Design Thinking and Compliance as Drivers for Decision Support System Adoption in Agriculture

To respond to increasing demands for good agricultural practices (GAP) and food safety, governments globally are introducing stringent regulations to govern agricultural compliance that affect production, storage, and sales activities. New legislation in Argentina to enforce GAP is an opportunity to test compliance as an incentive to adopt technological solutions. This research aims to determine whether compliance software is an effective gateway to shift farmers' decision-making strategies from intuition-based to evidence-based, improving agricultural productivity through technology. Integrating technology can be a significant hurdle for farms but is also a steppingstone towards more reliable processes. To address this, the authors prototype a decision support system (DSS) for greenhouse farmers in La Plata, Argentina, to help farmers keep traceable records of their crops and treatments to reduce compliance risk. The project incorporates lessons learned from previous DSS projects and utilises design-thinking strategies to involve the end-user in the development.

Achondroplasia in Latin America: practical recommendations for the multidisciplinary care of pediatric patients

Background

Achondroplasia is the most common bone dysplasia associated with disproportionate short stature, and other comorbidities, such as foramen magnum stenosis, thoracolumbar kyphosis, lumbar hyperlordosis, genu varum and spinal compression. Additionally, patients affected with this condition have higher frequency of sleep disorders, ear infections, hearing loss and slowed development milestones. Considering these clinical features, we aimed to summarize the regional experts’ recommendations for the multidisciplinary management of patients with achondroplasia in Latin America, a vast geographic territory with multicultural characteristics and with socio-economical differences of developing countries.

Methods

Latin American experts (from Argentina, Brazil, Chile and Colombia) particiáted of an Advisory Board meeting (October 2019), and had a structured discussion how patients with achondroplasia are followed in their healthcare centers and punctuated gaps and opportunities for regional improvement in the management of achondroplasia.

Results

Practical recommendations have been established for genetic counselling, prenatal diagnosis and planning of delivery in patients with achondroplasia. An outline of strategies was added as follow-up guidelines to specialists according to patient developmental phases, amongst them neurologic, orthopedic, otorhinolaryngologic, nutritional and anthropometric aspects, and related to development milestones. Additionally, the role of physical therapy, physical activity, phonoaudiology and other care related to the quality of life of patients and their families were discussed. Preoperative recommendations to patients with achondroplasia were also included.

Conclusions

This study summarized the main expert recommendations for the health care professionals management of achondroplasia in Latin America, reinforcing that achondroplasia-associated comorbidities are not limited to orthopedic concerns.

Skeletal dysplasias in Latin America

Skeletal dysplasias (SD) are disturbances in growth due to defects intrinsic to the bone and/or cartilage, usually affecting multiple bones and having a progressive character. In this article, we review the state of clinical and research SD resources available in Latin America, including three specific countries (Brazil, Argentina, and Chile), that have established multidisciplinary clinics for the care of these patients. From the epidemiological point of view, the SD prevalence of 3.2 per 10,000 births from nine South American countries included in the ECLAMC network represents the most accurate estimate not just in Latin America, but worldwide. In Brazil, there are currently five groups focused on SD. The data from one of these groups including the website www.ocd.med.br, created to assist in the diagnosis of SD, are highlighted showing that telemedicine for this purpose represents a good strategy for the region. The experience of more than 30 years of the SD multidisciplinary clinic in an Argentinian Hospital is presented, evidencing a solid experience mainly in the follow-up of the most frequent SD, especially those belonging the FGFR3 group and OI. In Chile, a group with 20 years of experience presents its work with geneticists and pediatricians, focusing on diagnostic purposes and clinical management. Altogether, although SD health-care and research activities in Latin America are in their early stages, the experience in these three countries seems promising and stimulating for the region as a whole.

Clinical and Radiologic Evaluation of an Individual with Hypochondroplasia and a Novel FGFR3 Mutation

Hypochondroplasia (HCH), a skeletal dysplasia caused by mutations in the fibroblast growth factor receptor 3 (FGFR3) gene, is characterized by disproportionate short stature. The p.Asn540Lys (p.N540K) mutation accounts for ∼50 to 70% of cases of HCH, but novel FGFR3 mutations are described. We present a family with disproportionately short stature and mild radiologic findings seen in a major public pediatric hospital in Argentina. A previously undescribed heterozygous missense variant in FGFR3, NM_000142.4:667C > T; p.(Arg223Cys) was identified. The predicted phenotype correlates well with the mild auxologic and radiologic characteristics observed. In this case, disproportionately short stature raised the suspicion of skeletal dysplasia.

