Promoting oral health in adults with learning disability

Introduction: It is complex to define learning disabilities, there is no single universal definition used; there are different interpretations and definitions used for learning disabilities in different countries and communities. Primarily, the term “learning disability” sometimes used as “learning difficulties” is a term widely used in UK. There are various types and degree of severity of learning disabilities depending upon the extent of disorder. Though different definitions used all over the world, its types and classification coupled with their health and oral health needs are discussed in this review. Objectives:  To review the background literature on definitions of learning disabilities and health needs of this population.  To review literature on individual clinical preventive intervention to determine the effectiveness in promoting oral health amongst adults in learning disabilities.  To review literature in relation to community based preventive dental measures.  To determine the interventions in this areas are appropriate to support policy and practice and if these interventions establish good evidence to suggest that the oral health needs of adults with learning disabilities are met or not.  To make recommendations in implementing future preventive oral health interventions for adults with learning disabilities. Methodology: It was develop a comprehensive narrative synthesis of previously published literature from different sources and summarizes the whole research in a particular area identifying gap of knowledge. It provides a broad perspective of a subject and supports continuing education. It also is directed to inform policy and further research. It is a qualitative type of research with a broad question and critical analysis of literature published in books, article and journals. The research question evaluated on PICOS criteria is: Effectiveness of preventive dental interventions in adults with learning disabilities. The research question clearly defines the PICOS i.e. participants, interventions, comparison, outcome and study design. The Cochrane database of systematic reviews (CDSR), Database of Abstracts of Reviews of effects (DARE) through York University and National institute of Health and Clinical Excellence (NICE) was searched to identify need of this review. There was no literature review found on the preventive dental interventions found hence, justifying this review. The guidance used in this review is from York University and methods opted for search of literature is based on the following: Type of participants, interventions, outcome measure, studies and search. The review of literature; author search; systematic and narrative reviews, through the following electronic databases via UFP library services: Pub-Med, Medline, EMBASE, CINHAL, Google scholar; Science Direct; Social and Medicine. A comprehensive search of all available literature from 1990-2015, including systematic reviews, policy documents and some guideline documents was done. Internet resource used to access; Department of Health, World Health Organization, Disability World, Disability Rights Commission, the Stationery office, MENCAP, Australian Learning Disability Association. The literature search was carried out with single word, combined words and phrases, authors' names and the title of literature search. Results: It is primarily looking at the oral health interventions available for adults with learning disabilities in clinical settings and the community measures observed over a period of 25 years 1990-2015. There were 7of the clinical intervention studies and one community based intervention study was added in this review. Conclusion: There is a gap of knowledge identified in not having ample research in the area of preventive dental interventions in adults with learning or intellectual disabilities and there is a need of more research, studies need to be of a better quality and a special consideration is required in the community settings where maintenance of oral hygiene for this vulnerable group of society is hugely dependent on their caregivers. Though, the policy and guideline directs on the preventive dental interventions of adults with LD there still a gap evident in understanding and implication of the guidance in practice by the dental and care support team. Understanding learning disabilities and to identify their behavior, compliance and oral health needs is paramount for all professionals working with or for them at each level.

Fallbasiertes E-Learning durch dynamische Verknüpfung von Fallstudien und Fachinhalten. Neue Diskussionsansätze zu einem vernachlässigten Konzept

Der Einsatz von Fallstudien kann als wichtiges Bindeglied zur Verknüpfung von Theorie und Praxis betrachtet werden. Fallstudien ermöglichen die Anwendung theoretischen Grundlagenwissens und die Entwicklung überfachlicher Kompetenzen. Damit können sie einen wichtigen Beitrag zur beruflichen Handlungskompetenz genau dort leisten, wo praktische Erfahrungen im Rahmen der Aus-und Weiterbildung nicht möglich sind. Der Einsatz von Fallstudien sollte aus diesem Grund nicht nur den „klassischen“ Anwendungsdisziplinen wie den Rechtswissenschaften, der Betriebswirtschaftslehre oder der Psychologie vorbehalten sein. Auch im Bereich der Informatik können sie eine wichtige Ergänzung zu den bisher eingesetzten Methoden darstellen. Das im Kontext des Projekts New Economy1 entwickelte und hier vorgestellte Konzept zur didaktischen und technischen Aufbereitung von Fallstudien am Beispiel der IT-Aus- und Weiterbildung soll diese Diskussion anregen. Mit Hilfe des vorgestellten Ansatzes ist es möglich, unterschiedliche methodische Zugänge zu einer Fallstudie für eine computerbasierte Präsentation automatisch zu generieren und mit fachlichen Inhalten zu verknüpfen. Damit ist ein entscheidender Mehrwert gegenüber den bisherigen statischen und in sich geschlossenen Darstellungen gegeben. Der damit zu erreichende Qualitätssprung im Einsatz von Fallstudien in der universitären und betrieblichen Aus- und Weiterbildung stellt einen wichtigen Beitrag zur praxisorientierten Gestaltung von Blended Learning-Ansätzen dar.(DIPF/Orig.)

