Effectiveness of the International Symbol of Access and inclusivity of other disability groups.

BACKGROUND: The International Symbol of Access (ISA) is recognized world-wide for designating and identifying areas which are wheelchair accessible, however its meaning has evolved to include both restricted use and universal accessibility. OBJECTIVE: This study seeks to investigate the effectiveness of the ISA in representing individuals of all impairment types. METHODS: A mixed-method survey was disseminated in the U.S. and internationally to persons without self-identified impairment and individuals of various impairment group types, including mobility, vision, hearing, and cognitive impairments, using convenience sampling (n = 981). Quantitative data was analyzed using ranking patterns and regression analysis. Qualitative data was analyzed using thematic analysis and triangulation. RESULTS: Participants with self-identified mobility impairments rated the ISA more favorably than other disability groups (p = 0.002). In addition, there is a significant correlation between age and effectiveness of the ISA, with participants rating the symbol more favorably as age increases. Common themes included association of the ISA with a mobility impairment, implications for restricted use or reserved space, and physical accessibility. CONCLUSIONS: The ISA is not effective in representing individuals with non-mobility impairments and its ambiguous nature leads to confusion for both persons with and without impairment.

Effect of surgeon experience and bony pelvic dimensions on surgical performance and patient outcomes in robot-assisted radical prostatectomy.

OBJECTIVES: To evaluate the effects of surgeon experience, body habitus, and bony pelvic dimensions on surgeon performance and patient outcomes after robot-assisted radical prostatectomy (RARP). PATIENTS, SUBJECTS AND METHODS: The pelvic dimensions of 78 RARP patients were measured on preoperative magnetic resonance imaging and computed tomography by three radiologists. Surgeon automated performance metrics (APMs [instrument motion tracking and system events data, i.e., camera movement, third-arm swap, energy use]) were obtained by a systems data recorder (Intuitive Surgical, Sunnyvale, CA, USA) during RARP. Two analyses were performed: Analysis 1, examined effects of patient characteristics, pelvic dimensions and prior surgeon RARP caseload on APMs using linear regression; Analysis 2, the effects of patient body habitus, bony pelvic measurement, and surgeon experience on short- and long-term outcomes were analysed by multivariable regression. RESULTS: Analysis 1 showed that while surgeon experience affected the greatest number of APMs (P < 0.044), the patient's body mass index, bony pelvic dimensions, and prostate size also affected APMs during each surgical step (P < 0.043, P < 0.046, P < 0.034, respectively). Analysis 2 showed that RARP duration was significantly affected by pelvic depth (ß = 13.7, P = 0.039) and prostate volume (ß = 0.5, P = 0.024). A wider and shallower pelvis was less likely to result in a positive margin (odds ratio 0.25, 95% confidence interval [CI] 0.09-0.72). On multivariate analysis, urinary continence recovery was associated with surgeon's prior RARP experience (hazard ratio [HR] 2.38, 95% CI 1.18-4.81; P = 0.015), but not on pelvic dimensions (HR 1.44, 95% CI 0.95-2.17). CONCLUSION: Limited surgical workspace, due to a narrower and deeper pelvis, does affect surgeon performance and patient outcomes, most notably in longer surgery time and an increased positive margin rate.

Energy Expenditure and Enjoyment During Active Video Gaming Using an Adapted Wii Fit Balance Board in Adults with Physical Disabilities: Observational Study.

BACKGROUND: Individuals with physical disabilities have fewer opportunities to participate in enjoyable physical activity. One option for increasing physical activity is playing active video games (AVGs); however, many AVGs are inaccessible or offer limited play options. OBJECTIVE: This study aimed to examine energy expenditure and enjoyment in adults with mobility impairment during AVG play using off-the-shelf (OTS) and adapted versions of the Wii Fit balance board (Nintendo). METHODS: During visit 1, participants completed a functional assessment and the familiarization period. During visit 2, metabolic data were collected during a 20-minute baseline and four 10-minute bouts of Wii Fit Plus game play, with two bouts on each of the boards. During the resting period, participants completed the Physical Activity Enjoyment Scale (PACES). Statistical analyses were computed using SPSS software. Data were analyzed separately for individuals who were able to play while standing on both boards (StdStd); those who could not play while standing on the OTS board, but were able to play while standing on the adapted board (aStd); and those who could only play while sitting on the adapted board (aSit). RESULTS: Data were collected for 58 participants (StdStd, n=17; aStd, n=10; aSit, n=31). The sample included 31 men and 27 women with a mean age of 41.21 (SD 12.70) years. Energy expenditure (metabolic equivalent [MET]) during game play was significantly greater than that during rest for all players. Only 17 participants (StdStd group) were able to play using the OTS board. During game play on the adapted board, the average MET values for the two game sets were 2.261 (SD 0.718) kcal/kg/hour and 2.233 (SD 0.751) kcal/kg/hour for the aSit group, 3.151 (SD 1.034) and 2.990 (SD 1.121) for the aStd group, and 2.732 (SD 0.655) and 2.777 (SD 0.803) for the StdStd group. For game play on the adapted board, self-reported ratings of perceived exertion on a 0-10 scale suggested greater exercise intensity levels, with median scores ranging from moderate (3) to very hard (7). The PACES scores indicated that all players enjoyed using the adapted board, with a median score of 4 on a 5-point scale. CONCLUSIONS: The adapted Wii Fit balance board provided an opportunity for individuals with mobility impairments, including wheelchair users, to engage in AVG. All participants were able to utilize the adapted controller and enjoyed the AVG activity. Although the average MET values achieved during AVG represented light-intensity exercise (<3 METs), 16% of sitting participants and 41% of standing participants achieved moderate-intensity exercise (3-6 METs) in at least one of the games. Factors not accounted for, which may have influenced the intensity of exercise, include game selection, limited familiarization period, and discomfort wearing the COSMED portable metabolic system for measurement of oxygen consumption. Accessible AVG controllers offer an innovative approach to overcome various barriers to participation in physical activity. The next steps include assessment of an AVG intervention using an adapted board gaming controller on health and fitness outcomes. TRIAL REGISTRATION: ClinicalTrials.gov NCT02994199; https://clinicaltrials.gov/ct2/show/NCT02994199 (Archived by Webcite at http://www.webcitation.org/75fc0mN39).

