A 20-year Prospective View of Accessibility and ICT

Over the past 40 years, the field of ICT accessibility has seen significant progress. What started with "special devices for special people" evolved into public and company-specific accessibility guidelines, international standards, and accessibility laws both in Europe and the U.S. Many large companies have dedicated teams to improve accessibility and have built significant accessibility features directly into their products. The growing emphasis on accessibility in the industry has given rise to consultants, accessibility evaluation and remediation companies, and training programs aimed at developing, training, and certifying accessibility specialists. Despite all of the progress in accessibility, however, there are still major shortcomings. Audits of the field reveal that a low percentage of websites and products are accessible. Moreover, while some products have built-in accessibility features, they are only accessible to some individuals with disabilities. For example, smartphone screen readers with their gesture controls are fantastic for some blind users but are too complicated or physically impossible for others who are blind. Additionally, many products do not effectively address the range of cognitive, language, and learning disabilities, even though this is cumulatively the largest disability group (Disability and Health Data System 2021). While we've made great progress from essentially zero products accessible to anyone 40 years ago, today, there are still only a fraction of products that are accessible. Even the best among these are still inaccessible to a wide range of individuals. In sum: 1. There are no products that are accessible across all of the different types, degrees, and combinations of disability. 2. There are a small number of products that are reasonably accessible across disabilities. But even those are only accessible to more typical or able individuals (e.g., those who are blind but are more digitally adroit versus the full range of people who are blind and who may have other disabilities). While it is essential to continue moving forward with our traditional methods, there is also a need to consider augmenting them with new approaches that: • can reach the large number of individuals who are currently left out and • require less effort, so more companies are willing and able to make their products accessible. Recent and emerging technological advances may give us the tools to do this. In this chapter, we will briefly discuss the evolution of ICT accessibility before introducing an alternate approach to accessibility, its potential benefits, and what might be required to implement such an approach.In den letzten 40 Jahren wurden auf dem Gebiet der IKT-Zugänglichkeit erhebliche Fortschritte erzielt. Was mit "speziellen Geräten für spezielle Menschen" begann, entwickelte sich zu öffentlichen und unternehmensspezifischen Barrierefreiheitsrichtlinien, internationalen Normen und Barrierefreiheitsgesetzen sowohl in Europa als auch in den USA. Viele große Unternehmen haben eigene Teams zur Verbesserung der Barrierefreiheit eingesetzt und wichtige Barrierefreiheitsfunktionen direkt in ihre Produkte eingebaut. Der wachsende Stellenwert der Barrierefreiheit in der Branche hat dazu geführt, dass Berater*innen, Unternehmen für die Bewertung und Behebung von Problemen mit der Barrierefreiheit sowie Schulungsprogramme für die Entwicklung, Schulung und Zertifizierung von Barrierefreiheitsspezialist*innen entstanden sind. Trotz aller Fortschritte im Bereich der Barrierefreiheit gibt es jedoch immer noch große Mängel. Prüfungen in diesem Bereich haben ergeben, dass nur ein geringer Prozentsatz der Websites und Produkte barrierefrei ist. Darüber hinaus verfügen einige Produkte zwar über integrierte Barrierefreiheitsfunktionen, sind aber nur für einen Teil der Menschen mit Behinderungen zugänglich. So sind z. B. Smartphone-Bildschirmlesegeräte mit ihren Gestensteuerungen für einige blinde Nutzer*innen fantastisch, für andere blinde Menschen jedoch zu kompliziert oder physisch unmöglich. Darüber hinaus gehen viele/ die meisten Produkte nicht auf die verschiedenen kognitiven, sprachlichen und Lernbeeinträchtigungen ein, obwohl dies insgesamt die größte Gruppe von Behinderungen ist (Disability and Health Data System 2021). Obwohl wir große Fortschritte gemacht haben, nachdem es vor 40 Jahren praktisch keine Produkte gab, die für jeden zugänglich waren, ist heute immer noch nur ein Bruchteil der Produkte barrierefrei. Selbst die besten unter ihnen sind immer noch für eine Vielzahl von Menschen unzugänglich. Zusammengefasst: 1. Es gibt keine Produkte, die für alle Arten, Grade und Kombinationen von Behinderungen zugänglich sind. 2. Es gibt eine kleine Anzahl von Produkten, die einigermaßen behinderungsübergreifend zugänglich sind, aber selbst diese sind nur für eher typische oder fähigere Menschen zugänglich (z. B. für blinde Menschen, die digital geschickter sind, im Gegensatz zu blinden Menschen, die möglicherweise andere Behinderungen haben). Es ist zwar wichtig, dass wir mit unseren traditionellen Methoden weitermachen, aber wir müssen auch darüber nachdenken, sie durch neue Ansätze zu ergänzen, die: • die große Zahl von Personen erreichen können, die derzeit nicht berücksichtigt werden, und • weniger Aufwand erfordern, so dass mehr Unternehmen bereit und in der Lage sind, ihre Produkte zugänglich zu machen. Jüngste und sich abzeichnende Fortschritte in der Technologie könnten uns die Instrumente dafür liefern. In diesem Kapitel werden wir kurz die Entwicklung der IKT-Barrierefreiheit diskutieren und, bevor wir einen alternativen Ansatz zur Barrierefreiheit vorstellen, seine potenziellen Vorteile und was es möglicherweise erfordert, um einen solchen Ansatz umzusetzen

