A flexible object orientated design approach for the realisation of assistive technology

This thesis contributes to a growing body of research conducted by the Interactive Systems Research Group (ISRG) at Nottingham Trent University within the fields of accessibility and accessible technologies. Core to this research is the exploration of how interactive technologies can be developed and applied as platforms for education, rehabilitation and social inclusion. To this end the group has been actively evolving the User Sensitive and Inclusive Design (USID) methodology for the design, development and evaluation of accessible software and related technologies. This thesis contributes to the further development of the USID method with a focus on its application for the design of assistive technology

An interface to virtual environments for people who are blind using Wii technology - mental models and navigation

Accessible games, both for serious and for entertainment purposes, would allow inclusion and participation for those with disabilities. Research into the development of accessible games, and accessible virtual environments, is discussed. Research into accessible Virtual Environments has demonstrated great potential for allowing people who are blind to explore new spaces, reducing their reliance on guides, and aiding development of more efficient spatial maps and strategies. Importantly, Lahav and Mioduser (2005, 2008) have demonstrated that, when exploring virtual spaces, people who are blind use more and different strategies than when exploring real physical spaces, and develop relatively accurate spatial representations of them. The present paper describes the design, development and evaluation of a system in which a virtual environment may be explored by people who are blind using Nintendo Wii devices, with auditory and haptic feedback. The nature of the various types of feedback is considered, with the aim of creating an intuitive and usable system. Using Wii technology has many advantages, not least of which are that it is mainstream, readily available and cheap. The potential of the system for exploration and navigation is demonstrated. Results strongly support the possibilities of the system for facilitating and supporting the construction of cognitive maps and spatial strategies. Intelligent support is discussed. Systems such as the present one will facilitate the development of accessible games, and thus enable Universal Design and accessible interactive technology to become more accepted and widespread

Using Wii technology to explore real spaces via virtual environments for people who are blind

Purpose - Virtual environments (VEs) that represent real spaces (RSs) give people who are blind the opportunity to build a cognitive map in advance that they will be able to use when arriving at the RS. Design - In this research study Nintendo Wii based technology was used for exploring VEs via the Wiici application. The Wiimote allows the user to interact with VEs by simulating walking and scanning the space. Finding - By getting haptic and auditory feedback the user learned to explore new spaces. We examined the participants' abilities to explore new simple and complex places, construct a cognitive map, and perform orientation tasks in the RS. Originality – To our knowledge, this finding presents the first virtual environment for people who are blind that allow the participants to scan the environment and by this to construct map model spatial representations

Term admissions to neonatal units in England: a role for transitional care? A retrospective cohort study

Objective To identify the primary reasons for term admissions to neonatal units in England, to determine risk factors for admissions for jaundice and to estimate the proportion who can be cared for in a transitional setting without separation of mother and baby. Design Retrospective observational study using neonatal unit admission data from the National Neonatal Research Database and data of live births in England from the Office for National Statistics. Setting All 163 neonatal units in England 2011–2013. Participants 133 691 term babies born ≥37 weeks gestational age and admitted to neonatal units in England. Primary and secondary outcomes Primary reasons for admission, term babies admitted for the primary reason of jaundice, patient characteristics, postnatal age at admission, total length of stay, phototherapy, intravenous fluids, exchange transfusion and kernicterus. Results Respiratory disease was the most common reason for admission overall, although jaundice was the most common reason for admission from home (22% home vs 5% hospital). Risk factors for admission for jaundice include male, born at 37 weeks gestation, Asian ethnicity and multiple birth. The majority of babies received only a brief period of phototherapy, and only a third received intravenous fluids, suggesting that some may be appropriately managed without separation of mother and baby. Admission from home was significantly later (3.9 days) compared with those admitted from elsewhere in the hospital (1.7 days) (p<0.001). Conclusion Around two-thirds of term admissions for jaundice may be appropriately managed in a transitional care setting, avoiding separation of mother and baby. Babies with risk factors may benefit from a community midwife postnatal visit around the third day of life to enable early referral if necessary. We recommend further work at the national level to examine provision and barriers to transitional care, referral pathways between primary and secondary care, and community postnatal care

Vitamin D in Early Childhood and the Effect on Immunity to Mycobacterium tuberculosis

A potential role for vitamin D as a therapeutic immunomodulator in tuberculosis (TB) has been recognised for over 150 years, but has only recently returned to the centre of the research arena due to the increasing awareness of the global vitamin D deficiency epidemic. As early as birth a child is often deficient in vitamin D, which may not only affect their bone metabolism but also modulate their immune function, contributing to the increased susceptibility to many infections seen early in life. Recent studies have begun to explain the mechanisms by which vitamin D affects immunity. Antimicrobial peptides are induced in conjunction with stimulation of innate pattern recognition receptors enhancing immunity to particular infections. In contrast the role of vitamin D within the adaptive immune response appears to be more regulatory in function, perhaps as a mechanism to reduce unwanted inflammation. In this paper we focus on the effect of vitamin D on immunity to TB. Where much of the attention has been paid by past reviews to the role of vitamin D in adult TB patients, this paper, where possible, focuses on research in paediatric populations

A systematic evaluation of current control devices used by people with intellectual disabilities in non-immersive virtual environments

