Informing disaster-risk management policies for education infrastructure using scenario-based recovery analyses

Recent natural-hazard events have shown that post-disaster education continuity is still a significant global challenge. Here, we propose a methodology to support various stakeholders in quantifying the impact of disaster management policies on education continuity in low- and lower-middle-income countries. We then apply the proposed methodology to a hypothetical earthquake scenario impacting a testbed education infrastructure in Central Sulawesi, Indonesia. This case study accounts for local practice influencing recovery through interviews with stakeholders involved in post-disaster management in the region. The analyses reveal that early response financing mechanisms can help speed up education recovery by a factor of three. Also, community-managed school reconstruction projects are likely to be completed up to three to five times faster than agency-managed projects. Furthermore, we demonstrate how the framework can be used to prioritize school reconstruction projects to ensure inclusive education continuity at the community level.

Integrating earthquake early warnings into business continuity and organisational resilience: lessons learned from Mexico City

Earthquake early warning (EEW) is becoming a popular tool for mitigating earthquake-induced losses. However, the current literature separates EEW technical components and their operational and behavioural implications. This paper investigates how EEW can be integrated into business continuity practices, organisational resilience, and disaster risk reduction (DRR). A mixed methods approach is applied to analyse EEW perceptions in the case-study context of Mexico City, Mexico, which is characterised by a high level of seismic hazard and social and physical exposure/vulnerability. The dataset includes evidence from 15 semi-structured interviews with representatives of the public and private sectors, such as governments and enterprises, and 78 valid questionnaires compiled by local organisations, including civil protection and education institutions. The results reveal inconsistencies between technical EEW methodologies and their integration into three core domains of organisational practice: accountability, governance, and jurisdiction; standardisation of plans and procedures; training and education. Finally, open challenges for future research are highlighted.

Modelling and quantifying tomorrow's risks from natural hazards

Understanding and modelling future risks from natural hazards is becoming increasingly crucial as the climate changes, human population grows, asset wealth accumulates, and societies become more urbanised and interconnected. This need is recognised by the 2015-2030 Sendai Framework for Disaster Risk Reduction, which emphasises the importance of preparing for the disasters that our world may face tomorrow through strategies/policies that aim to minimise uncontrolled development in hazardous areas. While the vast majority of natural-hazard risk-assessment frameworks have so far focused on static impacts associated with current conditions and/or are influenced by historical context, some authors have sought to provide decision makers with risk-quantification approaches that can be used to cultivate a sustainable future. This Review documents these latter efforts, explicitly examining work that has modelled and quantified the individual components that comprise tomorrow's risk, i.e., future natural hazards affected by climate change, future exposure (e.g., in terms of population, land use, and the built environment), and the evolving physical vulnerabilities of the world's infrastructure. We end with a discussion on the challenges faced by modellers in determining the risks that tomorrow's world may face from natural hazards, and the constraints these place on the decision-making abilities of relevant stakeholders.

Urban growth modelling and social vulnerability assessment for a hazardous Kathmandu Valley

In our rapidly urbanizing world, many hazard-prone regions face significant challenges regarding risk-informed urban development. This study addresses this issue by investigating evolving spatial interactions between natural hazards, ever-increasing urban areas, and social vulnerability in Kathmandu Valley, Nepal. The methodology considers: (1) the characterization of flood hazard and liquefaction susceptibility using pre-existing global models; (2) the simulation of future urban built-up areas using the cellular-automata SLEUTH model; and (3) the assessment of social vulnerability, using a composite index tailored for the case-study area. Results show that built-up areas in Kathmandu Valley will increase to 352 km² by 2050, effectively doubling the equivalent 2018 figure. The most socially vulnerable villages will account for 29% of built-up areas in 2050, 11% more than current levels. Built-up areas in the 100-year and 1000-year return period floodplains will respectively increase from 38 km² and 49 km² today to 83 km² and 108 km² in 2050. Additionally, built-up areas in liquefaction-susceptible zones will expand by 13 km² to 47 km². This study illustrates how, where, and to which extent risks from natural hazards can evolve in socially vulnerable regions. Ultimately, it emphasizes an urgent need to implement effective policy measures for reducing tomorrow's natural-hazard risks.

