information about the safety of IUC self-removal in order to safeguard adolescents' reproductive autonomy.

Condensation Behavior of Hierarchical Nano/Microstructured Surfaces Inspired by Euphorbia myrsinites.

In nature, many extant species exhibit functionalized surface structures during evolution. In particular, wettability affects the functionalization of the surface, and nano/microstructures have been found to enable functions, such as droplet jumping, thereby making self-cleaning, antifog, antibacterial, and antireflection surfaces. Important efforts are underway to understand the surface structure of plant leaves and establish rational design tools for the development of new engineering materials. In this study, we focused on the hierarchical nano/microstructure of the leaves of Euphorbia myrsinites (hereinafter, E. myrsinites), which has a hierarchical shape with microsized papillae, covered with nanosized protruding wax, and observed the condensation behavior on the leaf surface. Si is vertically etched via reactive ion etching (RIE) to artificially mimic the hierarchical nano/microstructures on the leaves of E. myrsinites. We made four types of artificial hierarchical structures, with micropillars having pillar diameters of 5.6 and 16 µm (pillar spacing of 20 and 40 µm, respectively) and heights of 6.5 and 19.5 µm, and nanopillars formed on the surface. The optical observation with a microscope revealed a very high density of condensed droplets on the artificial surface and a stable jumping behavior of droplets of 10 µm or more. Furthermore, in the samples with a micropillar diameter of 5.6 µm and a micropillar height of 19.5 µm, the droplets that had jumped and fallen thereupon bounced off, thereby preventing reattachment. As a result, no droplets of 35 µm or more could exist even after 10 min. In addition, it was clear that a small underlying droplet of less than 10 µm was generated at the bottom of the relatively large secondary droplet existing on the large micropillar of 16 µm, and a frequent coalescence of the droplets occurred. This study revealed the phenomenon of condensation on the surface of plants as well as made it possible to improve the heat exchange process by significantly promoting the heat transfer of condensation using artificial surfaces.

Solar anti-icing surface with enhanced condensate self-removing at extreme environmental conditions.

The inhibition of condensation freezing under extreme conditions (i.e., ultra-low temperature and high humidity) remains a daunting challenge in the field of anti-icing. As water vapor easily condensates or desublimates and melted water refreezes instantly, these cause significant performance decrease of most anti-icing surfaces at such extreme conditions. Herein, inspired by wheat leaves, an effective condensate self-removing solar anti-icing/frosting surface (CR-SAS) is fabricated using ultrafast pulsed laser deposition technology, which exhibits synergistic effects of enhanced condensate self-removal and efficient solar anti-icing. The superblack CR-SAS displays superior anti-reflection and photothermal conversion performance, benefiting from the light trapping effect in the micro/nano hierarchical structures and the thermoplasmonic effect of the iron oxide nanoparticles. Meanwhile, the CR-SAS displays superhydrophobicity to condensed water, which can be instantly shed off from the surface before freezing through self-propelled droplet jumping, thus leading to a continuously refreshed dry area available for sunlight absorption and photothermal conversion. Under one-sun illumination, the CR-SAS can be maintained ice free even under an ambient environment of -50 °C ultra-low temperature and extremely high humidity (ice supersaturation degree of ∼260). The excellent environmental versatility, mechanical durability, and material adaptability make CR-SAS a promising anti-icing candidate for broad practical applications even in harsh environments.

Confined Growth and Controlled Coalescence/Self-Removal of Condensate Microdrops on a Spatially Heterogeneously Patterned Superhydrophilic-Superhydrophobic Surface.

Manipulating condensate nucleation, growth, coalescence, and self-removal via bionic super-wettability surfaces has attracted intensive interest because of their significance in fundamental research and technological innovations, for example, water harvesting, power generation, air conditioning, and thermal management. However, it is still a challenge to simultaneously realize confined growth, coalescence, and self-ejection of condensate microdrops, which has not been reported to date. Here, we propose and demonstrate a type of new and more efficient coalescence/self-removal method based on spatially confined growth/coalescence/self-ejection of condensate microdrops, which can be realized using a rationally designed superhydrophobic surface with spatially heterogeneously patterned superhydrophilic microdots (SMDs). Exemplified by superhydrophobic closely packed zinc oxide nanoneedles with SMD patterns, we investigate how the geometric parameters of SMD patterns be designed to simultaneously realize the spatially confined growth/coalescence/self-ejection of patterned microdrops, which are rationalized via theoretical analyses.

"$231 to pull a string!!!" American IUD users' reasons for IUD self-removal: An analysis of internet forums.

