The realities of managing uncertainties surrounding pluvial urban flood risk: an ex post analysis in three European cities

Inner-city pluvial flooding is characterised by major uncertainties, often making response problematic. We explore this in London, Lisbon and Rotterdam, through ex post document analysis and semi-structured interviews. Traditional uncertainty analysis generally focuses on quantifiable factors, needing to clarify uncertainty for engineering design, flood warnings and incident management. But other uncertainties concern budgets, skills, legal issues and politics. There are also many relevant certainties or near-certainties, which can dominate. They need equal attention in understanding decision making for risk reduction. Responses to our cities’ flood risks – including portfolios of engineering and non-structural measures – also contain significant no-regret components requiring less certainty about risk. Our cities appear to be positioned along a learning continuum, related to flood experience and the consequential uncertainty reduction. However progress can be worryingly slow. Only experiencing actual flood events promotes accelerated action and often the certainties concerning resource constraints also outweigh the many uncertainties in risk assessment

Neonatal screening parameters in infants with congenital Cytomegalovirus infection.

Congenital Cytomegalovirus infection (cCMV) is the most common cause of congenital infections worldwide that can cause long-term impairment (LTI). The metabolic alterations due to cCMV are largely unknown. This study aims to assess the metabolites included in the neonatal screening in relation to cCMV and cCMV outcome, allowing the identification of prognostic markers for clinical outcome. Essential amino acids, hormones, carnitines and enzymes from Dried Blood Spots (DBS) were analyzed of 102 children with cCMV and 179 children without cCMV, and they were related to symptoms at birth and LTI at 6years of age. In this cohort, the neonatal screening parameters did not change in relation to cCMV, nor to symptoms at birth or LTI. However, metabolic changes were observed in children born preterm, with lower concentrations of essential amino acids in premature infants with cCMV compared to premature controls. Finally, a higher concentration of palmytoilcarnitine (C16) in the group with higher viral load was observed. Though these data demonstrate limitations in the use of neonatal screening data as predictors for long-term cCMV outcome, the metabolism of preterm neonates with cCMV merits further evaluation

Congenital Cytomegalovirus Infection: Child Development, Quality of Life and Impact on Daily Life.

Congenital cytomegalovirus (cCMV) infection is the most common congenital infection worldwide and can lead to long-term impairments such as developmental delay. It is currently unknown how this affects the daily life of children and their parents. Children For this study, children with cCMV were identified by testing stored dried blood spots of 31,484 five-year-old children born in 2008 in the Netherlands. Parents of 133 children with cCMV and 274 children without cCMV participated and filled in questionnaires on the child's development, the child's and parents' quality of life, care provided for the children and consequences of cCMV on daily life. School performance reports at 6 years of age were also investigated. Children with cCMV had delays in general and expressive language development more often, and they attended physical therapists more frequently than children without cCMV. School performance of children with cCMV and symptoms at birth was poorer than that of cCMV-negative children with similar symptoms at birth. The quality of life of children with long-term impairment was lower in children with cCMV than those without cCMV. Parents of children with cCMV and long-term impairments reported more physical and concentration problems than parents of children without cCMV. These findings indicate that cCMV has a considerable impact not only on the child's development and school performance but also on the daily life of children and their parents. The care for children with cCMV should therefore include support for motor and speech-language development as well as family-centered care

Healthcare costs attributable to congenital cytomegalovirus infection

Molecular basis of virus replication, viral pathogenesis and antiviral strategie

Long-term impairment attributable to congenital cytomegalovirus infection: a retrospective cohort study.

This study aimed to estimate long-term impairment attributable to congenital cytomegalovirus infection (cCMV)

Healthcare costs attributable to congenital cytomegalovirus infection.

Congenital cytomegalovirus infection (cCMV) can cause symptoms at birth as well as long-term impairment. This study estimates cCMV-related healthcare costs in the Netherlands in early childhood