674 research outputs found
Increasing flood exposure in the Netherlands: implications for risk financing
The effectiveness of disaster risk management and financing mechanisms
depends on an accurate assessment of current and future hazard exposure. The
increasing availability of detailed data offers policy makers and the
insurance sector new opportunities to understand trends in risk, and to make
informed decisions on ways to deal with these trends. In this paper we show
how comprehensive property level information can be used for the assessment
of exposure to flooding on a national scale, and how this information
provides valuable input to discussions on possible risk financing practices.
The case study used is the Netherlands, which is one of the countries most
exposed to flooding globally, and which is currently undergoing a debate on
strategies for the compensation of potential losses. Our results show that
flood exposure has increased rapidly between 1960 and 2012, and that the
growth of the building stock and its economic value in flood-prone areas has
been higher than in non-flood-prone areas. We also find that property values
in flood-prone areas are lower than those in non-flood-prone areas. We argue
that the increase in the share of economic value located in potential flood-prone
areas can have a negative effect on the feasibility of private
insurance schemes in the Netherlands. The methodologies and results
presented in this study are relevant for many regions around the world where
the effects of rising flood exposure create a challenge for risk financing
The safe development paradox:An agent-based model for flood risk under climate change in the European Union
With increasing flood risk due to climate change and socioeconomic trends, governments are under pressure to continue implementing flood protection measures, such as dikes, to reduce flood risk. However, research suggests that a sole focus on government-funded flood protection leads to an adverse increase in exposure as people and economic activities tend to concentrate in protected areas. Moreover, governmental flood protection can reduce the incentive for autonomous adaptation by local households, which paradoxically results in more severe consequences if an extreme flood event occurs. This phenomenon is often referred to as the ‘safe development paradox’ or ‘levee effect’ and is generally not accounted for in existing flood risk models used to assess developments in future flood risk under climate change. In this study we assess the impact of extreme flood events for the European Union using a large-scale agent-based model (ABM). We quantify how the safe development paradox affects (1) population growth and the increase in exposed property values, (2) the reduction in investments to flood-proof buildings as public protection increases, and (3) the increase in potential damage should a flood occur. For this analysis, we apply an ABM that integrates the dynamic behaviour of governments and residents into a large-scale flood risk assessment framework, in which we include estimates of changing population growth. We find that the impact of extreme flood events increases considerably when governments provide high protection levels, especially in large metropolitan areas. Moreover, we demonstrate how policy that stimulates the flood-proofing of buildings can largely counteract the effects of the safe development paradox
Strong decline in female sterilization rates in Norway after the introduction of a new copayment system: a registry based study
<p>Abstract</p> <p>Background</p> <p>January 1, 2002, copayment for outpatient female sterilization in Norwegian public hospitals increased from 33 euros to 750 euros after a revision of the health care system. The aim of the present study was to investigate the effect of the new copayment system on female sterilization epidemiology.</p> <p>Methods</p> <p>We retrieved data on all female sterilizations 1999–2005 (N = 23 1333) from the Norwegian Patient Register, an administrative register to which it is mandatory for all hospitals to report. Sterilizations with diagnostic codes indicative of vaginal delivery, caesarean section, spontaneous abortion, ectopic pregnancy, and termination of pregnancy were analyzed separately. All other sterilizations were defined as "interval sterilization".</p> <p>Results</p> <p>An abrupt fall in female sterilization was observed after the raise in copayment. Age-adjusted incidence rates dropped from 6.3–6.8 per 1000 women in 1999–2001 to 2.2–2.3 per 1000 women during 2002–2005. Interval sterilizations dropped to 25% of the previous level after the rise in copayment while sterilizations in conjunction with caesarean section and postpartum sterilization remained constant.</p> <p>Conclusion</p> <p>For many Norwegian women seeking contraception, sterilization is no longer an available alternative.</p
Isolation and partial characterization of heparan sulphate proteoglycans from human hepatic amyloid
A Practical Guide for the Diagnosis of Primary Enteric Nervous System Disorders