Virtual environments have a role to play in facilitating the acquisition of living skills in people with intellectual disabilities, improving their cognitive skills and providing them with entertainment. However, the currently recommended devices to allow navigation in and interaction with the environments are difficult to use. Using a methodology established in an earlier study, the study aims to systematically document the performance of users with the currently recommended devices in order to (i) inform the design of a usable control device or devices and (ii) act as a baseline against which they can be evaluated. 40 people with severe intellectual disabilities aged 21–67 years used four environments with an equal number of sessions with the different devices being evaluated. Results indicate that when forward movement is provided by the software using the mouse for both navigation and interaction allows better performance both initially and after exposure than using the fire button on the joystick. When the user had to initiate forward movement with the navigation device, the joystick allowed better performance than the arrows on the keyboard. Preventing slippage of the joystick base would make its use much easier and it is suggested that separate devices are retained for navigation and interaction

Term admissions to neonatal units in England: a role for transitional care? A retrospective cohort study

Objective To identify the primary reasons for term admissions to neonatal units in England, to determine risk factors for admissions for jaundice and to estimate the proportion who can be cared for in a transitional setting without separation of mother and baby. Design Retrospective observational study using neonatal unit admission data from the National Neonatal Research Database and data of live births in England from the Office for National Statistics. Setting All 163 neonatal units in England 2011–2013. Participants 133 691 term babies born ≥37 weeks gestational age and admitted to neonatal units in England. Primary and secondary outcomes Primary reasons for admission, term babies admitted for the primary reason of jaundice, patient characteristics, postnatal age at admission, total length of stay, phototherapy, intravenous fluids, exchange transfusion and kernicterus. Results Respiratory disease was the most common reason for admission overall, although jaundice was the most common reason for admission from home (22% home vs 5% hospital). Risk factors for admission for jaundice include male, born at 37 weeks gestation, Asian ethnicity and multiple birth. The majority of babies received only a brief period of phototherapy, and only a third received intravenous fluids, suggesting that some may be appropriately managed without separation of mother and baby. Admission from home was significantly later (3.9 days) compared with those admitted from elsewhere in the hospital (1.7 days) (p<0.001). Conclusion Around two-thirds of term admissions for jaundice may be appropriately managed in a transitional care setting, avoiding separation of mother and baby. Babies with risk factors may benefit from a community midwife postnatal visit around the third day of life to enable early referral if necessary. We recommend further work at the national level to examine provision and barriers to transitional care, referral pathways between primary and secondary care, and community postnatal care

Postnatal corticosteroid use for prevention or treatment of Bronchopulmonary Dysplasia in England and Wales 2012-2019: a retrospective population cohort study

Objective: Describe the population of babies who do and do not receive postnatal corticosteroids for prevention or treatment of bronchopulmonary dysplasia (BPD). Design: Retrospective cohort study using data held in the National Neonatal Research Database. Setting: National Health Service neonatal units in England and Wales. Patients: Babies born less than 32 weeks gestation and admitted to neonatal units from 1 January 2012 to 31 December 2019. Main outcomes: Proportion of babies given postnatal corticosteroid; type of corticosteroid; age at initiation and duration, trends over time. Secondary outcomes: Survival to discharge, treatment for retinopathy of prematurity, BPD, brain injury, severe necrotising enterocolitis, gastrointestinal perforation. Results: 8% (4713/62019) of babies born <32 weeks and 26% (3525/13527) born <27 weeks received postnatal corticosteroids for BPD. Dexamethasone was predominantly used 5.3% (3309/62019), followed by late hydrocortisone 1.5%, inhaled budesonide 1.5%. prednisolone 0.8%, early hydrocortisone 0.3% and methylprednisolone 0.05%. Dexamethasone use increased over time (2012: 4.5 vs 2019: 5.8%, p=0.04). Median postnatal age of initiation of corticosteroid course was around 3 weeks for late hydrocortisone, 4 weeks for dexamethasone, 6 weeks for inhaled budesonide, 12 weeks for prednisolone and 16 weeks for methylprednisolone. Babies who received postnatal corticosteroids were born more prematurely, had a higher incidence of comorbidities and a longer length of stay. Conclusions: In England and Wales, around 1 in 12 babies born less than 32 weeks and 1 in 4 born less than 27 weeks receive postnatal corticosteroids to prevent or treat BPD. Given the lack of convincing evidence of efficacy, challenges of recruiting to and length of time taken to conduct randomised controlled trial, our data highlight the need to monitor long-term outcomes in children who received neonatal postnatal corticosteroids

An evaluation of the Wii Nunchuk as an alternative assistive device for people with intellectual and physical disabilities using switch controlled software

Many people with intellectual disabilities also have physical difficulties which prevent them from using standard computer control devices. Custom made alternative devices for those with special needs can be expensive and the low unit turnover makes the prospect unattractive to potential manufacturers. One solution is to explore the potential of devices used in contemporary gaming technology, such as the Nintendo Wii. The Wii Nunchuk has the potential to replace joystick functions with the advantages of not being surface bound and easier for some individuals to grasp. This study evaluated the feasibility of using the Nunchuk by comparing its performance as a switch with the participant's usual switch. Twenty three volunteers aged between 17 and 21 with intellectual and physical disabilities completed a Single Switch Performance Test using the new device and their familiar device. For most functions of the switch, there was no significant difference between the participants' performance using the Nunchuck and their familiar device. Additional analysis found that some participants' performance did improve whilst using the Nunchuck, but this was not significantly related to physical or cognitive ability. Those whose performance was better with the Nunchuk were more likely to hold it in the conventional way than were those who had better performance with their familiar device. This merits it being offered as a possible alternative to currently available switches for those with physical difficulties affecting their grip