[Clinical, radiological and auxologic long-term evolution of 8 children with asphyxiating thoracic dysplasia]

Asphyxiating thoracic dysplasia is an uncommon condition with multiple organ affectation and high neonatal mortality. It presents with short stature, short extremities, narrow thorax. With growth, there is respiratory improvement, but emergence of renal, hepatic, pancreatic and/or retinal impairment.

OBJECTIVE

to describe the long-term evolution of 8 patients of a pediatric hospital.

METHODS

we retrospectively evaluated age at diagnosis, sex, anthropometric variables, complications and radiology.

RESULTS

male/female 6/2. Median age at diagnosis: 2.54 years.

EVOLUTION

8/8 respiratory compromise, 3/8 kidney, liver 2/8, 1/8 ophthalmologic, cardiac 1/8. Median height at diagnosis -1.76 DS, normal postnatal growth and body proportions. Radiology: 8/8 narrow chest and brachyphalangia in hands. 5/8 acetabular abnormalities.

DISCUSSION

for surveillance it is recommended to monitor renal, liver and eye function. The pediatrician should suspect this entity in a newborn with narrow thorax and respiratory distress.

Growth references for height, weight, and head circumference for Argentine children with achondroplasia

In order to prepare growth references for height, weight, and head circumference for Argentine children with Achondroplasia, 228 children (114 boys) aged 0-18 years attending the Growth Clinic at Hospital Garrahan were measured between 1992 and 2009. Centiles were calculated by LMS, a method for summarizing growth data which adjusts for skewness. Curves for centiles are obtained using the formula: [Formula: see text], where Z (α) is the normal equivalent deviate for tail area α; C100α is the weight or height centile corresponding to Z (α), t is age in years, and L(t) is (skewness)(t), M(t) is median, S (t) is coefficient variation and C(100α) (t) indicates the corresponding values of each curve at age t. Boys and girls centiles for height were similar to USA references in infancy and childhood but lower than that references at adolescence. Final height was 1.7 and 5.1 cm below USA achondroplasia references in girls and boys, respectively. Head circumference centiles were, at all ages, lower than USA references in both genders. Countries need national references for clinical growth assessment of their local population. Likewise, specific local growth references for children with some genetic conditions (such us achondroplasia) are valuable tools for detecting additional conditions affecting growth, for estimating final height and for evaluating the impact of growth-promoting treatments.

CONCLUSION

references presented here can also be used in other countries with similar ethnographics characteristics.

[A non invasive method for assessing sexual development at adolescence]

INTRODUCTION

Observational assessments of puberty that invades the adolescent's privacy are not acceptable for research in population groups. Results based on self assessment have been variable, and in many cases poor.

OBJECTIVES

To evaluate the validity of a questionnaire with simple questions addressed to assess early, intermediate and advanced puberty periods rather than specific stages.

MATERIAL AND METHODS

In an outpatient clinic at the Service of Adolescence of a public hospital, 188 and 142 healthy girls and boys aged 8-18 years, and 36 girls and boys aged 8-9 years attending a public school were studied. Adolescents attended the Service for the first time. Those with chronic diseases were excluded from the study. Children answered the questionnaire before entering the doctor's office, where a trained professional clinically assessed their puberal development (Tanner's stage). The questionnaire was previously tested in 30 adolescents.

RESULTS

The highest concordance were found in the questions: "Have you started puberty?", with Tanner's stages III, IV or V (Kappa value= 0.60); "Have you already had your first menstrual period?" with stages IV-V (K= 0.69); and "Do you shave?" with stages IV-V (K= 0.66). In most cases, these questions showed high (> or = 0.80) sensitivity and specificity for detecting the mentioned puberty periods.

CONCLUSIONS

The method showed to be reliable, and its further evaluation in a non medical setting (schools, households, etc.) is recommended.

[Growth references for weight and height for Argentinian girls and boys from birth to maturity: incorporation of data from the World Health Organisation from birth to 2 years and calculation of new percentiles and LMS values]

Argentine growth references have been widely used by paediatricians in the country for the last 20 years. Two main difficulties were detected during this period: the lack of data on breast-fed children in the first months of age, and problems in the calculation of "z" scores. On these basis, local data on weight and height during the first two years of life were replaced by data from the longitudinal international study recently carried out by WHO. L, M and S values were obtained from the original percentile data for ages 2 to maturity, and smoothed with cubic splines. Selected percentiles for weight and height from birth to maturity were then re-calculated using LMS values. Charts were designed in two formats: birth to maturity and birth to 6.0 years. Now, users can calculate "z" scores automatically at the new site provided by the Department of Growth and Development, Hospital Garrahan, which enables the use of the LMS growth programme. We have also incorporated into the new charts, percentiles of the age of attaining menarche and Tanner s stage II of breast, genitalia and pubic hair for Argentine children. We think the new references represent an improvement in the assessment of growth in our country.

