Alternative Access Methods Research Articles

LOGISTICS OF TRANSPORT SERVICES FOR PEOPLE WITH DISABILITIES IN POLAND- CASE STUDY

This study embarks on a profound investigation into the experiences and challenges confronted by individuals with disabilities. It emphasizes their interactions with architectural structures and their engagement with assisting technologies. Based on a meticulously curated survey, the study reveals that the educational background of respondents is diverse, with secondary education emerging as the most prevalent. A significant segment of the sample, 48%, is identified with a profound degree of disability (I disability group), underscoring the need to address their unique challenges. Key findings highlight a range of architectural barriers, with stairs lacking alternative access methods as the primary impediment. This highlights the urgency for urban planning and infrastructural updates tailored for inclusivity. The frequency of outdoor activities, predominantly daily, provides insights into mobility patterns and potential challenges faced. On the technological front, the survey reveals a disparity in the adoption and satisfaction levels with assisting technologies. Only a small minority use these tools daily, with a significant segment expressing inadequacy or partial alignment with their needs. Interestingly, a pronounced affinity towards these technologies is observed among highereducated individuals, suggesting potential links between education and technological engagement. Furthermore, the study explores the intricacies of architectural barriers in residential areas. Larger cities, for instance, present unique challenges, such as the lack of appropriate voice signaling. Such insights advocate for location-specific interventions. This research provides a comprehensive understanding of the diverse challenges faced by individuals with disabilities in Poland. By integrating these insights, the study emphasizes the need for holistic and targeted solutions, laying the foundation for creating an inclusive and accessible societal environment. This paper also aims to explore the logistics of transport services for people with disabilities in Poland, focusing on their availability, accessibility, cost, regulations, and the awareness and education surrounding these services. By examining these factors, this paper seeks to identify the challenges faced by people with disabilities when using transport services in Poland and suggests measures to enhance the logistics of these services.

Transvenous Access for Emergent Thoracic and Thoracoabdominal Aortic Aneurysm Repair in Patients Without Femoral Access.

To describe the technique of transvenous access for emergent endovascular repair of thoracic and thoracoabdominal aneurysms exemplified with 2 cases. Transvenous access to the aorta is described as an alternative access method to deliver aortic endografts in emergency situations. A 68-year-old female patient with severely compromised iliac and subclavian artery access was treated for a ruptured extent V thoraco-abdominal aortic aneurysm with a t-Branch (Cook Medical, Bjaeverskov, Denmark) delivered through a transcaval access. To avoid severe aortocaval shunting a balloon-expandable covered stent was deployed through a carotid access due to severe bilateral subclavian ostial stenosis. A 71-year-old man with an acute type B aortic dissection and bilateral narrow long-segment stenting of the iliac arteries was treated with a physician-modified thoracic endovascular aortic repair using an arteriovenous fenestration created at the level of the common iliac artery. We describe the access creation by fenestration using a transseptal needle. Transvenous access for thoracic and thoraco-abdominal aortic aneurysm repair is safe and feasible in selected emergent cases. A transvenous approach may be helpful in selected patients when an endovascular repair needs to be performed but no arterial femoral access is available. This approach proved to be feasible even with large-bore introducer sheaths, taking its place in the armamentarium of the vascular surgeon for emergent complex endovascular aortic repairs.

Designing an app for alternative access assessments: using interviews to uncover and define user needs

ABSTRACT To support effective alternative access assessment and service delivery for people with motor impairments, we are developing an app called Access Navigator. This paper describes the first stage of the project: the interviews we conducted as part of a discovery process to improve our understanding of user needs. We individually interviewed 8 assistive technology practitioners and 3 clients who use alternative access methods, to learn what practitioners were currently doing in their access assessments, identify opportunities for improving current practice, and understand what the assessment process was like for clients. We extracted 236 relevant quotes from interview transcripts, and clustered the quotes using the affinity wall method, yielding 42 themes. Here we present the 21 highest priority themes, along with the app requirements that support those themes. Results confirmed the need for a tool to support more effective assessments, with emphasis on taking the worry out of access assessments and supporting early success. Results also revealed specific needs such as flexible workflow, personalized test-drive tasks, and a choice of metrics (including client preference). With a richer understanding of user needs, we are in a much better position to design software that can address those needs.