A 1.77 Mb deletion in 3p26.3 encompassing CNTN6 and CNTN4 genes: case report

Chromosome microarray analysis is a powerful diagnostic tool and is being used as a first-line approach to detect chromosome imbalances associated with intellectual disability, dysmorphic features and congenital abnormalities. This test enables the identification of new copy number variants (CNVs) and their association with new microdeletion/microduplication syndromes in patients previously without diagnosis. We report the case of a 7 year-old female with moderate intellectual disability, severe speech delay and auto and hetero aggressivity with a previous 45,XX,der(13;14)mat karyotype performed at a younger age. Affymetrix CytoScan 750K chromosome microarray analysis was performed detecting a 1.77 Mb deletion at 3p26.3, encompassing 2 OMIM genes, CNTN6 and CNTN4. These genes play an important role in the formation, maintenance, and plasticity of functional neuronal networks. Deletions or mutations in CNTN4 gene have been implicated in intellectual disability and learning disabilities. Disruptions or deletions in the CNTN6 gene have been associated with development delay and other neurodevelopmental disorders. The haploinsufficiency of these genes has been suggested to participate to the typical clinical features of 3p deletion syndrome. Nevertheless inheritance from a healthy parent has been reported, suggesting incomplete penetrance and variable phenotype for this CNV. We compare our patient with other similar reported cases, adding additional value to the phenotype-genotype correlation of deletions in this region.

Relatório de estágio : Centro de Apoio ao Desenvolvimento Infantil, CADIn

O presente relatório descreve a prática profissional desenvolvida no Centro de Apoio ao Desenvolvimento Infantil (CADIn), no âmbito do Ramo de Aprofundamento de Competências Profissionais (RACP), enquadrado no 2º Ano do 2º Ciclo de Reabilitação Psicomotora, correspondente ao ano letivo 2014/2015. O trabalho desenvolvido no CADIn foi realizado, principalmente, junto de crianças e jovens com Dificuldades de Aprendizagem Específicas (DAE). As DAE, de origem neurobiológica e intrínsecas ao indivíduo, caracterizam-se por um conjunto de traços heterogéneos que se manifestam na aquisição e uso das competências auditivas, da fala, da leitura, da escrita, do raciocínio e/ou matemáticas. Podem coexistir com outras perturbações, como é o caso da Perturbação de Hiperatividade e Défice de Atenção (PHDA). A heterogeneidade dos perfis de aprendizagem de crianças com DAE torna o processo de intervenção um desafio permanente. Neste sentido, a intervenção psicomotora surge como uma resposta que permite o desenvolvimento holístico do indivíduo, viabilizando a apropriação dos processos simbólicos. O relatório está organizado em Enquadramento da Prática Profissional, que inclui o Enquadramento Teórico e o Enquadramento Institucional, e Realização da Prática Profissional, onde são abordados dois estudos de caso, de uma forma mais detalhada.

Disabling and Enabling Technologies for Learning in Higher Education for All : Issues and Challenges for Whom?

Integration, inclusion, and equity constitute fundamental dimensions of democracy in post-World War II societies and their institutions. The study presented here reports upon the ways in which individuals and institutions both use and account for the roles that technologies, including ICT, play in disabling and enabling access for learning in higher education for all. Technological innovations during the 20th and 21st centuries, including ICT, have been heralded as holding significant promise for revolutionizing issues of access in societal institutions like schools, healthcare services, etc. (at least in the global North). Taking a socially oriented perspective, the study presented in this paper focuses on an ethnographically framed analysis of two datasets that critically explores the role that technologies, including ICT, play in higher education for individuals who are “differently abled” and who constitute a variation on a continuum of capabilities. Functionality as a dimension of everyday life in higher education in the 21st century is explored through the analysis of (i) case studies of two “differently abled” students in Sweden and (ii) current support services at universities in Sweden. The findings make visible the work that institutions and their members do through analyses of the organization of time and space and the use of technologies in institutional settings against the backdrop of individuals’ accountings and life trajectories. This study also highlights the relevance of multi-scale data analyses for revisiting the ways in which identity positions become framed or understood within higher education.

