Mifepristone-misoprostol for menstrual regulation in public sector facilities in Bangladesh.

OBJECTIVE: To examine the use of mifepristone and misoprostol for menstrual regulation among Bangladeshi women attending public sector facilities. METHODS: In a prospective study, women (aged ≥18 years) with up to 9 weeks of amenorrhea were enrolled at 24 government health facilities in Bangladesh from November 2012 to June 2015. Paramedics or female welfare visitors provided most menstrual regulation care. Participants took 200 mg mifepristone followed by 800 µg buccal misoprostol after 24 hours, and were asked to return to the clinic 10-14 days later for clinical assessment and an exit interview. The primary outcome was successful evacuation of the uterus without need for surgical intervention. Women who completed follow-up were included in analyses for the primary outcome. RESULTS: Among 1744 enrolled participants, 1738 completed follow-up. Most (1674, 96.3%) had a successful uterine evacuation without the need for surgical intervention. A successful outcome was significantly more common in primary (724/744, 97.3%) and secondary facilities (861/895, 96.2%) than in the specialty hospital (89/99, 89.9%; P<0.001 and P=0.004, respectively). CONCLUSION: Menstrual regulation with mifepristone and misoprostol can be provided effectively in public sector facilities in Bangladesh. CLINICALTRIALS.GOV: NCT01798017.

Increasing access to safe menstrual regulation services in Bangladesh by offering medical menstrual regulation.

In spite of wide availability of menstrual regulation services, women often resort to a variety of medicines for inducing abortion. The Bangladeshi Government is now supporting attempts to investigate the introduction of medical menstrual regulation in the public sector. This study examined the acceptability of medical menstrual regulation in public sector urban-based clinics, public sector rural-based clinics and urban-based clinics run by Marie Stopes, a non-governmental organization. Of the 2,976 women who attended for menstrual regulation services during the eight-month study period, 68% attended urban Maternal and Child Welfare Centres and the Marie Stopes clinics, while 32% went to the rural public facilities of the Union Health and Family Welfare Centre. Women were offered both medical and manual vacuum aspiration methods of menstrual regulation; 1,875 (63%) chose the medical method and 1,101 (37%) chose manual vacuum aspiration. Around 7.1% of women at Maternal and Child Welfare centres and 11.9% at the Marie Stopes clinics knew about medical menstrual regulation before taking the service, compared to a much higher proportion (43%) at the rural facilities. Overall 61.4% of women who used medical menstrual regulation found the method satisfactory, and 34.2% were very satisfied. Of the 3.9% of women who were not satisfied, most received services from rural facilities.

Climatic correlates of tree mortality in water- and energy-limited forests.

Recent increases in tree mortality rates across the western USA are correlated with increasing temperatures, but mechanisms remain unresolved. Specifically, increasing mortality could predominantly be a consequence of temperature-induced increases in either (1) drought stress, or (2) the effectiveness of tree-killing insects and pathogens. Using long-term data from California's Sierra Nevada mountain range, we found that in water-limited (low-elevation) forests mortality was unambiguously best modeled by climatic water deficit, consistent with the first mechanism. In energy-limited (high-elevation) forests deficit models were only equivocally better than temperature models, suggesting that the second mechanism is increasingly important in these forests. We could not distinguish between models predicting mortality using absolute versus relative changes in water deficit, and these two model types led to different forecasts of mortality vulnerability under future climate scenarios. Our results provide evidence for differing climatic controls of tree mortality in water- and energy-limited forests, while highlighting the need for an improved understanding of tree mortality processes.

Climate change and microbiological water quality at California beaches.

Daily microbiological water quality and precipitation data spanning 6 years were collected from monitoring stations at southern California beaches. Daily precipitation projected for the twenty-first century was derived from downscaled CNRM CM3 global climate model. A time series model of Enterococcus concentrations that was driven by precipitation, matched the general trend of empirical water quality data; there was a positive association between precipitation and microbiological water contamination (P < 0.001). Future projections of precipitation result in a decrease in predicted Enterococcus levels through the majority of the twenty-first century. Nevertheless, variability of storminess due to climate change calls for innovative adaptation and surveillance strategies.

Comparative tight junction protein expressions in colonic Crohn's disease, ulcerative colitis, and tuberculosis: a new perspective.

We intended to see the pattern of TJ protein expression along with ultrastructural changes in colonic biopsies from patients with Crohn's disease (CD), ulcerative colitis (UC), and tuberculosis (cTB). Colonic biopsies from 11 patients with active CD and ten patients each with active UC and untreated cTB were taken along with biopsies from six patients with irritable bowel syndrome as controls. These were evaluated for expression pattern of key TJ proteins which included claudin-2 as TJ pore-forming protein, claudin-4 as pore-sealing protein, ZO-1 as scaffold protein, and occludin as TJ protein related to cell migration and polarity. Claudin-2 expression was upregulated along the whole length of intercellular junction (ICJ) in biopsies from patients with active CD and UC in comparison to the biopsies from cTB patients and controls, where its expression was limited to the uppermost part of ICJ. There was reduced expression of ZO-1 in UC, CD, and cTB. On transmission electron microscopic examination, the pentalaminar structure of TJs was destroyed in patients with CD and UC but no significant change was seen in those with cTB and in controls. The expression of claudin-2 was distinctly different in active CD and UC in comparison to its expression pattern in patients with cTB and in controls. The redistribution of claudin-2 expression was in accordance with the TJ ultrastructural changes in patients with UC, CD, and cTB. Altered claudin-2 expression, along with destroyed TJs, may result in loss of selective permeability in patients with UC and CD.

Future dryness in the southwest US and the hydrology of the early 21st century drought.

Recently the Southwest has experienced a spate of dryness, which presents a challenge to the sustainability of current water use by human and natural systems in the region. In the Colorado River Basin, the early 21st century drought has been the most extreme in over a century of Colorado River flows, and might occur in any given century with probability of only 60%. However, hydrological model runs from downscaled Intergovernmental Panel on Climate Change Fourth Assessment climate change simulations suggest that the region is likely to become drier and experience more severe droughts than this. In the latter half of the 21st century the models produced considerably greater drought activity, particularly in the Colorado River Basin, as judged from soil moisture anomalies and other hydrological measures. As in the historical record, most of the simulated extreme droughts build up and persist over many years. Durations of depleted soil moisture over the historical record ranged from 4 to 10 years, but in the 21st century simulations, some of the dry events persisted for 12 years or more. Summers during the observed early 21st century drought were remarkably warm, a feature also evident in many simulated droughts of the 21st century. These severe future droughts are aggravated by enhanced, globally warmed temperatures that reduce spring snowpack and late spring and summer soil moisture. As the climate continues to warm and soil moisture deficits accumulate beyond historical levels, the model simulations suggest that sustaining water supplies in parts of the Southwest will be a challenge.

Human-induced changes in the hydrology of the western United States.

Observations have shown that the hydrological cycle of the western United States changed significantly over the last half of the 20th century. We present a regional, multivariable climate change detection and attribution study, using a high-resolution hydrologic model forced by global climate models, focusing on the changes that have already affected this primarily arid region with a large and growing population. The results show that up to 60% of the climate-related trends of river flow, winter air temperature, and snow pack between 1950 and 1999 are human-induced. These results are robust to perturbation of study variates and methods. They portend, in conjunction with previous work, a coming crisis in water supply for the western United States.