Overcoming systematic global barriers to AT: a new methodology and quickstart testing through a £20m programme

Between March and June 2018, the Global Disability Innovation Hub (GDI) led a consortium tasked by the UK Department for International Development (DfID) with comprehensively scoping the barriers to Assistive Technology (AT) access in order to inform the design of a significant new global programme. This paper summarises the evidence examined in that Scoping Report; presents the methodology it proposed; and shares the early findings for the subsequent £20m funded programme, called ‘AT2030 – Access to Assistive Technology for All’ (www.AT2030.org).The Scoping Report sought to unpick the multi-layered and multi-faceted ways in which economic, social, and political factors interact to create barriers to AT for those who need it the most. The team used a mixed-methods approach which was necessarily flexible and iterative, bringing in expertise from the broad partnership. The data showed that the challenge of AT access represents a complex web of market and system failures, compounded by a lack of participation from AT users, that results in a supply/demand mismatch affecting almost a billion people. This makes AT access one of the most pressing global challenges. Because of poor data on use, need and impact this ‘wicked problem’ is largely hidden from view to all but those facing the daily struggles its absence creates. Yet at an individual, family and community level there is no doubt at all about the implications of lack of access to appropriate AT; isolation, economic and social exclusion, poor physical and mental health, and reduced life expectancy. Our evidence suggests that barriers to AT access are about far more than just cost. Issues such as undeveloped policy frameworks, inefficient or non-existent markets, poorly resourced services, stigma and discrimination all play a role, often with a gender impact. The Scoping Report proposed that the resulting global programme (AT2030) trial strategic interventions based on the principles of: building a global mission-led approach; generating better research and data; piloting market-shaping activity; delivering systems strengthening interventions; harnessing innovation; and building community participating and capacity. Findings from the first ten months of delivery have reinforced and confirmed the need for a mission-led approach to AT, embedded within a normative framework of social development. ‘Amazing early results’1 have resulted in a slightly tightened impact framework (theory of change) along with doubled investment. The programme is still in its early stages, but the working assumption is still that the participation of AT users is a necessary factor in the design of innovative solutions, and moreover that the availability of AT products alone is not sufficient to ‘enable a lifetime of potential’ without a systematic approach to inclusion

Critical Junctures in Assistive Technology and Disability Inclusion

It is clear from the events of the last 18 months that while technology has a huge potential for transforming the way we live and work, the entire ecosystem—from manufacturing to the supply chain—is vulnerable to the vagaries of that ecosystem, as well as having the potential to exacerbate new and existing inequalities [...

A Case Study on Improving Accessibility of Healthcare Care Facility in Low-resource Settings

Accessibility in a hospital is challenging for people in low-income countries due to a lack of accessible mediums to communicate wayfinding, accessibility, and healthcare information. This results in delays and stress but can also result in sub-optimal treatment or sometimes a complete lack of treatment for the visitors. Sensible physical and digital interventions can greatly ease the experience of visitors and reduce the work-related stress of healthcare providers. We present a case study on wayfinding and service design for a mega ophthalmic care facility that has a daily footfall of 2500 patients. From our mixed-methods study we identified: (i) there are very few accessible mediums available to communicate wayfinding, accessibility, and healthcare information; (ii) there is a lack of inclusively designed interventions to accommodate the diversity of visitors; (iii) spatial ambiguity and situational impairment due to crowd density exasperate the situation and (iv) there exist missing as well as misleading information. We developed a spectrum of solutions on the environmental and digital infrastructures available within this context to deliver wayfinding and procedural information. We completed a progressive intervention across digital and physical mediums over a duration of 18 months. This has shown the impact of each medium on visitors' experience. We found the choice of interface to access information depends on the ease of access, and ease of access depends on visitors' abilities. Therefore, both the environment and digital mediums are found to be useful for visitors. Based on these empirical findings, we draw recommendations for an inclusive service design that incorporates using elements of the environment, human and digital infrastructure to support a more positive healthcare visitors experience

Acute Responses to High Intensity Interval Exercise and Moderate Aerobic Exercise on Anaerobically and Aerobically Trained Athletes

