From urban meteorology, climate and environment research to integrated city services

Accelerating growth of urban populations, especially in developing countries, has become a driving force of human development. Crowded cities are centres of creativity and economic progress, but polluted air, flooding and other climate impacts, means they also face major weather, climate and environment-related challenges. Increasingly dense, complex and interdependent urban systems leave cities vulnerable: a single extreme event can lead to a widespread breakdown of a city’s infrastructure often through domino effects. The World Meteorological Organization (WMO) recognizes that rapid urbanization necessitates new types of services which make the best use of science and technology and considers the challenge of delivering these as one of the main priorities for the meteorological community. Such Integrated Urban Weather, Environment and Climate Services should assist cities in facing hazards such as storm surges, flooding, heat waves, and air pollution episodes, especially in changing climates. The aim is to build urban services that meet the special needs of cities through a combination of dense observation networks, high-resolution forecasts, multi-hazard early warning systems, and climate services for reducing emissions, that will enable the building of resilient, thriving sustainable cities that promote the Sustainable Development Goals. A number of recent international studies have been initiated to explore these issues. The paper provides a brief overview of recent WMO and collaborators research programs and activities in urban hydrometeorology, climate and air pollution; describes the novel concept of urban integrated weather, climate and environment related services; and highlights research needs for their realisation

Life-threatening infections in children in Europe (the EUCLIDS Project): a prospective cohort study

Background: Sepsis and severe focal infections represent a substantial disease burden in children admitted to hospital. We aimed to understand the burden of disease and outcomes in children with life-threatening bacterial infections in Europe. Methods: The European Union Childhood Life-threatening Infectious Disease Study (EUCLIDS) was a prospective, multicentre, cohort study done in six countries in Europe. Patients aged 1 month to 18 years with sepsis (or suspected sepsis) or severe focal infections, admitted to 98 participating hospitals in the UK, Austria, Germany, Lithuania, Spain, and the Netherlands were prospectively recruited between July 1, 2012, and Dec 31, 2015. To assess disease burden and outcomes, we collected demographic and clinical data using a secured web-based platform and obtained microbiological data using locally available clinical diagnostic procedures. Findings: 2844 patients were recruited and included in the analysis. 1512 (53·2%) of 2841 patients were male and median age was 39·1 months (IQR 12·4–93·9). 1229 (43·2%) patients had sepsis and 1615 (56·8%) had severe focal infections. Patients diagnosed with sepsis had a median age of 27·6 months (IQR 9·0–80·2), whereas those diagnosed with severe focal infections had a median age of 46·5 months (15·8–100·4; p<0·0001). Of 2844 patients in the entire cohort, the main clinical syndromes were pneumonia (511 [18·0%] patients), CNS infection (469 [16·5%]), and skin and soft tissue infection (247 [8·7%]). The causal microorganism was identified in 1359 (47·8%) children, with the most prevalent ones being Neisseria meningitidis (in 259 [9·1%] patients), followed by Staphylococcus aureus (in 222 [7·8%]), Streptococcus pneumoniae (in 219 [7·7%]), and group A streptococcus (in 162 [5·7%]). 1070 (37·6%) patients required admission to a paediatric intensive care unit. Of 2469 patients with outcome data, 57 (2·2%) deaths occurred: seven were in patients with severe focal infections and 50 in those with sepsis. Interpretation: Mortality in children admitted to hospital for sepsis or severe focal infections is low in Europe. The disease burden is mainly in children younger than 5 years and is largely due to vaccine-preventable meningococcal and pneumococcal infections. Despite the availability and application of clinical procedures for microbiological diagnosis, the causative organism remained unidentified in approximately 50% of patients

Plasma lipid profiles discriminate bacterial from viral infection in febrile children