Demands Associated With an Augmentative and Alternative Communication System in Relation to Alternative Forms of Access for Individuals With Motor Impairments

Successful adoption and use of aided augmentative and alternative communication (AAC) must address how to promote fluid, efficient, and organized execution of the motor behavior needed to access the AAC system. A substantial number of people who use AAC have significant motor impairments and require "alternative" access options, such as eye gaze or switch use. Such individuals may be particularly vulnerable to interference from a poorly designed system. However, the inherent demands of alternative access methods have received little direct study. The goal of this tutorial is to offer a clinically and theoretically guided framework for considerations concerning AAC access, with the hope of spurring further discussion and empirical research. A framework that draws upon dynamic systems theory was used to illustrate the interactions between the various elements of importance to AAC access. Information and research from the fields of motor learning, developmental dynamic systems theory, AAC, and assistive technology was integrated into this tutorial to examine their applications for alternative AAC access methods. The framework illustrated that AAC access involves a complex coordination between individual skills, the demands of the communication environment, the activity being undertaken, and the supports and demands inherent in the AAC system itself. Awareness of the many demands that alternative forms of access place on the person who uses them can guide clinicians during assessment and intervention decision making regarding access options for individuals with significant motor impairments. Specific directions for future research are considered.

Vascular Access for TAVI in the Era of Intravascular Lithotripsy

Transcatheter aortic valve implantation (TAVI) is an established alternative to surgical aortic valve replacement (SAVR) across a range of indications and surgical risk categories [1]. Peripheral vascular assessment is important in pre-procedural planning for TAVI, as femoral access has been established as the superior access method for procedural outcomes [2,3]. Unfortunately, severe calcific iliofemoral disease can impede femoral access, and alternative access methods, which carry higher risks of peri-procedural complications, were previously used in these cases.

Short- and Mid-Term Outcomes in Patients Deemed Inoperable Undergoing Transapical and Transfemoral TAVR with an STS-PROM below Four Percent.

Transapical (TA) TAVR is known to be associated with increased mortality and vascular complications compared with transfemoral (TF) TAVR in high-risk and inoperable patients. However, safe alternative access methods remain crucial. We aimed to (1) evaluate the 30-day and 1-year outcomes comparing TA and TF TAVR in patients with an STS-PROM of <4% deemed inoperable and (2) determine dependent and independent predictors for all-cause one-year mortality. Data were collected from a single-center registry consisting of 340 eligible patients. One-to-one propensity score matching was performed (n = 50 TA, n = 50 TF). Primary endpoints were all-cause mortality, stroke, and major bleeding. Predictors for all-cause one-year mortality were evaluated. Thirty-day mortality (TF vs. TA: 0.0% vs. 4.0%; p = 0.153) was comparable in both cohorts. One-year all-cause mortality was twice as high in TA patients (TF vs. TA: 10.0% vs. 20.0%, p logrank = 0.165, HR 2.10). Cerebrovascular events and major bleeding during one-year follow-up were similar. The multivariate analysis identified hemoglobin <12 g/dL at admission and dual antiplatelet therapy as strong predictors for one-year mortality. Although femoral access is the primary access with favorable 30-day and 1-year results, transapical access was successful for patients unsuitable for TF TAVR, showing acceptable short- and mid-term results in inoperable patients with low-risk profiles.

Status of Alternative Approaches for Thyroidectomy: Is There Any Evidence to Substitute in Place of Conventional Surgery?