High Intensity Interval Training (HIIT) is emerging as the popular method of training recently for its ability to deliver an exercise that still elicits almost the same health benefits, when compared to traditional methods of training. Those who are trained possess higher lactate thresholds than those who are not trained. However, there is little research on males whom are trained as anaerobically or aerobically, and their differences on lactate or blood glucose recovery. PURPOSE: The purpose of this study is to compare the acute effects of high intensity interval exercise and moderate aerobic exercise on lactic acid and blood glucose levels on athletes who are either anaerobically trained or aerobically trained. METHODS: Males (20± 2.774) of average cardiorespiratory fitness (VO2max =35 ±5.95 ) participated in a high intensity interval exercise (HIIE) and a moderate aerobic trial in a balanced cross-over design in which the subject was randomized and assessed for changes in blood lactate levels and glucose levels during exercise. The HIIE is a 4 x 4 trial in which the subject pedaled on a cycle for four intervals of 4 minutes at 90-95% of maximal aerobic capacity (VO2max), interspersed with 3 minutes of active recovery at 60% VO2max. The subjects were assessed for blood lactate and blood glucose via finger stick prior to exercise, at minute 4, 13, 24, 32 and every 10 minutes post-exercise up to 30 minutes following the cessation of the exercise bout. The subjects also participated in a moderate aerobic trial at 60% of VO2max. The subjects were assessed for blood lactate and blood glucose via finger stick however time points are varied per subject due to variations in total work outputs. RESULTS: The main effect for recovery was not significant in lactate when comparing training status across both HIIE/Mod (Ana=5.7± 4.3, Aer=8.3± 4.7) (p=0.3470). The main effect for glucose was also not significant when comparing training status across both HIIE/Mod (Ana=93± 12.5, Aer=102.7± 12.5) (p=0.2350). The main effect for lactate when comparing training (Aer/Ana) across intensity (HIIE/Mod) was not significant (AnaHi=4.6± 1.2, AnaMod=6.9± 8.2, AerHi=5.7± 1.3, AerMod=10.9± 9.0) (p=0.5620). The main effect for glucose when comparing training (Aer/Ana) across intensity (HIIE/Mod) was also not significant (AnaGlucHi=93.5± 20.1, AnaGlucMod=92.5± 13.6, AerGlucHi=112.8± 20.1, AerGlucMod=92.6± 13.6) (p=0.2100) CONCLUSIONS: Although lactate nor glucose were statistically significant in this study, when comparing the values, anaerobically trained males buffered lactic acid more efficiently than those who are aerobically trained. This might suggest that those whom are anaerobically trained possess higher lactate threshold than those who are aerobically trained

Numerical study on diverging probability density function of flat-top solitons in an extended Korteweg-de Vries equation

We consider an extended Korteweg-de Vries (eKdV) equation, the usual Korteweg-de Vries equation with inclusion of an additional cubic nonlinearity. We investigate the statistical behaviour of flat-top solitary waves described by an eKdV equation in the presence of weak dissipative disorder in the linear growth/damping term. With the weak disorder in the system, the amplitude of solitary wave randomly fluctuates during evolution. We demonstrate numerically that the probability density function of a solitary wave parameter $\kappa$ which characterizes the soliton amplitude exhibits loglognormal divergence near the maximum possible $\kappa$ value.Comment: 8 pages, 4 figure

Systems Evolutionary Biology of Waddington’s Canalization and Genetic Assimilation

In recent years, there has been growing interest in computer modeling of the evolution of gene and cell regulatory networks, in general, and in computational studies of the classic ideas of Baldwin, Schmalhausen, Waddington, and followers, in particular. Two related aspects of Waddington’s evolutionary theories are the concepts of canalization and of genetic assimilation. Canalization is associated with the robust development of an individual to diverse perturbations and noise, though, when fluctuations in developmental factors exceed a particular limit, the normal developmental trajectory can be “thrown out” of the robust canal, resulting in an altered phenotype. If selective pressure favors the new phenotype, an initial individual loss of canalization can lead to phenotypic changes in the population (with canalization then becoming established for the new phenotype). Genetic assimilation is the subsequent genetic fixing of the new trait in the population. Recent experimental and theoretical works have established a quantitative basis for these classic concepts of Waddington; this chapter will review these new developments in systems evolutionary biology