Assessment of head size adjusted for height: an anthropometric tool for clinical use based on Argentinian data

BACKGROUND

Relative macrocephaly describes a large head in relation to stature, and this indicator could be helpful in depicting syndromes with large heads and short stature, providing the existence of some relationship between both measurements in normal children.

OBJECTIVE

The aims of this study were (1) to evaluate the existence of a relationship between head circumference (HC), height and weight, (2) to build an instrument for evaluating it and validate its clinical utility.

SUBJECTS AND METHODS

Relationship between HC, height and weight was explored in a national sample of 3571 healthy, well nourished boys and girls aged 0-5.99 years. Age-adjusted correlation coefficients calculated were: HC and height, 0.30; HC and weight, 0.37; and height and weight, 0.60. A growth standard of HC to height ratio was constructed using the LMS method with both sexes pooled, and selected centiles and SD scores of HC to height ratio for each age were estimated. Z-scores of HC for age, and HC to height ratio were calculated for 13 children with hypochondroplasia, and 90 with achondroplasia, both conditions associated with macrocephaly.

RESULTS

Only four children with hypochondroplasia had HC for age above 2.00 SD, whereas all of them showed SD scores above 2.00 when the HC to height ratio was evaluated. Results suggest that the prepared standard may be of clinical utility.

CONCLUSIONS

A new standard is proposed, capable of pinpointing children with relative macrocephaly.

Growth in post-viral chronic lung disease

INTRODUCTION

Acute lower respiratory infection due to adenovirus is an important cause of chronic lung disease (CLD) in infants. The objectives of this paper is to describe growth in the height and weight of children with post-viral chronic lung disease (PVCLD) and to relate it with associated variables (invasive mechanical ventilation, chronic hypercapnia, oxygen therapy at home and steroid treatment).

MATERIALS AND METHODS

Ninety-nine patients with diagnosis of PVCLD with one or more years of follow-up were included in the study. The median duration of follow-up was 3.10 years. The median age at onset of the disease was 0.50 years.

RESULTS

According to the growth in height, there were 48 children with normal growth (Type A) and 50 with slow growth (Type B) followed by catch-up growth (N=45) or normal growth velocity (N=5); only one patient showed persistent slow growth. Chronic hypercapnia was a risk factor significantly associated to slow growth, with odds ratio, OR: 5.03; and 95% confidence interval, CI: 1.83/13.83. Patients with higher weight for height at the end of the slow-growth period showed greater gains in height during the following period (r=0.46).

CONCLUSION

Growth in children with PVCLD is heterogeneous but, in the majority of individual cases, it can be considered satisfactory. Chronic hypercapnia was associated with slow growth.

Mortality risk score in liver transplantation: changes over time in its predicting power

Since the onset of our liver transplantation program in 1992, 362 transplants were performed in 338 children. A risk score for predicting mortality was designed and implemented over time. The description of a method utilized to design the risk score, changes in mortality rate over 12 yr and the analysis of factors that might have influenced these changes are presented and discussed in this paper.

PATIENTS AND METHODS

Cox regression analysis was applied to a retrospective sample of 110 patients with liver cirrhosis, transplanted between 1992 and 2000. A risk score was prepared using beta coefficients of the two significant variables related to survival time: age (1.08, p=0.02) and bilirubin levels (0.93, p=0.03), and two groups were identified: low- and high-risk score. The score was applied in two consecutive samples: 2000-2002 and 2002-2004.

RESULTS

In the first sample (1992-2000), we found 69 and 41 as low- and high-risk patients, with a median survival time of 93.13 and 2.93 months (p=0.0001). In the 2000-2002 sample, a median survival time of 41.7 and 2.33 months (p=0.03) was found for low- and high-risk groups, respectively. In the third sample (2002-2004), there was a remarkable decrease in mortality in the high-risk group (n=29) and the score did not discriminate between high- and low-risk groups (p=0.35).

CONCLUSION

A scoring system to identify risk levels in liver transplantation patients is an operative and powerful tool during a given period of time but it has to be updated as risk factors will vary following the team's learning curve.