Remote laboratory access for students with vision impairment

The delivery of laboratory exercises to students that are unable to attend in person due to physical disabilities is a significant issue. Both Netlab and Packet Tracer are inaccessible to many students who use assistive technology, perticularly those with vision impairment. This paper presents the development of an accessible, cost effective, remote laboratory and describes the modification to laboratory sessions necessary for the blind to undertake CCNA laboratory sessions remotely and with full accessibility. Also discussed is the development of an accessible network simulator, iNetSim, illustrating possible methodologies that may be applied to make existing simulation packages accessible to those with severe vision impairment

Evaluating Cisco e-learning courses modified for the vision impaired

The needs of vision impaired students are quite different to sighted students. The increasing use of e-learning means higher education must move to multi-modal user interfaces in order to make e-learning materials accessible to all students. E-Learning materials (particularly in the sciences and technology) are predominantly visual, presented via computer keyboard and screen. Software and devices designed to aid the visin impaired are unable to decipher most images and visual-centric objects contained in e-learning materials.This paper discusses a project undertaken over the past two years to modify the content and presentation of Cisco certification e-learning courses to enable accessibility by vision impaired and blind students. These modifications necessitated rewriting the learning materials so they could be effectively presented via multi-modal user interfaces to vision impaired students, involving speech, aufio, haptics and force-feed devices and methods.Evaluatin of sections of the project by the vision impaired students using a model based upon Stufflebeam's CIPP model and Kirkpatrick's Four-Level training program evaluation model has been carried out and the results are presented

E-learning for the vision impaired: a holistic perspective

Problems faced by vision impaired students are different from those experienced by sighted students. Most e-learning environments are designed for sighted students, utilizing complex visual images and interactive features; however students with acute vision impairments are not able to utilize these features and must rely on applications to translate the contents of screen displays and documents into forms that are accessible. Learning environments for people with physical disabilities need specific considerations in design and implementation to ensure their appropriateness and accessibility. This paper initially discusses specific problems faced by students with acute vision impairments and how e-learning environments need to address these problems in order for the student to achieve the same learning outcomes as sighted students. A brief outline of the research method is followed by a description of the holistic model proposed for accessible e-learning environment design

Exploring a physiotherapy well-being review to deliver community-based rehabilitation in patients with pulmonary hypertension

Background: Highly structured, supervised exercise training has been shown to be beneficial in patients with pulmonary hypertension. Despite evidence of the effectiveness of community-based rehabilitation in other cardiopulmonary diseases there are limited data in patients with pulmonary hypertension. Methods: This prospective study evaluated the intervention of a physiotherapist well-being review in patients with pulmonary hypertension who had been established on targeted drug therapy for between 3 and 12 months. The intervention included a detailed consultation assessing functional, social and motivational status to identify individual patient rehabilitation goals and facilitate tailored referrals to community-based services. Results: One hundred and thirty eight patients (79% pulmonary arterial hypertension, 17% chronic thromboembolic disease), age 67±14 years, diagnosed over a one year period were evaluated between July 2017 and January 2018. Fifty-two percent of patients were referred to community-based pulmonary rehabilitation programmes, 19% received other forms of community rehabilitation, 17% were given exercise advice, 5% had an assessment of social support and 7% declined any intervention. At the end of the study 32% of patients were undertaking independent exercise. Conclusion: This study has identified that the majority of patients with pulmonary hypertension who are optimised on targeted drug therapy have rehabilitation needs. The use of a physiotherapy well-being review can identify this need and facilitate access to community-based rehabilitation. Further research is required to evaluate the efficacy of such interventions in pulmonary hypertension

Caribou conservation and recovery in Ontario: development and implementation of the Caribou Conservation Plan

The range of Ontario’s woodland caribou (Rangifer tarandus caribou) (forest-dwelling ecotype) has receded northward substantially over many decades, leading to its current Threatened designation. Ontario released its Caribou Conservation Plan (CCP) in the fall of 2009. This policy responded to public input and recommendations from the Ontario Woodland Caribou Recovery Team and the Caribou Science Review Panel, and outlines conservation and recovery actions to conserve and recover caribou. Within an adaptive management framework, the CCP builds upon a recent history of managing at large landscape scales in Ontario to implement a range management approach as the basis for recovery actions. These commitments and actions include enhanced research and monitoring, improved caribou habitat planning at the landscape scale, an integrated range analysis approach using advanced assessment tools to evaluate thresholds of habitat amount, arrangement and disturbance, the assessment of probability of persistence, consideration of cumulative effects, meeting forest management silvicultural performance requirements, consideration of caribou recovery implications when managing other wildlife, an initial focus on the southern edge of caribou distribution where threats are most significant, improved outreach and stewardship, and consideration of Aboriginal Traditional Knowledge in recovery actions. Implementation of the CCP signifies a long-term provincial commitment to caribou recovery, initially focusing on identified priorities within the CCP

A systematic review of psychological interventions in adults with pulmonary hypertension: Is the evidence-base disproportionate to the problem?