Machine learning per l'idrologia: applicazione del metodo random forests per la previsione degli eventi di piena fluviale con un approccio probabilistico

Le tecniche di Machine Learning sono molto utili in quanto consento di massimizzare l’utilizzo delle informazioni in tempo reale. Il metodo Random Forests può essere annoverato tra le tecniche di Machine Learning più recenti e performanti. Sfruttando le caratteristiche e le potenzialità di questo metodo, la presente tesi di dottorato affronta due casi di studio differenti; grazie ai quali è stato possibile elaborare due differenti modelli previsionali. Il primo caso di studio si è incentrato sui principali fiumi della regione Emilia-Romagna, caratterizzati da tempi di risposta molto brevi. La scelta di questi fiumi non è stata casuale: negli ultimi anni, infatti, in detti bacini si sono verificati diversi eventi di piena, in gran parte di tipo “flash flood”. Il secondo caso di studio riguarda le sezioni principali del fiume Po, dove il tempo di propagazione dell’onda di piena è maggiore rispetto ai corsi d’acqua del primo caso di studio analizzato. Partendo da una grande quantità di dati, il primo passo è stato selezionare e definire i dati in ingresso in funzione degli obiettivi da raggiungere, per entrambi i casi studio. Per l’elaborazione del modello relativo ai fiumi dell’Emilia-Romagna, sono stati presi in considerazione esclusivamente i dati osservati; a differenza del bacino del fiume Po in cui ai dati osservati sono stati affiancati anche i dati di previsione provenienti dalla catena modellistica Mike11 NAM/HD. Sfruttando una delle principali caratteristiche del metodo Random Forests, è stata stimata una probabilità di accadimento: questo aspetto è fondamentale sia nella fase tecnica che in fase decisionale per qualsiasi attività di intervento di protezione civile. L'elaborazione dei dati e i dati sviluppati sono stati effettuati in ambiente R. Al termine della fase di validazione, gli incoraggianti risultati ottenuti hanno permesso di inserire il modello sviluppato nel primo caso studio all’interno dell’architettura operativa di FEWS.

Integrating Machine Learning Paradigms for Predictive Maintenance in the Fourth Industrial Revolution era

In the last decade, manufacturing companies have been facing two significant challenges. First, digitalization imposes adopting Industry 4.0 technologies and allows creating smart, connected, self-aware, and self-predictive factories. Second, the attention on sustainability imposes to evaluate and reduce the impact of the implemented solutions from economic and social points of view. In manufacturing companies, the maintenance of physical assets assumes a critical role. Increasing the reliability and the availability of production systems leads to the minimization of systems’ downtimes; In addition, the proper system functioning avoids production wastes and potentially catastrophic accidents. Digitalization and new ICT technologies have assumed a relevant role in maintenance strategies. They allow assessing the health condition of machinery at any point in time. Moreover, they allow predicting the future behavior of machinery so that maintenance interventions can be planned, and the useful life of components can be exploited until the time instant before their fault. This dissertation provides insights on Predictive Maintenance goals and tools in Industry 4.0 and proposes a novel data acquisition, processing, sharing, and storage framework that addresses typical issues machine producers and users encounter. The research elaborates on two research questions that narrow down the potential approaches to data acquisition, processing, and analysis for fault diagnostics in evolving environments. The research activity is developed according to a research framework, where the research questions are addressed by research levers that are explored according to research topics. Each topic requires a specific set of methods and approaches; however, the overarching methodological approach presented in this dissertation includes three fundamental aspects: the maximization of the quality level of input data, the use of Machine Learning methods for data analysis, and the use of case studies deriving from both controlled environments (laboratory) and real-world instances.

Applied deep learning and data science with a human-centric and data-centric approach

The term Artificial intelligence acquired a lot of baggage since its introduction and in its current incarnation is synonymous with Deep Learning. The sudden availability of data and computing resources has opened the gates to myriads of applications. Not all are created equal though, and problems might arise especially for fields not closely related to the tasks that pertain tech companies that spearheaded DL. The perspective of practitioners seems to be changing, however. Human-Centric AI emerged in the last few years as a new way of thinking DL and AI applications from the ground up, with a special attention at their relationship with humans. The goal is designing a system that can gracefully integrate in already established workflows, as in many real-world scenarios AI may not be good enough to completely replace its humans. Often this replacement may even be unneeded or undesirable. Another important perspective comes from, Andrew Ng, a DL pioneer, who recently started shifting the focus of development from “better models” towards better, and smaller, data. He defined his approach Data-Centric AI. Without downplaying the importance of pushing the state of the art in DL, we must recognize that if the goal is creating a tool for humans to use, more raw performance may not align with more utility for the final user. A Human-Centric approach is compatible with a Data-Centric one, and we find that the two overlap nicely when human expertise is used as the driving force behind data quality. This thesis documents a series of case-studies where these approaches were employed, to different extents, to guide the design and implementation of intelligent systems. We found human expertise proved crucial in improving datasets and models. The last chapter includes a slight deviation, with studies on the pandemic, still preserving the human and data centric perspective.

