Objectives. This study was undertaken to determine the performance of the levonorgestrel intrauterine system (LNG IUS) IntroductionThis report concludes the study of which the 12-month and 24-month results have been published. 1,2 The concept of intrauterine administration of a progestin-only contraceptive as an alternative to oral, parenteral or subdermal implants was first considered in 1970. 3 Experiments with various slow-release membranes and intrauterine contraceptive device (IUD)-carrying frames resulted in the development of an intrauterine system (IUS) releasing levonorgestrel, now marketed as Mirena ® which was introduced in Finland in 1990 and in the UK in May 1995.Very low pregnancy rates have been reported, between 0.5 and 1.1 cumulative gross rates per 100 users at 5 years [4][5][6] (Table 1). Expulsion rates have been similar to that of other IUDs. The Mirena ® is recommended for use up to 5 years, although very low pregnancy rates have also been reported after up to 7 years of use. 7 The endometrium remains atrophic while the levonorgestrel is at a sufficient level to suppress it, 8 and therefore changes in menstrual patterns are likely to occur. Sivin and Stern, 9 reporting a multicentre study, commented that 'menstrual patterns during contraception were radically altered by the LNG'.Several randomised trials have found that discontinuation rates because of heavy or prolonged menstrual blood flow were significantly lower with the LNG IUS than with copper IUDs. 10 Sivin et al. 11 found that discontinuation attributable to amenorrhoea was the principal contributor to differences in continuation rates between the LNG IUS and the Cu T380A ® IUD.There is a need to determine the performance of the LNG IUS in British women with particular regard to the nature and incidence of side effects. Methods Key message pointsAt 5 years of use the LNG IUS (Mirena ® ) has been shown to have a very low pregnancy rate and a low expulsion rate. The rate for removal for complaints of bleeding problems was high during the first year. There is a need for careful counselling before fitting to prepare women for changes in bleeding patterns during the first 12 months of use. Removals were also required for side effects that may be due to absorbed levonorgestrel. The reductions in duration and quantity of periods in many women were significant advantages.

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Testing accommodations allow students with disabilities to both participate in and demonstrate their knowledge and abilities on statewide assessments. This article discusses accommodation-related research findings of a 3-year federally funded research study. The data analysis includes an examination of accommodation policies and discipline rates in all 50 states, participation rates in states for which data were available, and the relationships among these data as indicated by statistical correlations. Also, a detailed discussion of the proctor/scribe accommodation is included, because it correlated more strongly with higher participation rates than any other specific accommodation. Implications of these findings for students, parents, policymakers, and practitioners are discussed.

Summary

Objectives. The purpose of the study was to evaluate the pregnancy and complication rates of this new device, with its increased area of copper, in comparison with IntroductionThis report concludes the study of which the 12-month and 24-month results have been published. 1,2 It has been suggested that the contraceptive efficacy of copper intrauterine devices (IUDs) correlates positively to the area of copper-releasing surface but the evidence has been conflicting. [3][4][5][6] Nevertheless it is now generally thought that increased copper does reduce pregnancy rates and prolong usability of the device. 7 The Nova T ® IUD (also available as the Novagard ® until May 1998) has a copper wire on the central stem with a surface area of 200 mm 2 . The present study is of the Nova T380 ® in which the surface area of copper has been increased to 380 mm 2 , all the copper being on the central stem. The purpose of the present study was to evaluate the pregnancy and complication rates of this new device, with its increased area of copper, in comparison with other published results, in the clinical setting of British general practice and family planning clinics. MethodsThe study was an open, single group, multicentre phase III study in outpatients. Doctors working in general practice and at family planning clinics throughout the UK who collaborate in the UK Family Planning and Reproductive Health Research Network were responsible for the Nova T380 ® fittings reported in this paper. The study was sponsored by Leiras Oy and Schering Health Care Limited. Ethics committee approval for the study was obtained at all centres.The Nova T380 ® has a polyethylene frame shaped as a modified T with 380 mm 2 of silver-cored copper wound around the vertical arm. The silver core is intended to prevent corrosion-induced fragmentation.The device was fitted according to the doctor's own clinical judgement, in parous women attending for family planning advice and requesting intrauterine contraception. Those enrolled were aged 18-45 years, exposed to the risk of pregnancy, in good health and with normal menstrual Key message pointsAt 5 years of use in the UK the Nova T380 ® intrauterine device (IUD) has been shown to have a very low pregnancy rate. There was a higher than expected removal rate for bleeding/pain. There was a higher than expected expulsion rate. There was a very low removal rate for pelvic inflammatory disease (PID).