Fever is the most common reason that children present to Emergency Departments. Clinical signs and symptoms suggestive of bacterial infection are often non-specific, and there is no definitive test for the accurate diagnosis of infection. The 'omics' approaches to identifying biomarkers from the host-response to bacterial infection are promising. In this study, lipidomic analysis was carried out with plasma samples obtained from febrile children with confirmed bacterial infection (n = 20) and confirmed viral infection (n = 20). We show for the first time that bacterial and viral infection produces distinct profile in the host lipidome. Some species of glycerophosphoinositol, sphingomyelin, lysophosphatidylcholine and cholesterol sulfate were higher in the confirmed virus infected group, while some species of fatty acids, glycerophosphocholine, glycerophosphoserine, lactosylceramide and bilirubin were lower in the confirmed virus infected group when compared with confirmed bacterial infected group. A combination of three lipids achieved an area under the receiver operating characteristic (ROC) curve of 0.911 (95% CI 0.81 to 0.98). This pilot study demonstrates the potential of metabolic biomarkers to assist clinicians in distinguishing bacterial from viral infection in febrile children, to facilitate effective clinical management and to the limit inappropriate use of antibiotics

Gastroschisis; perinatal and postnatal aspects

Nowadays, gastroschisis is almost always diagnosed prenatally during routine first and second trimester ultrasound examinations. The pathogenesis of gastroschisis is still poorly understood and counselling the parents expecting a child with gastroschisis is challenging. Not much is known about the long-term outcome of these children. To determine short-term outcome of children born with isolated gastroschisis (no extra-gastrointestinal congenital abnormalities) we performed an international cohort study and a meta-analysis. Seventeen studies were included for further meta-analysis comprising a total of 1652 patients. The mean time to full enteral feeding (TFEF) was 35.3 ± 4.4 days, length of ventilation was 5.5 ± 2.0 days, length of stay (LOS) was 46.4 ± 5.2 days and mortality risk was 0.06 (0.04-0.07 95%-CI). TFEF, ventilation time, LOS were significant longer and mortality rate was 3.64 (1.95 – 6.83 95%-CI) times higher in complex cases (born with bowel atresia, volvulus, perforation or necrosis). To assess the long-term outcome of gastroschisis we determined motor, cognitive and behavioural outcomes of sixteen school aged children born with gastroschisis compared to 32 controls matched for gender, gestational age, birth weight, and corrected for socioeconomic status and being small for gestational age. The median verbal intelligence quotient and global executive functioning scores of children born with gastroschisis were poorer than of controls. Children with gastroschisis were more often classified as borderline or abnormal than controls regarding response inhibition, selective visual attention, sustained auditory attention, and fine motor skills. Grade retention was more prevalent in gastroschisis children. The follow-up of children born with gastroschisis deserves attention regarding these specific domains, to improve their functional outcomes. Structural clinical examination directed to morphologic anomalies and genetic testing was performed in 21 gastroschisis children and their parents and compared to a validated control group to assess the value of genetic testing and morphological examination in the gastroschisis population. We detected significantly more minor morphological anomalies, one de novo copy number variation and one, possibly two, monogenetic disorders in two children with severe intellectual and motor retardation. Pediatric follow-up, syndrome diagnosis and genetic analysis are indicated in children with gastroschisis, especially when additional anomalies and/or intellectual disability present. A prospective longitudinal national multi-centre study with fetal ultrasound assessment and surveillance according to a standard protocol was performed in order to assess ultrasound markers related to outcome of isolated gastroschisis cases. The primary outcome was simple or complex gastroschisis and secondary outcomes were TFEF, LOS and mortality. Seventy-nine (80.6%) liveborn infants had simple and 19 (19.4%) had complex gastroschisis. There were 3 neonatal deaths, one in the simple and 2 in the complex group. TFEF and LOS were significantly longer in the complex cases compared to the simple group. Based on this large prospective longitudinal study we conclude that only the intra-abdominal bowel dilation appears to be associated with complex gastroschisis especially. However, high cut-off values have to be applied to identify some of those cases reliably