Long-term Follow-up Of Patients With 46,xy Partial Gonadal Dysgenesis Reared As Males.

Background/Aims. Studies on 46,XY partial gonadal dysgenesis (PGD) have focused on molecular, gonadal, genital, and hormone features; little is known about follow-up. Our aim was to analyze long-term outcomes of PGD. Methods. Retrospective longitudinal study conducted at a reference service in Brazil. Ten patients were first evaluated in the 1990s and followed up until the 2010s; follow-up ranged from 13.5 to 19.7 years. All were reared as males and had at least one scrotal testis; two bore NR5A1 mutations. Main outcomes were: associated conditions, pubertal development, and growth. Results. All patients had normal motor development but three presented cognitive impairment; five had various associated conditions. At the end of the prepubertal period, FSH was high or high-normal in 3/6 patients; LH was normal in all. At the last evaluation, FSH was high or high-normal in 8/10; LH was high or high-normal in 5/10; testosterone was decreased in one. Final height in nine cases ranged from -1.57 to 0.80 SDS. All had spontaneous puberty; only one needed androgen therapy. Conclusions. There is good prognosis for growth and spontaneous pubertal development but not for fertility. Though additional studies are required, screening for learning disabilities is advisable.

The use of fluorescence in situ hybridization in the diagnosis of hidden mosaicism: apropos of three cases of sex chromosome anomalies

FISH has been used as a complement to classical cytogenetics in the detection of mosaicism in sex chromosome anomalies. The aim of this study is to describe three cases in which the final diagnosis could only be achieved by FISH. Case 1 was an 8-year-old 46,XY girl with normal female genitalia referred to our service because of short stature. FISH analysis of lymphocytes with probes for the X and Y centromeres identified a 45,X/46,X,idic(Y) constitution, and established the diagnosis of Turner syndrome. Case 2 was a 21-month-old 46,XY boy with genital ambiguity (penile hypospadias, right testis, and left streak gonad). FISH analysis of lymphocytes and buccal smear identified a 45,X/46,XY karyotype, leading to diagnosis of mixed gonadal dysgenesis. Case 3 was a 47,XYY 19-year-old boy with delayed neuromotor development, learning disabilities, psychological problems, tall stature, small testes, elevated gonadotropins, and azoospermia. FISH analysis of lymphocytes and buccal smear identified a 47,XYY/48,XXYY constitution. Cases 1 and 2 illustrate the phenotypic variability of the 45,X/46,XY mosaicism, and the importance of detection of the 45,X cell line for proper management and follow-up. In case 3, abnormal gonadal function could be explained by the 48,XXYY cell line. The use of FISH in clinical practice is particularly relevant when classical cytogenetic analysis yields normal or uncertain results in patients with features of sex chromosome aneuploidy. Arq Bras Endocrinol Metab. 2012;56(8):545-51

Proposta educacional on-line sobre úlcera por pressão para alunos e profissionais de enfermagem

OBJETIVOS: Desenvolver uma proposta educacional on-line sobre o tema úlcera por pressão para alunos e profissionais de enfermagem. MÉTODOS: Pesquisa aplicada, de produção tecnológica, composta pelas etapas de concepção/ planejamento e desenvolvimento, caracterizadas por um conjunto de procedimentos, documentação, digitalização de informações e de imagens. Foram utilizados recursos computacionais didáticos interativos como: o Cybertutor e o Homem Virtual. RESULTADOS: Desenvolvimento de uma proposta educacional virtual sobre úlcera por pressão (UP) dividida em módulos de aprendizagem, contendo lista de discussão, estudos de casos e recursos didáticos, tais como fotos e o Homem Virtual. CONCLUSÕES: Utilizou-se de novas tecnologias educacionais, com a finalidade de promover o aprendizado sobre UP a estudantes de graduação de enfermagem e possibilitar a educação continuada de enfermeiros, uma vez que as UP representam um desafio aos profissionais da saúde e aos serviços de saúde.