Over the past 20 years, various alternative cervical minimally invasive (partly endoscopically assisted) and extracervical endoscopic (partly robot-assisted) approaches have been developed. All of these alternative access methods aim at optimizing the cosmetic results. In principle, the indication for the use of alternative access procedures does not differ from that for conventional surgery. Nonetheless, appropriate experience in traditional thyroid surgery and suitable patient selection, taking into account thyroid volumes and the underlying pathology, are important prerequisites. General contraindications for an alternative approach are large goiter with symptoms of compression, advanced thyroid carcinoma, recurrent interventions or previous radiotherapy in the operating area. The alternative surgical approaches to the thyroid can be divided into cervical minimally invasive, extracervical endoscopic (robot-assisted) and transoral procedures. This article gives an overview of the clinically used alternative approaches in thyroid surgery. The desire for an optimal cosmetic result should not be prioritized over patient safety. Only a few alternative procedures (minimally invasive video-assisted thyroidectomy, transaxillary robot-assisted thyroidectomy) can currently be viewed as a useful addition to conventional thyroid surgery, even when in responsible, experienced hands for a selected group of patients.

Integrated Head-Tilt and Electromyographic Cursor Control.

This study evaluated the performance of two alternate computer access methods that could be used for two-dimensional cursor control. The first method, ACC/sEMG, integrates head acceleration and facial surface electromyography. The second method, Camera Mouse, is a free-to-use, computer vision-based access method. Twenty-four healthy adults performed a target acquisition task using each computer access method across two lighting conditions and three computer orientations. Performance in the task was evaluated using metrics of target selection accuracy, movement time, and path efficiency. Using ACC/sEMG resulted in better mean path efficiency and target selection accuracy, whereas using Camera Mouse resulted in faster target selection. Moreover, performance in the task when using Camera Mouse depended on lighting conditions in the room. The findings of this study show that the ACC/sEMG system is an effective computer access method across different lighting conditions and computer orientations. However, there is a tradeoff between speed and accuracy: ACC/sEMG system provided higher target selection accuracy compared to Camera Mouse, while the latter provided faster target selection. Future development should focus on evaluating performance of each method in populations with limited motor abilities.

877 Requirements for Surgical Bailout Following Transcatheter Aortic Valve Implantation

Vascular and cardiac complications during transcatheter aortic valve implantation (TAVI) are are rare but important complications. While cardiothoracic surgical backup is traditionally mandatory, the need for vascular surgical support may be underappreciated. We examined rates of surgical complications requiring bailout during TAVI in a single centre. All patients who underwent TAVI in a single centre were reviewed in a retrospective cohort analysis. Demographic data and outcomes according to the Valve Academic Research Consortium-2 (VARC-2) were collected in addition to specific data regarding vascular and cardiothoracic surgical bailout. From August 2008 - April 2020, 567 patients underwent TAVI in a single centre (mean age 82.4±7.6 years, 42% female, mean body mass index 28.1±12.5 kg/mˆ2). Femoral approach was used in 97% of cases with direct aortic, trans-apical, subclavian, carotid, and transcaval as alternate access methods. CoreValve/Evolut-R/Evolut-Pro, SapienXT/3, Symetis, and Lotus prostheses were implanted. Rates of VARC-2 major and minor vascular complications were 1.1% and 5.4%, respectively, and were similar across time periods. Vascular surgical bailout was required in 2.2% of all patients. In contrast major cardiac complications requiring consideration of urgent cardiac surgery which included tamponade, aortic dissection, and valve dislocation/embolisation was 0.7% in total, but 1.9% prior to 2016 and 0.3% from 2016-2020. The requirement for any form of surgical bailout was reassuringly low. Vascular surgical bailout was three times more common than cardiothoracic surgical bailout. Our results suggest routine inclusion of vascular surgeons in the heart team may be justified.

Optimized and Predictive Phonemic Interfaces for Augmentative and Alternative Communication.

