Constructing an Inclusive Web Design Checklist for Health-Related Sites for Older Adults with Complex Chronic Disease

Health-related sites are not optimally usable by older adults(aged 50 and over) who live with complex chronic disease (CCD) because most sites do not deliver online information with these users in mind. While the current literature explains how to design Web sites for older adults, it lacks guidance in how to design Web sites for older adults with CCD that have diverse abilities. My research examined the Web design features that provide this user population a better Web experience. This research paper started with the synthesis of current checklists that target older adult Web users and findings from an empirical study of the online experiences of older adults living with CCD. The results led to the construction of a checklist of inclusive Web design features that support designers in creating more usable and accessible health-related sites. The final Inclusive Web Design Checklist is comprised of 16 categories and 55 criteria

Making it personal: Understanding the online learning experience to enable design of an inclusive, integrated e-learning solution for students

Despite the availability of online learning applications and management systems used to deliver, house and organize e-learning content, students learning online continue to struggle with barriers that create an unnecessary disconnect between themselves and their peers, professors, the learning material and their parents (where applicable). Barriers personally experienced through participation in a synchronous online university-level graduate class, and documented barriers experienced by other students in similar distance learning environments, served as the primary narrative and driving incentive for this study. In addition to an extensive literature review, an in-depth study of a distance learning environment was conducted using an adaptation of Smart Design�s 6 Real People approach which included 5 persona�s, based on 5 real participants; a high school special needs class, a Masters of Inclusive Design Class, the Director of Education for Special Needs, A University Professor of Distance Learning, and a Visually Impaired User (Blind Participant). The users� experiences were documented through means of ethnographic observations, direct observations, and detailed interviews. Findings from these revealed many barriers and disruptions, including psychological, emotional, social, gender-related, environmental and cultural issues that were detrimental to class involvement and student success. These findings were then synthesized and applied to create a prototype, called inClass, developed to address these barriers and provide a model for a more cohesive, unified and accessible e-learning solution. Although this paper does not refer directly to design patterns, and does not claim to follow a pattern-based methodology it demonstrates some effective user-centred design techniques which pattern scouts and authors should consider as powerful tools for mining, elaborating and validating patterns

Quantifying Lipid Contents in Enveloped Virus Particles with Plasmonic Nanoparticles

Phosphatidylserine (PS) and monosialotetrahexosylganglioside (GM1) are examples of two host-derived lipids in the membrane of enveloped virus particles that are known to contribute to virus attachment, uptake, and ultimately dissemination. A quantitative characterization of their contribution to the functionality of the virus requires information about their relative concentrations in the viral membrane. Here, a gold nanoparticle (NP) binding assay for probing relative PS and GM1 lipid concentrations in the outer leaflet of different HIV-1 and Ebola virus-like particles (VLPs) using sample sizes of less than 3 × 106 particles is introduced. The assay evaluates both scattering intensity and resonance wavelength, and determines relative NP densities through plasmon coupling as a measure for the target lipid concentrations in the NP-labeled VLP membrane. A correlation of the optical observables with absolute lipid contents is achieved by calibration of the plasmon coupling-based methodology with unilamellar liposomes of known PS or GM1 concentration. The performed studies reveal significant differences in the membrane of VLPs that assemble at different intracellular sites and pave the way to an optical quantification of lipid concentration in virus particles at physiological titers.NIH grants RO1CA138509 (B.M.R.), RO1A1064099 (S. G., and 1R56Al104393 (B.M.R. and S. G.; Ethan Edmonds support (CHE 1156666

Management of covert brain infarction survey: A call to care for and trial this neglected population

BACKGROUND Covert brain infarction (CBI) is highly prevalent and linked with stroke risk factors, increased mortality, and morbidity. Evidence to guide management is sparse. We sought to gain information on current practice and attitudes toward CBI and to compare differences in management according to CBI phenotype. METHODS We conducted a web-based, structured, international survey from November 2021 to February 2022 among neurologists and neuroradiologists. The survey captured respondents' baseline characteristics, general approach toward CBI and included two case scenarios designed to evaluate management decisions taken upon incidental detection of an embolic-phenotype and a small-vessel-disease phenotype. RESULTS Of 627 respondents (38% vascular neurologists, 24% general neurologists, and 26% neuroradiologists), 362 (58%) had a partial, and 305 (49%) a complete response. Most respondents were university hospital senior faculty members experienced in stroke, mostly from Europe and Asia. Only 66 (18%) of respondents had established institutional written protocols to manage CBI. The majority indicated that they were uncertain regarding useful investigations and further management of CBI patients (median 67 on a slider 0-100, 95% CI 35-81). Almost all respondents (97%) indicated that they would assess vascular risk factors. Although most would investigate and treat similarly to ischemic stroke for both phenotypes, including initiating antithrombotic treatment, there was considerable diagnostic and therapeutic heterogeneity. Less than half of respondents (42%) would assess cognitive function or depression. CONCLUSIONS There is a high degree of uncertainty and heterogeneity regarding management of two common types of CBI, even among experienced stroke physicians. Respondents were more proactive regarding the diagnostic and therapeutic management than the minimum recommended by current expert opinions. More data are required to guide management of CBI; meantime, more consistent approaches to identification and consistent application of current knowledge, that also consider cognition and mood, would be promising first steps to improve consistency of care