ALFABETIZAÇÃO DIGITAL: proposição de parâmetros metodológicos em competência informacional

Much has been discussed about Digital Literacy, but it is quite obscure the identification of the skills required to develop such process. This study was done towards an integration of the Digital Literacy process to the specific informational skills a person may dominate, search, retrieve and use information efficiently, in its professional, academic or personal life. The main objective of this work is to propose methodological parameters for training in informational skills. Otherwise, the specific objectives are associated to the supposition and identification of the desired skills of the Digital Literacy program participants. The methodological procedures applied to the research are of exploratory character, and to do so two tools are used: the literature research and case studies. Besides having the methodology in structured information competence, the study points out to the fact that the country is too far from what is desired concerning development and employment of Digital Literacy programs consistent enough to support the teaching and learning of searching, recovering and using of information by the participants. Therefore, it is essential to create programs that provide not only machinery, but motivate individuals to develop informational skills to help in the learning process.

Healthy ageing - Adults with intellectual disabilities: Physical health issues

This report has been prepared by the Ageing Special Interest Research Group of the International Association for the Scientific Study of Intellectual Disabilities (IASSID) in collaboration with the Department of Mental Health and Substance Dependence and the Programme on Ageing and Health, World Health Organization (WHO), Geneva, Switzerland, and all rights are reserved by the above mentioned organization. The document may, however, be freely reviewed, abstracted, reproduced or translated in part, but not for sale or use in conjunction with commercial purposes. It may also be reproduced in full by non-commercial entities for information or for educational purposes with prior permission from WHO/IASSID. The document is likely to be available in other languages also.

Advances in application of climate prediction in agriculture

Agricultural ecosystems and their associated business and government systems are diverse and varied. They range from farms, to input supply businesses, to marketing and government policy systems, among others. These systems are dynamic and responsive to fluctuations in climate. Skill in climate prediction offers considerable opportunities to managers via its potential to realise system improvements (i.e. increased food production and profit and/or reduced risks). Realising these opportunities, however, is not straightforward as the forecasting skill is imperfect and approaches to applying the existing skill to management issues have not been developed and tested extensively. While there has been much written about impacts of climate variability, there has been relatively little done in relation to applying knowledge of climate predictions to modify actions ahead of likely impacts. However, a considerable body of effort in various parts of the world is now being focused on this issue of applying climate predictions to improve agricultural systems. In this paper, we outline the basis for climate prediction, with emphasis on the El Nino-Southern Oscillation phenomenon, and catalogue experiences at field, national and global scales in applying climate predictions to agriculture. These diverse experiences are synthesised to derive general lessons about approaches to applying climate prediction in agriculture. The case studies have been selected to represent a diversity of agricultural systems and scales of operation. They also represent the on-going activities of some of the key research and development groups in this field around the world. The case studies include applications at field/farm scale to dryland cropping systems in Australia, Zimbabwe, and Argentina. This spectrum covers resource-rich and resource-poor farming with motivations ranging from profit to food security. At national and global scale we consider possible applications of climate prediction in commodity forecasting (wheat in Australia) and examine implications on global wheat trade and price associated with global consequences of climate prediction. In cataloguing these experiences we note some general lessons. Foremost is the value of an interdisciplinary systems approach in connecting disciplinary Knowledge in a manner most suited to decision-makers. This approach often includes scenario analysis based oil simulation with credible models as a key aspect of the learning process. Interaction among researchers, analysts and decision-makers is vital in the development of effective applications all of the players learn. Issues associated with balance between information demand and supply as well as appreciation of awareness limitations of decision-makers, analysts, and scientists are highlighted. It is argued that understanding and communicating decision risks is one of the keys to successful applications of climate prediction. We consider that advances of the future will be made by better connecting agricultural scientists and practitioners with the science of climate prediction. Professions involved in decision making must take a proactive role in the development of climate forecasts if the design and use of climate predictions are to reach their full potential. (C) 2001 Elsevier Science Ltd. All rights reserved.

Information internalisation in internationalising the firm

Internationalisation occurs when the firm expands its selling, production, or other business activities into international markets. Many enterprises, especially small- and medium-size firms (SMEs), are internationalising today at an unprecedented rate. Managers are strategically using information to achieve degrees of internationalisation previously considered the domain of large firms. We extend existing explanations of firm internationalisation by examining the nature and fundamental, antecedent role of internalising appropriate information and translating it into relevant knowledge. Based on case studies of internationalising firms, we advance a conceptualisation of information internalisation and knowledge creation within the firm as it achieves internationalisation readiness. In the process, we offer several propositions intended to guide future research. (C) 2002 Elsevier Science Inc. All rights reserved.