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This paper examines the continued growth in the use of underground space beneath cities and the widespread lack of significant and broad planning efforts for its use. The paper is drawn from the collective experience and prior research of the authors together with information exchanges afforded by the activities of the International Tunnelling and Underground Space Association's Committee on Underground Space (ITACUS). The particular focus of this paper is on sustainability issues related to urban underground space use including contribution to an environmentally sustainable and aesthetically acceptable landscape, anticipated structural longevity and the maintenance of opportunity for urban development by future generations. However, owing to their initial cost and permanent alteration of the underground environment, underground structures put a special emphasis on long-range planning which considers life-cycle cost-benefits and the selection of projects that offer the highest contribution to urban sustainability rather than a short-term fix to an individual need.

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ObjectivesAs more families participate expanded newborn screening for metabolic disorders in China, the overall number of false positives increases. Our goal was to assess the potential impact on parental stress, perceptions of the child's health, and family relationships.MethodsParents of 49 infants with false-positive screening results for metabolic disorders in the expanded newborn screening panel were compared with parents of 42 children with normal screening results. Parents first completed structured interview using likert scales, closed and open questions. Parents also completed the parenting stress index.ResultsA total of 88 mothers and 41 fathers were interviewed. More mothers in the false-positive group reported that their children required extra parental care (21%), compared with 5% of mothers in the normal-screened group (P<0.001). 39% of mothers in the false-positive group reported that they worry about their child's future development, compared with 10% of mothers in the normal-screened group (P<0.001). Fathers in the false-positive group did not differ from fathers in the normal-screened group in reporting worry about their child's extra care requirements, and their child's future development. Children with false-positive results compared with children with normal results were triple as likely to experience hospitalization (27%vs 9%, respectively; P<0.001).ConclusionsThe results showing false-positive screening results may affect parental stress and the parent-child relationship. Parental stress and anxiety can be reduced with improved education and communication to parents about false-positive results.