Data Representativeness in Accessibility Datasets: A Meta-Analysis

As data-driven systems are increasingly deployed at scale, ethical concerns have arisen around unfair and discriminatory outcomes for historically marginalized groups that are underrepresented in training data. In response, work around AI fairness and inclusion has called for datasets that are representative of various demographic groups. In this paper, we contribute an analysis of the representativeness of age, gender, and race & ethnicity in accessibility datasets - datasets sourced from people with disabilities and older adults - that can potentially play an important role in mitigating bias for inclusive AI-infused applications. We examine the current state of representation within datasets sourced by people with disabilities by reviewing publicly-available information of 190 datasets, we call these accessibility datasets. We find that accessibility datasets represent diverse ages, but have gender and race representation gaps. Additionally, we investigate how the sensitive and complex nature of demographic variables makes classification difficult and inconsistent (e.g., gender, race & ethnicity), with the source of labeling often unknown. By reflecting on the current challenges and opportunities for representation of disabled data contributors, we hope our effort expands the space of possibility for greater inclusion of marginalized communities in AI-infused systems.Comment: Preprint, The 24th International ACM SIGACCESS Conference on Computers and Accessibility (ASSETS 2022), 15 page

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Exploring remote service provision in adult day centers during the COVID-19 pandemic

The COVID-19 pandemic profoundly impacted the long-term services and supports (LTSS) sector, necessitating a rapid shift from in-person services to remote. Adult day service centers (ADSCs) – a type of LTSS – offer in-person community-based programs comprised of health and wellness services to historically underserved populations, such as communities of color, low-income, and older adults. Based on data collected from 23 semi-structured interviews with 22 providers from eight ADSCs across a Mid-Atlantic state, this thesis explores the experiences of ADSC providers – such as directors, activity staff, and nurses – as they navigated pandemic-related closures. To ensure uninterrupted services, centers leveraged their existing infrastructure and adapted to a remote service model. An intricate interplay of technical (e.g., access to devices, internet) to non-technical (e.g., digital literacy, sociocultural context, limited staff) variables affected the overall success of remote services. Simultaneously, ADSCs grappled with limited reimbursement for remote services – which directly impacted their operations and the sustainability of remote services. These findings offer insights into the challenges and adaptations providers experienced amidst an unprecedented crisis, shedding light on the systemic issues throughout this period. The study seeks to inform future interventions that promote the sustainability of remote services in ADSCs, with a specific focus on preventing service disruptions for historically underserved populations

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries

Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was$216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with$195 for low FiO2 leading to a −$11 (95$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was$1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this

Use of Telemedicine for Post-discharge Assessment of the Surgical Wound: International Cohort Study, and Systematic Review with Meta-analysis

Objective: This study aimed to determine whether remote wound reviews using telemedicine can be safely upscaled, and if standardised assessment tools are needed. Summary background data: Surgical site infection is the most common complication of surgery worldwide, and frequently occurs after hospital discharge. Evidence to support implementation of telemedicine during postoperative recovery will be an essential component of pandemic recovery. Methods: The primary outcome of this study was surgical site infection reported up to 30-days after surgery (SSI), comparing rates reported using telemedicine (telephone and/or video assessment) to those with in-person review. The first part of this study analysed primary data from an international cohort study of adult patients undergoing abdominal surgery who were discharged from hospital before 30-days after surgery. The second part combined this data with the results of a systematic review to perform a meta-analysis of all available data conducted in accordance with PRIMSA guidelines (PROSPERO:192596). Results: The cohort study included 15,358 patients from 66 countries (8069 high, 4448 middle, 1744 low income). Of these, 6907 (45.0%) were followed up using telemedicine. The SSI rate reported using telemedicine was slightly lower than with in-person follow-up (13.4% vs. 11.1%, P&lt;0.001), which persisted after risk adjustment in a mixed-effects model (adjusted odds ratio: 0.73, 95% confidence interval 0.63-0.84, P&lt;0.001). This association was consistent across sensitivity and subgroup analyses, including a propensity-score matched model. In nine eligible non-randomised studies identified, a pooled mean of 64% of patients underwent telemedicine follow-up. Upon meta-analysis, the SSI rate reported was lower with telemedicine (odds ratio: 0.67, 0.47-0.94) than in-person (reference) follow-up (I2=0.45, P=0.12), although there a high risk of bias in included studies. Conclusions: Use of telemedicine to assess the surgical wound post-discharge is feasible, but risks underreporting of SSI. Standardised tools for remote assessment of SSI must be evaluated and adopted as telemedicine is upscaled globally