OBJECTIVE: The perspectives and experiences of intrauterine device (IUD) users who consider IUD self-removal are largely unknown. This study describes the reasons for IUD self-removal as documented in internet forums by IUD users discussing self-removal. STUDY DESIGN: This qualitative study used an internet search strategy to document IUD users' reasons for self-removal in the United States. We employed a content analysis of online data using inductive and deductive qualitative techniques to examine the reasons why IUD users consider self-removal. RESULTS: Search results initially identified 235 websites, of which 28 had online health or parenting forums with content related to IUD self-removal. Individual websites contained between 1 and 637 posts by between 1 and 454 individual users. IUD users described a variety of reasons for IUD discontinuation including undesired symptoms or side effects as well as planning for pregnancy. IUD users discussed difficulties accessing provider-removal because of cost or lack of appointment availability. IUD users also discussed how reading about others' successful self-removal experiences or approval by medical providers made self-removal a feasible or acceptable option. CONCLUSIONS: Some IUD users utilize online forums for advice about IUD removal, and attempt IUD self-removal due to side effects or because they desire pregnancy. Lack of access to a provider led some patients to attempt self-removal who may have preferred provider-removal. IMPLICATIONS: For those who prefer self-removal, anticipatory counseling from a clinician regarding self-removal might be useful and reassuring. Improving access to self-removal may help preserve reproductive autonomy for those who face barriers to IUD removal in the clinical setting.

Microdrop-Assisted Microdomain Hydrophilicization of Superhydrophobic Surfaces for High-Efficiency Nucleation and Self-Removal of Condensate Microdrops.

Superhydrophobic-hydrophilic hybrid surfaces have attracted intensive interest because of their significant academic and commercial values. However, almost all reported microdomain hydrophilicization methods rely on costly micropatterning techniques that need special instruments. Here, we report a microdrop-assisted method for microdomain hydrophilicization of a low-adhesive superhydrophobic surface and demonstrate its utility in high-efficiency nucleation and self-removal of condensate microdrops. Micrometer-sized fogdrops containing polyvinyl alcohol molecules can be selectively captured by breath figures of superhydrophobic surfaces with specific sizes and spatial distributions and can be converted into desired hydrophilic microdomains after thermal evaporation. After exploring the influence of hydrophilic microdomains' distributions and sizes to surface wettability, adhesion, and condensation dynamics, we achieved an optimal hybrid surface, which possesses 240% average microdrop density, 387% microdrop self-removal rate, and 75% average microdrop diameter as compared to the contrast superhydrophobic surface with uniform chemistry nature. This method is dispensed with special equipment, easy to implement, very cheap, and eco-friendly, which would help develop other superhydrophobic-hydrophilic hybrid surfaces with different functions such as water harvesting, dehumidification, and heat exchange.

Queens stay, workers leave: caste-specific responses to fatal infections in an ant.

BACKGROUND: The intense interactions among closely related individuals in animal societies provide perfect conditions for the spread of pathogens. Social insects have therefore evolved counter-measures on the cellular, individual, and social level to reduce the infection risk. One striking example is altruistic self-removal, i.e., lethally infected workers leave the nest and die in isolation to prevent the spread of a contagious disease to their nestmates. Because reproductive queens and egg-laying workers behave less altruistically than non-laying workers, e.g., when it comes to colony defense, we wondered whether moribund egg-layers would show the same self-removal as non-reproductive workers. Furthermore, we investigated how a lethal infection affects reproduction and studied if queens and egg-laying workers intensify their reproductive efforts when their residual reproductive value decreases ("terminal investment"). RESULTS: We treated queens, egg-laying workers from queenless colonies, and non-laying workers from queenright colonies of the monogynous (single-queened) ant Temnothorax crassispinus either with a control solution or a solution containing spores of the entomopathogenic fungus Metarhizium brunneum. Lethally infected workers left the nest and died away from it, regardless of their reproductive status. In contrast, infected queens never left the nest and were removed by workers only after they had died. The reproductive investment of queens strongly decreased after the treatment with both, the control solution and the Metarhizium brunneum suspension. The egg laying rate in queenless colonies was initially reduced in infected colonies but not in control colonies. Egg number increased again with decreasing number of infected workers. CONCLUSIONS: Queens and workers of the ant Temnothorax crassispinus differ in their reaction to an infection risk and a reduced life expectancy. Workers isolate themselves to prevent contagion inside the colony, whereas queens stay in the nest. We did not find terminal investment; instead it appeared that egg-layers completely shut down egg production in response to the lethal infection. Workers in queenless colonies resumed reproduction only after all infected individuals had died, probably again to minimize the risk of infecting the offspring.

Taking the provider "out of the loop:" patients' and physicians' perspectives about IUD self-removal.

OBJECTIVE: This study describes the perspectives of patients and providers about intrauterine device (IUD) self-removal. STUDY DESIGN: This qualitative study is a subanalysis of two datasets from a single project, which included semistructured individual interviews with 15 patients and 12 physicians. We derived the data for this analysis from portions of the interviews pertaining to IUD self-removal and provider removal. We analyzed data using deductive and inductive techniques to perform content and thematic analyses. RESULTS: The majority of patients and physicians cited both concerns about and potential benefits of IUD self-removal. Patients cited concerns about safety as the reason they did not wish to remove their own IUD, but physicians did not share these concerns; instead, physicians were apprehensive about not being involved in the discussion to remove the IUD. Both patients and physicians valued having the provider "in the loop" and reported fears about hasty or coerced removal. CONCLUSIONS: IUD self-removal is an option that some patients may be interested in. Addressing concerns about safety may make self-removal more appealing to some patients. Addressing physicians' concern about "hasty" removal may require additional training so that providers are better able to support patients' decision making around contraceptive use. IMPLICATIONS: The option of self-removal could have a positive impact on reproductive autonomy and patient decision making.