Intravenous tPA for Acute Ischemic Stroke in Patients with COVID-19

BACKGROUND/PURPOSE: Coronavirus disease 2019 (COVID-19) is associated with increased risk of acute ischemic stroke (AIS), however, there is a paucity of data regarding outcomes after administration of intravenous tissue plasminogen activator (IV tPA) for stroke in patients with COVID-19. METHODS: We present a multicenter case series from 9 centers in the United States of patients with acute neurological deficits consistent with AIS and COVID-19 who were treated with IV tPA. RESULTS: We identified 13 patients (mean age 62 (±9.8) years, 9 (69.2%) male). All received IV tPA and 3 cases also underwent mechanical thrombectomy. All patients had systemic symptoms consistent with COVID-19 at the time of admission: fever (5 patients), cough (7 patients), and dyspnea (8 patients). The median admission NIH stroke scale (NIHSS) score was 14.5 (range 3-26) and most patients (61.5%) improved at follow up (median NIHSS score 7.5, range 0-25). No systemic or symptomatic intracranial hemorrhages were seen. Stroke mechanisms included cardioembolic (3 patients), large artery atherosclerosis (2 patients), small vessel disease (1 patient), embolic stroke of undetermined source (3 patients), and cryptogenic with incomplete investigation (1 patient). Three patients were determined to have transient ischemic attacks or aborted strokes. Two out of 12 (16.6%) patients had elevated fibrinogen levels on admission (mean 262.2 ± 87.5 mg/dl), and 7 out of 11 (63.6%) patients had an elevated D-dimer level (mean 4284.6 ±3368.9 ng/ml). CONCLUSIONS: IV tPA may be safe and efficacious in COVID-19, but larger studies are needed to validate these results

Role of Echocardiography in Atrial Fibrillation

Atrial fibrillation (AF) is most common arrhythmia and its prevalence appears to be increasing as the population ages. Echocardiography can play a key role in risk stratification and management of patients with AF. Transthoracic echocardiography allows rapid and comprehensive assessment of cardiac anatomical structure and function. Pulmonary vein flow monitoring using echocardiography has the potential to an increasing role in the evaluation of cardiac function and AF ablation procedures. Transesophageal echocardiography also provides accurate information about the presence of a thrombus in the atria and thromboembolic risk. The novel technique of intracardiac echocardiography has emerged as a popular and useful tool in the everyday practice of interventional electrophysiology. Other imaging modalities, such as computed tomography and magnetic resonance imaging have complementary roles in risk stratification and assessment of patients with AF. Echocardiography continues to be the foundation of clinical evaluation and management of AF

Acute ischaemic stroke associated with SARS-CoV-2 infection in North America

BACKGROUND: To analyse the clinical characteristics of COVID-19 with acute ischaemic stroke (AIS) and identify factors predicting functional outcome. METHODS: Multicentre retrospective cohort study of COVID-19 patients with AIS who presented to 30 stroke centres in the USA and Canada between 14 March and 30 August 2020. The primary endpoint was poor functional outcome, defined as a modified Rankin Scale (mRS) of 5 or 6 at discharge. Secondary endpoints include favourable outcome (mRS ≤2) and mortality at discharge, ordinal mRS (shift analysis), symptomatic intracranial haemorrhage (sICH) and occurrence of in-hospital complications. RESULTS: A total of 216 COVID-19 patients with AIS were included. 68.1% (147/216) were older than 60 years, while 31.9% (69/216) were younger. Median [IQR] National Institutes of Health Stroke Scale (NIHSS) at presentation was 12.5 (15.8), and 44.2% (87/197) presented with large vessel occlusion (LVO). Approximately 51.3% (98/191) of the patients had poor outcomes with an observed mortality rate of 39.1% (81/207). Age \u3e60 years (aOR: 5.11, 95% CI 2.08 to 12.56, p\u3c0.001), diabetes mellitus (aOR: 2.66, 95% CI 1.16 to 6.09, p=0.021), higher NIHSS at admission (aOR: 1.08, 95% CI 1.02 to 1.14, p=0.006), LVO (aOR: 2.45, 95% CI 1.04 to 5.78, p=0.042), and higher NLR level (aOR: 1.06, 95% CI 1.01 to 1.11, p=0.028) were significantly associated with poor functional outcome. CONCLUSION: There is relationship between COVID-19-associated AIS and severe disability or death. We identified several factors which predict worse outcomes, and these outcomes were more frequent compared to global averages. We found that elevated neutrophil-to-lymphocyte ratio, rather than D-Dimer, predicted both morbidity and mortality