Investigating the potential effectiveness of earthquake early warning across Europe

Here we assess the potential implementation of earthquake early warning (EEW) across Europe, where there is a clear need for measures that mitigate seismic risk. EEW systems consist of seismic networks and mathematical models/algorithms capable of real-time data telemetry that alert stakeholders (e.g., civil-protection authorities, the public) to an earthquake’s nucleation seconds before shaking occurs at target sites. During this time, actions can be taken that might decrease detrimental impacts. We investigate distributions of EEW lead times available across various parts of the Euro-Mediterranean region, based on seismicity models and seismic network density. We then determine the potential usefulness of these times for EEW purposes by defining their spatial relationship with population exposure, seismic hazard, and an alert accuracy proxy, using well-established earthquake-engineering tools for measuring the impacts of earthquakes. Our mapped feasibility results show that, under certain conditions, EEW could be effective for some parts of Europe.

The viability of earthquake early warning (EEW) in Europe is highly dependent on the magnitude of the ongoing earthquake and the ground-shaking threshold for alert issuance. The potential effectiveness of EEW is highest for Turkey, Italy, and Greece.

Association of syndromic mental retardation and autism with 22q11.2 duplication

We describe a 5.3-year-old girl with autism, mental retardation, hypotonia, marked speech delay, and mild dysmorphic features with a 22q11.2 duplication. Her mother carries the same duplication and presents cleft palate, and normal intelligence. The clinical and behavioural phenotype of this relatively new syndrome is very heterogeneous, with high variability also in the familiar cases. Up till now, about 50 cases of 22q11.2 duplication have been reported, but only three of them are associated with autistic disorders. We propose that in addition to 22q13.3 deletion syndrome, also 22q11.2 duplication should be suspected in a patient with unspecified dysmorphisms, mental retardation, autism, hypotonia, and severe speech delay.

Association of Trp53 polymorphic variants at codon 72 with nonsyndromic mental retardation

Mental retardation is the most common developmental disability affecting 2-3% of the population, a consequence of a wide range of genetic or nongenetic etiologic factors. The cause of mental retardation remains unknown in about 50% of cases. Trp53 (transformation related protein 53, also known as p53) is a tumor suppressor gene that activates the expression of genes involved in inducing growth arrest of cells in response to multiple forms of cellular stress and it plays a significant role in apoptotic cell death during the early development of the nervous system. In this study, we examined 246 children with nonsyndromic mental retardation from three Italian populations and 213 healthy children from the same populations. We observed that the Pro72/Pro72 genotype of p53 is much less represented in children with nonsyndromic mental retardation than in controls (6.5% versus 14.08%) (OR=0.42; 95% CI 0.21-0.83). These data suggest that subjects carrying the Pro allele are protected from this disease.

Primary retroperitoneal angiosarcoma: MR imaging features

We report a rare case of retroperitoneal angiosarcoma in a 72-year-old man who presented with abdominal pain. Diagnosis was obtained histologically after radical excision of the tumour. Fat-suppression MRI after intravenous administration of the contrast agent gadolinium-DTPA was able to define tissue planes between the lesion and the adjacent structures, suggesting the vascular nature of the lesion, and provided useful information for an accurate surgical approach. To the best of our knowledge, this is the first report that illustrates the MRI characteristics of a retroperitoneal angiosarcoma.

Long-term treatment with growth hormone improves final height in a patient with Pallister-Hall syndrome

Pallister-Hall syndrome is a disorder of development consisting of hypothalamic hamartoma, pituitary dysfunction, central polydactyly and visceral malformations. This disorder is inherited as an autosomal dominant trait and is caused by mutations of the GLI3 gene encoding a zinc finger transcription factor. We describe a case of Pallister-Hall syndrome with growth hormone neurosecretory dysfunction, successfully treated with growth hormone until attainment of final height. We conclude that children with Pallister-Hall syndrome and short stature be evaluated carefully for spontaneous somatotropic function and, if necessary, treated with growth hormone.

Effects of long-term growth hormone therapy on adrenal steroidogenesis in Turner syndrome