Objective:Primary gastrointestinal neuropathies are a heterogeneous group of enteric nervous system (ENS) disorders that continue to cause difficulties in diagnosis and histological interpretation. Recently, an international working group published guidelines for histological techniques and reporting, along with a classification of gastrointestinal neuromuscular pathology. The aim of this article was to review and summarize the key issues for pediatric gastroenterologists on the diagnostic workup of congenital ENS disorders. In addition, we provide further commentary on the continuing controversies in the field.Results:Although the diagnostic criteria for Hirschsprung disease are well established, those for other forms of dysganglionosis remain ill-defined. Appropriate tissue sampling, handling, and expert interpretation are crucial to maximize diagnostic accuracy and reduce interobserver variability. The absence of validated age-related normal values for neuronal density, along with the lack of correlation between clinical and histological findings, result in significant diagnostic uncertainties while diagnosing quantitative aberrations such as hypoganglionosis or ultrashort Hirschsprung disease. Intestinal neuronal dysplasia remains a histological description of unclear significance.Conclusions:The evaluation of cellular quantitative or qualitative abnormalities of the ENS for clinical diagnosis remains complex. Such analysis should be carried out in laboratories that have the necessary expertise and access to their own validated reference values
Speeding Up Microevolution: The Effects of Increasing Temperature on Selection and Genetic Variance in a Wild Bird Population
The authors show that environmental variation may lead to a positive association between the annual strength of selection and expression of genetic variance in a wild bird population, which can speed up microevolution and have important consequences for how fast natural populations adapt to environmental changes
ERNICA Consensus Conference on the Management of Patients with Esophageal Atresia and Tracheoesophageal Fistula: Follow-up and Framework
Introduction Improvements in care of patients with esophageal atresia (EA) and tracheoesophageal fistula (TEF) have shifted the focus from mortality to morbidity and quality-of-life. Long-term follow-up is essential, but evidence is limited and standardized protocols are scarce. Nineteen representatives of the European Reference Network for Rare Inherited Congenital Anomalies (ERNICA) from nine European countries conducted a consensus conference on the surgical management of EA/TEF.
Materials and Methods The conference was prepared by item generation (including items of surgical relevance from the European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN)-The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) guidelines on follow-up after EA repair), item prioritization, formulation of a final list containing the domains Follow-up and Framework, and literature review. Anonymous voting was conducted via an internet-based system. Consensus was defined as ≥75% of those voting with scores of 6 to 9.
Results Twenty-five items were generated in the domain Follow-up of which 17 (68%) matched with corresponding ESPGHAN-NASPGHAN statements. Complete consensus (100%) was achieved on seven items (28%), such as the necessity of an interdisciplinary follow-up program. Consensus ≥75% was achieved on 18 items (72%), such as potential indications for fundoplication. There was an 82% concordance with the ESPGHAN-NASPGHAN recommendations. Four items were generated in the domain Framework, and complete consensus was achieved on all these items.
Conclusion Participants of the first ERNICA conference reached significant consensus on the follow-up of patients with EA/TEF who undergo primary anastomosis. Fundamental statements regarding centralization, multidisciplinary approach, and involvement of patient organizations were formulated. These consensus statements will provide the cornerstone for uniform treatment protocols and resultant optimized patient care
Early rheumatoid arthritis is characterized by a distinct and transient synovial fluid cytokine profile of T cell and stromal cell origin
Pathological processes involved in the initiation of rheumatoid synovitis remain unclear. We undertook the present study to identify immune and stromal processes that are present soon after the clinical onset of rheumatoid arthritis ( RA) by assessing a panel of T cell, macrophage, and stromal cell related cytokines and chemokines in the synovial fluid of patients with early synovitis. Synovial fluid was aspirated from inflamed joints of patients with inflammatory arthritis of duration 3 months or less, whose outcomes were subsequently determined by follow up. For comparison, synovial fluid was aspirated from patients with acute crystal arthritis, established RA and osteoarthritis. Rheumatoid factor activity was blocked in the synovial fluid samples, and a panel of 23 cytokines and chemokines measured using a multiplex based system. Patients with early inflammatory arthritis who subsequently developed RA had a distinct but transient synovial fluid cytokine profile. The levels of a range of T cell, macrophage and stromal cell related cytokines ( e. g. IL-2, IL-4, IL-13, IL-17, IL-15, basic fibroblast growth factor and epidermal growth factor) were significantly elevated in these patients within 3 months after symptom onset, as compared with early arthritis patients who did not develop RA. In addition, this profile was no longer present in established RA. In contrast, patients with non-rheumatoid persistent synovitis exhibited elevated levels of interferon-gamma at initiation. Early synovitis destined to develop into RA is thus characterized by a distinct and transient synovial fluid cytokine profile. The cytokines present in the early rheumatoid lesion suggest that this response is likely to influence the microenvironment required for persistent RA
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