Gastroschisis; perinatal and postnatal aspects

Nowadays, gastroschisis is almost always diagnosed prenatally during routine first and second trimester ultrasound examinations. The pathogenesis of gastroschisis is still poorly understood and counselling the parents expecting a child with gastroschisis is challenging. Not much is known about the long-term outcome of these children. To determine short-term outcome of children born with isolated gastroschisis (no extra-gastrointestinal congenital abnormalities) we performed an international cohort study and a meta-analysis. Seventeen studies were included for further meta-analysis comprising a total of 1652 patients. The mean time to full enteral feeding (TFEF) was 35.3 ± 4.4 days, length of ventilation was 5.5 ± 2.0 days, length of stay (LOS) was 46.4 ± 5.2 days and mortality risk was 0.06 (0.04-0.07 95%-CI). TFEF, ventilation time, LOS were significant longer and mortality rate was 3.64 (1.95 – 6.83 95%-CI) times higher in complex cases (born with bowel atresia, volvulus, perforation or necrosis). To assess the long-term outcome of gastroschisis we determined motor, cognitive and behavioural outcomes of sixteen school aged children born with gastroschisis compared to 32 controls matched for gender, gestational age, birth weight, and corrected for socioeconomic status and being small for gestational age. The median verbal intelligence quotient and global executive functioning scores of children born with gastroschisis were poorer than of controls. Children with gastroschisis were more often classified as borderline or abnormal than controls regarding response inhibition, selective visual attention, sustained auditory attention, and fine motor skills. Grade retention was more prevalent in gastroschisis children. The follow-up of children born with gastroschisis deserves attention regarding these specific domains, to improve their functional outcomes. Structural clinical examination directed to morphologic anomalies and genetic testing was performed in 21 gastroschisis children and their parents and compared to a validated control group to assess the value of genetic testing and morphological examination in the gastroschisis population. We detected significantly more minor morphological anomalies, one de novo copy number variation and one, possibly two, monogenetic disorders in two children with severe intellectual and motor retardation. Pediatric follow-up, syndrome diagnosis and genetic analysis are indicated in children with gastroschisis, especially when additional anomalies and/or intellectual disability present. A prospective longitudinal national multi-centre study with fetal ultrasound assessment and surveillance according to a standard protocol was performed in order to assess ultrasound markers related to outcome of isolated gastroschisis cases. The primary outcome was simple or complex gastroschisis and secondary outcomes were TFEF, LOS and mortality. Seventy-nine (80.6%) liveborn infants had simple and 19 (19.4%) had complex gastroschisis. There were 3 neonatal deaths, one in the simple and 2 in the complex group. TFEF and LOS were significantly longer in the complex cases compared to the simple group. Based on this large prospective longitudinal study we conclude that only the intra-abdominal bowel dilation appears to be associated with complex gastroschisis especially. However, high cut-off values have to be applied to identify some of those cases reliably

Plasma lipid profiles discriminate bacterial from viral infection in febrile children

Fever is the most common reason that children present to Emergency Departments. Clinical signs and symptoms suggestive of bacterial infection are often non-specific, and there is no definitive test for the accurate diagnosis of infection. The 'omics' approaches to identifying biomarkers from the host-response to bacterial infection are promising. In this study, lipidomic analysis was carried out with plasma samples obtained from febrile children with confirmed bacterial infection (n = 20) and confirmed viral infection (n = 20). We show for the first time that bacterial and viral infection produces distinct profile in the host lipidome. Some species of glycerophosphoinositol, sphingomyelin, lysophosphatidylcholine and cholesterol sulfate were higher in the confirmed virus infected group, while some species of fatty acids, glycerophosphocholine, glycerophosphoserine, lactosylceramide and bilirubin were lower in the confirmed virus infected group when compared with confirmed bacterial infected group. A combination of three lipids achieved an area under the receiver operating characteristic (ROC) curve of 0.911 (95% CI 0.81 to 0.98). This pilot study demonstrates the potential of metabolic biomarkers to assist clinicians in distinguishing bacterial from viral infection in febrile children, to facilitate effective clinical management and to the limit inappropriate use of antibiotics