It has been shown that growth hormone (GH) and insulin-like growth factor-1 (IGF1) enhance steroidogenesis responsiveness to ACTH in cultured adrenal cells. To investigate the GH effect on adrenal steroidogenesis in non-GH-deficient subjects, we studied 9 girls with Turner syndrome (chronological age 5.5-7.2 years; bone age 5-7 years). In all subjects an ACTH test (Synacthen depot, 0.25 mg i.v. with blood samples at 0 and 60 min) was performed basally at 8-9 a.m. and 6 months after GH therapy (1 IU/kg/week). 17-Hydroxypregnenolone (17PGN), 17-hydroxyprogesterone (17OHP), dehydroepiandrosterone (DHA), its sulfate (DHA-S), androstenedione and cortisol were evaluated by radioimmunoassay. Two groups of normal girls were selected as controls: group A age-matched the patients at the start of the study, and group B age-matched the patients at the end of the study. The responsiveness of each hormone to ACTH was expressed as the difference between stimulated and basal values. A p value of < 0.01 was considered to indicate significance. There were no significant differences between pre- and posttreatment basal values of 17PGN, 17OHP, DHA, androstenedione and cortisol in the Turner syndrome patients, whereas a significant increase was observed for basal DHA-S (1.57+/-0.31; 1.89+/-0.43 micromol/l, p < 0.01). Comparison of increments before and after GH treatment showed a significant increase in responsiveness to ACTH after GH therapy DHA (p < 0.01). The increase in 17PGN was evident (p < 0.02), but the established significant p value was not reached. No differences for 17OHP, androstenedione and cortisol were found. The stimulated 17PGN/17OHP ratio was significantly higher (p < 0.01) after GH, whereas the 17OHP/androstenedione ratio was considerably lower, but the p value was < 0.02. No differences between pretreatment values with the control group androstenedione was found, whereas basal and stimulated posttreatment values of DHA and stimulated values of 17PGN were higher in patients after GH therapy than in control group B. No differences between the 2 control groups were found. In conclusion our study showed that adrenal steroid responsiveness to ACTH increases in Turner syndrome after long-term treatment with high GH doses. An increase in the number of ACTH adrenal receptors and/or a modulation of enzyme activities may be suggested. The positive or negative pharmacological implications of these data remain to be determined especially when taking into consideration the wide use of GH therapy in non-GH-deficient subjects.

[Antiepileptic drugs in pregnancy and malformations]

The use of antiepileptic drugs in pregnancy may be responsible of minor or major developmental abnormalities at birth or in infancy. The severity of effects and heterogeneity of that abnormalities might be related to a special genetic background giving the fetus a predisposition for epilepsy and vulnerability to major or minor anomalies. The authors report the case of a pregnant woman self prescribing of a politherapy without medical control. She gave birth to a newborn with sever intrauterin retardation, various dysmorphic features and moderate psychomotor delayed.

Natural history of Wolf-Hirschhorn syndrome: experience with 15 cases

Wolf-Hirschhorn syndrome (WHS) is a well-known chromosomal disorder attributable to partial deletion of the short arm of chromosome 4 (4p-). Although about 120 cases have been reported so far, there is still very little data on its natural history. Information given to parents at the time of diagnosis tends to be skewed to the extreme negative. To help delineate more thoroughly the natural history of WHS, and to obtain better information to answer parents' questions in a clinical setting, we evaluated 15 patients (12 females, 3 males) in three centers with the 4p- syndrome. Four of the cases had a follow-up spanning 16 years. Thirteen cases were detected by standard cytogenetics (regular G-banding 10, high-resolution banding 3), while the remaining 2 required fluorescence in situ hybridization. A total of 5/15 (33.3%) had heart lesions; 7/15 (46. 6%) had oral facial clefts; 13/15 (86.6%) had a seizure disorder, that tended to disappear with age; and 100% had severe/profound developmental retardation. One Italian patient had sensorineural deafness and 1 Utah patient had a right split hand defect. Of note, 2 Utah patients were able to walk with support (at 4 and 12 years of age, respectively), whereas 3 Italian patients and 1 Utah patient were able to walk unassisted (at 4, 5, 5 years 9 months, and 7 years of age, respectively). Two of the 3 Italian patients also achieved sphincter control (by day). The 8 patients receiving serial electroencephalogram studies showed fairly distinctive abnormalities, usually outlasting seizures. A slow, but constant progress in development was observed in all cases, during the follow-up period. In conclusion, the combined cases of the three centers represent considerable experience, providing new information on several aspects of this important deletion syndrome.

A new case of Ambras syndrome associated with a paracentric inversion (8) (q12; q22)

Ambras syndrome (AS) is a special form of congenital universal hypertrichosis described for the first time by Baumeister et al. (1). This form differs from other forms of congenital hypertrichosis in the pattern of hair distribution and its associated anomalies. The molecular-genetic cause of AS is unknown; the association of AS with a pericentric inversion (8) (p11.2; q22) described in the case of Baumeister so far has been unique in the literature. This report is the tenth with clinical signs of AS so far described in the literature and the second with an inversion in chromosome 8 and the first with evaluation of peripheral androgens. The new-born girl presented with abundant and dark hair on the face and ears, on the shoulders and on the arms; the other parts of the body were covered with fine, lightly pigmented hair. The face showed many dysmorphic features. Chromosome analysis showed a paracentric inversion of one chromosome 8. The breakpoints were localised at q12 and q22. The parental karyotypes were normal. Laboratory investigation showed normal plasma levels of testosterone, androstenedione (A), 17-hydroxyprogesterone, dehydroepiandrosterone-sulphate (DHA-S), free testosterone (FT), dihydrotestosterone (DHT) and 3alpha-androstanediol-glucuronide (3AG). Here we report a chromosomal inversion similar to that found previously not associated with alterations in androgen plasma levels.