Introduction: Our understanding of the psychological impact of living with pulmonary hypertension (PH) is growing, particularly for how anxiety and depression present in this group. There is evidence for the use of psychological interventions in other chronic lung conditions; however, trials focusing on adults with PH have yet to be subject to a systematic review. Methods: We systematically searched four databases for evidence examining the effectiveness of psychological interventions for adults with PH. A narrative approach has been used to present findings. Results: Overall, 186 unique articles were identified of which four were suitable. Data was gathered from 143 individuals. Cognitive behavioural therapy (CBT), metacognitive therapy (MCT) or counselling were investigated. All three studies reported a significant reduction in anxiety and depression, and some secondary outcomes were also associated with change. Discussion: The evidence supporting the use of psychological therapies for adults with PH is promising, although limited. There is an urgent need for more research in this area to better understand how we can support this clinical group

Towards new recommendations to reduce the burden of alcohol-induced hypertension in the European Union

Background Hazardous and harmful alcohol use and high blood pressure are central risk factors related to premature non-communicable disease (NCD) mortality worldwide. A reduction in the prevalence of both risk factors has been suggested as a route to reach the global NCD targets. This study aims to highlight that screening and interventions for hypertension and hazardous and harmful alcohol use in primary healthcare can contribute substantially to achieving the NCD targets. Methods A consensus conference based on systematic reviews, meta-analyses, clinical guidelines, experimental studies, and statistical modelling which had been presented and discussed in five preparatory meetings, was undertaken. Specifically, we modelled changes in blood pressure distributions and potential lives saved for the five largest European countries if screening and appropriate intervention rates in primary healthcare settings were increased. Recommendations to handle alcohol-induced hypertension in primary healthcare settings were derived at the conference, and their degree of evidence was graded. Results Screening and appropriate interventions for hazardous alcohol use and use disorders could lower blood pressure levels, but there is a lack in implementing these measures in European primary healthcare. Recommendations included (1) an increase in screening for hypertension (evidence grade: high), (2) an increase in screening and brief advice on hazardous and harmful drinking for people with newly detected hypertension by physicians, nurses, and other healthcare professionals (evidence grade: high), (3) the conduct of clinical management of less severe alcohol use disorders for incident people with hypertension in primary healthcare (evidence grade: moderate), and (4) screening for alcohol use in hypertension that is not well controlled (evidence grade: moderate). The first three measures were estimated to result in a decreased hypertension prevalence and hundreds of saved lives annually in the examined countries. Conclusions The implementation of the outlined recommendations could contribute to reducing the burden associated with hypertension and hazardous and harmful alcohol use and thus to achievement of the NCD targets. Implementation should be conducted in controlled settings with evaluation, including, but not limited to, economic evaluation

Femoral Nerve Block Intervention in Neck of Femur Fracture (FINOF): a randomized controlled trial

Objective Fractured neck of femur is a severely painful condition with significant mortality and morbidity. We investigated whether early and continuous use of femoral nerve block can improve pain on movement and mobility after surgery in older participants with fragility neck of femur fracture. Design Prospective single centre, randomised controlled pragmatic trial. Setting Secondary care, acute NHS Trust, UK. Participants Participants admitted with a history and examination suggesting fractured neck of femur. Intervention Immediate continuous femoral nerve block via catheter or standard analgesia. Results One hundred and forty one participants were recruited, with 23 excluded. No significant difference was detected between cumulative dynamic pain scores (standard care (n = 56) vs 4 intervention (n = 55) 20 (IQR 15-24) vs 20 (15-23) p=0.51) or cumulated ambulation scores (standard care vs intervention 6 (5-9) vs 7 (5-10) p=0.76). There were no statistically different differences in secondary outcomes except cumulative pain at rest: 5 (0.5-6.5) in the standard care group and 2 (0-5) in the intervention group (p=0.043). Conclusions Early application of continuous femoral nerve block compared with standard systemic analgesia did not result in improved dynamic pain scores or superior post-operative ambulation. This technique may provide superior pain relief at rest. Continuous femoral nerve block did not delay initial control of pain, or mobilisation after surgery