Ideas and Enhancements Related to Mobile Applications to Support Type 1 Diabetes

Background: Mobile devices have become increasingly important to young people who now use them to access a wide variety of health-related information. Research and policy related to the integration of health information and support with this technology do not effectively consider the viewpoint of a younger patient. Views of young people with type 1 diabetes are vital in developing quality services and improving their own health-related quality of life (HRQOL), yet research on their lifestyle and use of Web and mobile technology to support their condition and in non–health-related areas is sparse. Objective: To develop insight into young people with type 1 diabetes and their current use of Web and mobile technology and its potential impact on HRQOL. This can be achieved by constructing an in-depth picture of their day-to-day experiences from qualitative interviewing and exploring how they make use of technology in their lives and in relation to their condition and treatment. The goal was then to build something to help them, using the researcher’s technical expertise and seeking users’ opinions during the design and build, utilizing sociotechnical design principles. Methods: Data were collected by semistructured, in-depth qualitative interviews (N=9) of young people with type 1 diabetes aged 18-21. Interviews were transcribed and loaded onto NVivo for theme identification. Data analysis was undertaken during initial interviews (n=4) to locate potential ideas and enhancements for technical development. Latter interviews (n=5) assisted in the iterative sociotechnical design process of the development and provided additional developmental ideas. Results: Six themes were identified providing an understanding of how participants lived with and experienced their condition and how they used technology. Four technological suggestions for improvement were taken forward for prototyping. One prototype was developed as a clinically approved app. A number of ideas for new mobile apps and enhancements to currently existing apps that did not satisfactorily cater to this age group’s requirements for use in terms of design and functionality were suggested by interviewees but were not prototyped. Conclusions: This paper outlines the nonprototyped suggestions from interviewees and argues that young people with type 1 diabetes have a key role to play in the design and implementation of new technology to support them and improve HRQOL. It is vital to include and reflect on their suggestions as they have a radically different view of technology than either their parents or practitioners. We need to consider the relationship to technology that young people with type 1 diabetes have, and then reflect on how this might make a difference to them and when it might not be a suitable mechanism to use

Knowledge, Food and Place: a way of producing a way of knowing

The article examines the dynamics of knowledge in the valorisation of local food, drawing on the results from the CORASON project (A cognitive approach to rural sustainable development: the dynamics of expert and lay knowledge), funded by the EU under its Framework Programme 6. It is based on the analysis of several in-depth case studies on food relocalisation carried out in 10 European countries

The Origin of X-shaped Radio Galaxies: Clues from the Z-symmetric Secondary Lobes

Existing radio images of a few X-shaped radio galaxies reveal Z-symmetric morphologies in their weaker secondary lobes which cannot be naturally explained by either the galactic merger or radio-lobe backflow scenarios, the two dominant models for these X-shaped radio sources. We show that the merger picture can explain these morphologies provided one takes into account that, prior to the coalescence of their supermassive black holes, the smaller galaxy releases significant amounts of gas into the ISM of the dominant active galaxy. This rotating gas, whose angular momentum axis will typically not be aligned with the original jets, is likely to provide sufficient ram pressure at a distance ~10 kpc from the nucleus to bend the extant jets emerging from the central engine, thus producing a Z-symmetry in the pair of radio lobes. Once the two black holes have coalesced some 10^7 yr later, a rapid reorientation of the jets along a direction close to that of the orbital angular momentum of the swallowed galaxy relative to the primary galaxy would create the younger primary lobes of the X-shaped radio galaxy. This picture naturally explains why such sources typically have powers close to the FR I/II break. We suggest that purely Z-symmetric radio sources are often en route to coalescence and the concomitant emission of substantial gravitational radiation, while X-shaped ones have already merged and radiated.Comment: 12 pages, 1 compressed figure; accepted for publication in ApJ Letter