Clinical and roentgenographic findings in a patient with primordial microcephalic dwarfism type Caroline Crachami

We describe a patient with primordial microcephalic dwarfism with severe intrauterine growth retardation and severe and progressive postnatal deficit in length, weight and head circumference. The patient was extroverted and sociable but mildly mentally retarded. He had marked delay of bone maturation and an enlargement of the sella turcica. This child and two previously reported patients [Boscherini et al., Eur J Pediatr 137:237-242, 1981] have many characteristics in common with Caroline Crachami, the famous "Sicilian dwarf". We think that these patients belong to a separate category of microcephalic primordial dwarfism.

Final height in Turner syndrome patients treated with growth hormone

Growth hormone (GH), alone or in combination with anabolic steroids, seems to improve the growth rate in Turner syndrome, but to exert a less striking effect on the final height (FH). Reports on the FH usually lack a control group, and the GH effect is determined using the gain in centimeters over projected height. Out of a cohort of 32 Turner syndrome girls under recombinant human GH (rhGH) therapy (0.5 IU/kg/week during the 1st year and 1 IU/kg/week subsequently), 18 (treated for 3-6 years) attained FH. The mean chronological age at the first examination was 9.6 +/- (SD) 2.1 years and at the start of GH therapy 13.0 +/- 2.0 (range 8.8-17.2) years. Eighteen untreated subjects matched for chronological age and karyotype served as control group. The FH as SDS according to Lyon and to unpublished Italian Turner syndrome girl standards was not significantly different as compared with pretreatment. In comparison with Italian cross-sectional Turner syndrome standards (FH 142.5 +/- 7.0 cm), the FH of the control group was quite similar (142.2 +/- 4.9 cm), whereas the rhGH-treated group showed a FH of 147.6 +/- 7.3 cm with a mean increment of about 5 cm. The height gain during therapy (as delta height in SDS either according to Lyon or to Italian SDS standards) was compared for each girl with that of a matched girl of the control group during a comparable observation period. A significantly different delta height was observed in the treated versus control groups: 0.3 +/- 1.1 vs. -1.0 +/- 0.8 according to Lyon (p < 0.001) and 0.8 +/- 0.7 vs -0.3 +/- 0.5 according to Italian standards (p < 0.001). If we compared the FH with the projected height according to Lyon standards, the height gain (as delta height in cm) was significantly higher than in the untreated subjects (-1.1 +/- 4.8 vs. -6.2 +/- 3.9 cm; p < 0.05). It seems worthwhile to undertake GH treatment in Turner syndrome girls who represent a very short stature population, even though the response is less significant than in classic GH deficiency and shows a striking variability, probably due to a sort of peripheral resistance.

[Dyggve-Melchior-Clausen syndrome: description of 2 further cases]

In this paper we describe the clinical and radiographic features of a spondylo-epi-methaphyseal dysplasia. Dyggve-Melchior-Clausen syndrome. In these two new cases, without severe mental retardation, we have highlighted the clinical and radiological findings, progression of the skeletal changes that have allowed us to make a diagnosis.

Growth hormone and dysmorphic syndromes

In order to study the pathogenesis of short stature in some of the best known and most frequent dysmorphic syndromes, we have reviewed the most significant studies conducted on somatrotropin secretion and on response to replacement treatment with human growth hormone in pediatric patients. In particular, the study examines the results presented in the literature, and in a few of our cases, those obtained with regard to Noonan, Silver-Russell and Prader-Willi syndrome patients, to achondroplasia and hypochondroplasia patients, and to Down syndrome patients. Finally, we shall present a review of a few, less frequent dysmorphic syndromes with short stature, in which a growth hormone deficiency has been diagnosed and replacement treatment attempted.

Hypoparathyroidism as the major manifestation in two patients with 22q11 deletions

We report on two adolescents with 22q11 deletion. Their main clinical manifestation was chronic symptomatic hypocalcemia secondary to hypoparathyroidism, together with seizures and cerebral calcifications. Neither congenital cardiac abnormality nor T cell deficiency were detected. The phenotypic manifestations of the observed patients were consistent with velo-cardio-facial syndrome (VCFS). A microdeletion of chromosome region 22q11 has been demonstrated in approximately 90% of DiGeorge syndrome (DGS) patients and in 75% of VCFS patients; the association of the deletion with a wide spectrum of clinical findings suggests the existence of a contiguous gene syndrome. The presence of certain traits of DGS/VCFS should lead to investigations of the parathyroid function and molecular analysis of the 22q11 region hybridization studies.