International Guideline on Dose Prioritization and Acceptance Criteria in Radiation Therapy Planning for Nasopharyngeal Carcinoma

Purpose: The treatment of nasopharyngeal carcinoma requires high radiation doses. The balance of the risks of local recurrence owing to inadequate tumor coverage versus the potential damage to the adjacent organs at risk (OARs) is of critical importance. With advancements in technology, high target conformality is possible. Nonetheless, to achieve the best possible dose distribution, optimal setting of dose targets and dose prioritization for tumor volumes and various OARs is fundamental. Radiation doses should always be guided by the As Low As Reasonably Practicable principle. There are marked variations in practice. This study aimed to develop a guideline to serve as a global practical reference. Methods and Materials: A literature search on dose tolerances and normal-tissue complications after treatment for nasopharyngeal carcinoma was conducted. In addition, published guidelines and protocols on dose prioritization and constraints were reviewed. A text document and preliminary set of variants was circulated to a panel of international experts with publications or extensive experience in the field. An anonymized voting process was conducted to rank the proposed variants. A summary of the initial voting and different opinions expressed by members were then recirculated to the whole panel for review and reconsideration. Based on the comments of the panel, a refined second proposal was recirculated to the same panel. The current guideline was based on majority voting after repeated iteration for final agreement. Results: Variation in opinion among international experts was repeatedly iterated to develop a guideline describing appropriate dose prioritization and constraints. The percentage of final agreement on the recommended parameters and alternative views is shown. The rationale for the recommendations and the limitations of current evidence are discussed. Conclusions: Through this comprehensive review of available evidence and interactive exchange of vast experience by international experts, a guideline was developed to provide a practical reference for setting dose prioritization and acceptance criteria for tumor volumes and OARs. The final decision on the treatment prescription should be based on the individual clinical situation and the patient's acceptance of optimal balance of risk. (C) 2019 Elsevier Inc. All rights reserved

Compression of Auditory Space during Forward Self-Motion

<div><h3>Background</h3><p>Spatial inputs from the auditory periphery can be changed with movements of the head or whole body relative to the sound source. Nevertheless, humans can perceive a stable auditory environment and appropriately react to a sound source. This suggests that the inputs are reinterpreted in the brain, while being integrated with information on the movements. Little is known, however, about how these movements modulate auditory perceptual processing. Here, we investigate the effect of the linear acceleration on auditory space representation.</p> <h3>Methodology/Principal Findings</h3><p>Participants were passively transported forward/backward at constant accelerations using a robotic wheelchair. An array of loudspeakers was aligned parallel to the motion direction along a wall to the right of the listener. A short noise burst was presented during the self-motion from one of the loudspeakers when the listener’s physical coronal plane reached the location of one of the speakers (null point). In Experiments 1 and 2, the participants indicated which direction the sound was presented, forward or backward relative to their subjective coronal plane. The results showed that the sound position aligned with the subjective coronal plane was displaced ahead of the null point only during forward self-motion and that the magnitude of the displacement increased with increasing the acceleration. Experiment 3 investigated the structure of the auditory space in the traveling direction during forward self-motion. The sounds were presented at various distances from the null point. The participants indicated the perceived sound location by pointing a rod. All the sounds that were actually located in the traveling direction were perceived as being biased towards the null point.</p> <h3>Conclusions/Significance</h3><p>These results suggest a distortion of the auditory space in the direction of movement during forward self-motion. The underlying mechanism might involve anticipatory spatial shifts in the auditory receptive field locations driven by afferent signals from vestibular system.</p> </div