Examining perceptions of existing and newly created accessibility symbols.

BACKGROUND: Symbols are used to convey messages in a clear, understandable manner, without the use of written language. The most widely recognized symbol used to denote access for persons with disabilities is the International Symbol of Access. This symbol has been criticized for its inadequate representation of disability diversity poorly representing universal design of space and products. OBJECTIVE: This descriptive study explored individual comprehension and perceptions of nine existing and newly created accessibility pictograph symbols and identified one that represented universal access to fitness equipment. METHODS: A survey was disseminated electronically and face-to-face to individuals, groups and organizations affiliated with inclusive fitness equipment, space and programming. Quantitative data was analyzed for descriptive statistics, rank order of symbols and group comparisons of rankings. Thematic analysis of open-ended question results revealed themes to enhance understanding of symbol rank order. RESULTS: 981 participants completed the survey. Symbol four, shaped as a Venn diagram containing three icons representing individuals with varying ability levels, was ranked highest with no significant differences in group comparisons between participants with and without a disability and U.S. residents versus non-U.S. residents. 85.4% of participants demonstrated accurate comprehension of this symbol. Though symbol five had the same symbol rank median value, this symbol's distribution of scores was lower. CONCLUSIONS: Participants accurately comprehended symbol four and it was identified as the highest ranked symbol representing universal access to fitness equipment. Because of symbol unfamiliarity, adoption will require education and consistency of use and placement.

Effects of Styrene-Acrylic Sizing on the Mechanical Properties of Carbon Fiber Thermoplastic Towpregs and Their Composites.

Thermoplastic towpregs are convenient and scalable raw materials for the fabrication of continuous fiber-reinforced thermoplastic matrix composites. In this paper, the potential to employ epoxy and styrene-acrylic sizing agents was evaluated for the making of carbon fiber thermoplastic towpregs via a powder-coating method. The protective effects and thermal stability of these sizing agents were investigated by single fiber tensile test and differential scanning calorimetry (DSC) measurement. The results indicate that the epoxy sizing agent provides better protection to carbon fibers, but it cannot be used for thermoplastic towpreg processing due to its poor chemical stability at high temperature. The bending rigidity of the tows and towpregs with two styrene-acrylic sizing agents was measured by cantilever and Kawabata methods. The styrene-acrylic sized towpregs show low torque values, and are suitable for further processing, such as weaving, preforming, and winding. Finally, composite panels were fabricated directly from the towpregs by hot compression molding. Both of the composite panels show superior flexural strength (>400 MPa), flexural modulus (>63 GPa), and interlaminar shear strength (>27 MPa), indicating the applicability of these two styrene-acrylic sizing agents for carbon fiber thermoplastic towpregs.

Methods for managing and analyzing electronic medical records: a formative examination of a hospital-congregation-based intervention.

Electronic medical records (EMRs) can be a valuable tool in evaluating interventions involving faith-based institutions. Working with EMRs is complex. Methodological designs that can be used by public health and health administrators to assess the effectiveness of interventions are lacking. The study team conducted a formative evaluation of the Congregational Health Network (CHN) using propensity matching and Cox proportional hazard models to examine health outcomes and readmission rates. Along with CHN's relevance in addressing the needs of the most vulnerable population, factors are discussed that must be taken into consideration when designing such methodologies as well as limitations that merit attention from public health researchers and hospital administrators interested in conducting a formative evaluation using existing data to track the effectiveness of an intervention.