[Multiple pterygium syndrome: description of a new clinical case]

Multiple Pterygium Syndrome is a rare autosomal recessive disorder characterized by short stature, multiple pterygium, joint contractures, vertebral fusions and minor facial anomalies. Due to the extreme phenotypic variability of this syndrome many mild cases may be misdiagnosed or not recognized. The importance of an early diagnosis is to provide an adequate follow-up of these children in order to try to prevent many of the clinical problems they may encounter in their life-time.

Immune function in growth hormone-deficient children treated with biosynthetic growth hormone

Conflicting data regarding the immune function in growth hormone (GH) -deficient children or changes in immune parameters during substitutive GH therapy have been reported. We have studied the immune function in 13 patients with GH deficiency before and during treatment with biosynthetic GH (12 IU/m2 body surface/week) after 6 and 12 months of therapy. We found that the absolute number of total T lymphocytes and T-cell subsets (using monoclonal Ab as markers), Natural Killer cell activity (target K562) and response of lymphocytes to polyclonal mitogens (PHA, ConA, PWM) were all in the normal range and remained so after 6 and 12 months of therapy. The absolute number of B lymphocytes was in the normal range before treatment and after 6 months of therapy but dropped significantly after 12 months of treatment. Serum immunoglobulins (IgG, IgA, IgM) did not show a parallel drop and remained normal throughout the whole study. Our GH-deficient patients did not show any undue susceptibility to infections and our data thus seem to confirm that the immune function is basically intact in these children and that it is not suppressed by GH treatment. Although a drop in B lymphocytes was observed, the normal level of immunoglobulins and the normal functional response to PWM seem to demonstrate the maintenance of a normal humoral immune response.

Growth hormone treatment in children with sporadic primary microcephaly

Four children with sporadic primary microcephaly associated with short stature, delayed bone age, and low growth velocity are described. All of the children showed a normal growth hormone response to standard pharmacological tests but one of the patients had a reduced spontaneous growth hormone nocturnal secretion. Regardless of the results of their somatotropic function evaluation, the patients were treated with exogenous growth hormone and all of them showed an increase in growth rate.

[Treatment of somatotropic deficiency with biosynthetic growth hormone]

A total of 21 patients with somatotropic deficiency have been enrolled in a clinical trial of biosynthetic growth hormone (bio-GH) and pituitary growth hormone (pit-GH). Five of them not previously treated (naïve) and 7 previously treated with pit-GH, received bio-GH; 9 received only pit-GH. Biosynthetic-GH was given 12 UI/m2/week. Height velocities during treatment rose, for naïve patients, from 3.6 +/- 0.3 cm/year (before treatment) to 8.7 +/- 1.3 cm/year (after 12 months treatment). For previously treated patients, after a period at least 6 months without any GH therapy, the increase in height was from 2.5 +/- 0.9 cm/year to 6.8 cm/year; and for the patients who received only pit-GH was from 3.4 +/- 1.2 cm/year to 8.0 +/- 1.1 cm/year. No significant difference was observed between the growth velocities obtained with the two preparations. No specific side-effects were noted.

Twelve-hour spontaneous nocturnal growth hormone secretion in growth retarded patients

Twelve-hour nocturnal GH secretion was studied in 30 children with familial short stature (FSS), constitutional growth delay (CGD), total growth hormone deficiency (TGHD), partial growth hormone deficiency (PGHD), or idiopathic short stature (ISS). No difference was observed between subjects with FSS and children with CGD. The mean 12-hour serum GH concentration was significantly lower in patients with TGHD (p less than 0.001), children with PGHD (p less than 0.01), and subjects with ISS (p less than 0.01) than in subjects with FSS and CGD. No overlap was observed between the range of mean concentration values of children with TGHD and that of subjects with FSS. A significant correlation was found between growth velocity expressed as SD from the mean for bone age and GH concentration (p less than 0.001). All patients with a growth velocity less than 3rd percentile for bone age showed a mean nocturnal concentration less than 4 ng/ml. These data suggest that evaluation of 12-hour spontaneous nocturnal GH secretion with GH sampling every 30 minutes can be usefully employed in the diagnosis of GH deficiency.