Purpose We empirically assessed the results of computational optimization and prediction in communication interfaces that were designed to allow individuals with severe motor speech disorders to select phonemes and generate speech output. Method Interface layouts were either random or optimized, in which phoneme targets that were likely to be selected together were located in proximity. Target sizes were either static or predictive, such that likely targets were dynamically enlarged following each selection. Communication interfaces were evaluated by 36 users without motor impairments using an alternate access method. Each user was assigned to 1 of 4 interfaces varying in layout and whether prediction was implemented (random/static, random/predictive, optimized/static, optimized/predictive) and participated in 12 sessions over a 3-week period. Six participants with severe motor impairments used both the optimized/static and optimized/predictive interfaces in 1-2 sessions. Results In individuals without motor impairments, prediction provided significantly faster communication rates during training (Sessions 1-9), as users were learning the interface target locations and the novel access method. After training, optimization acted to significantly increase communication rates. The optimization likely became relevant only after training when participants knew the target locations and moved directly to the targets. Participants with motor impairments could use the interfaces with alternate access methods and generally rated the interface with prediction as preferred. Conclusions Optimization and prediction led to increases in communication rates in users without motor impairments. Predictive interfaces were preferred by users with motor impairments. Future research is needed to translate these results into clinical practice. Supplemental Material https://doi.org/10.23641/asha.8636948.

A Softwarized Paradigm for Mobile Virtual Networks: Overcoming a Lack of Access Infrastructure

Market analysis reports suggest that the mobile virtual network operator (MVNO) market will experience subscriber growth at a compound annual growth rate (CAGR) of 10.7% from 2014 to 2020. This optimistic news presents great opportunities as well as many challenges. The major issue lies in the MVNOs' lack of spectrum allocation and an end-to-end network infrastructure, which means they must rely on mobile network operators (MNOs) for wireless access network connectivity to service their customers. In this article, we propose an approach that provides alternative wireless access methods to enable MVNOs to minimize their dependency on MNO networks. This leverages the fifth-generation (5G) softwarization technologies to provide selective multipath device-to-infrastructure (D2I) connections and service assortments. Supervised by software-defined networking (SDN)-based edge controllers, the multipath D2I connections provide flexible user data delivery over available communication resources without strict consideration of the MNO's infrastructure restraints. Additionally, a priority-based classification policy is applied to user data providing service assortments before it reaches the network infrastructure. Multiple pilot scenarios are implemented to verify the feasibility and performance tradeoff between the communication metrics of the proposed approach.

When You Can't Touch a Touch Screen.

AbstractA touch screen can be an intuitive interface method for many people. Mobile phones, tablets, and tablet computer combinations have made this technology part of daily use. Touchscreen technologies are common and present unique difficulties for individuals who require alternative access methods. Dedicated augmentative and alternative communication systems continue to offer a range of access methods, but it is also important to examine existing accessibility options from mainstream companies (e.g., Microsoft [Redmond, WA], Apple [Cupertino, CA]) and how current tools can be used to allow individuals to interact with touch screen technologies. An overview of current accessibility features available on popular mainstream devices (e.g., Microsoft Surface, Apple iPad) is provided along with discussion of alternative access methods for current technologies, future research directions, and the potential impact of speech recognition, virtual reality, and augmented reality for interfacing with multiple devices.

A new procedure for a trans-conduit puncture by grasping the dilator tip with a snare catheter: An alternative access method during catheter ablation of supraventricular tachycardias after an extracardiac Fontan operation

There have been 2 reports of catheter ablation (CA) of supraventricular tachycardias (SVTs) after extracardiac Fontan procedures (EC-Fs) via trans-conduit punctures. 1 Dave A.S. Aboulhosn J. Child J.S. Shivkumar K. Transconduit puncture for catheter ablation of atrial tachycardia in a patient with extracardiac fontan palliation. Heart Rhythm. 2010; 7: 413-416 Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar , 2 Pass R.H. Nappo L. Eugenio P. Lopez L. A transbaffle approach to ablation in a child with an extracardiac fontan. Pacing Clin Electrophysiol. 2010; 33: 368-371 Crossref PubMed Scopus (13) Google Scholar However, it was difficult to stabilize the needle tip during the puncture. We report 2 consecutive cases undergoing CA of SVTs using a new trans-conduit puncture procedure.

Intraosseous Vascular Access for In-Hospital Emergency Use

Intraosseous (IO) vascular access is a viable primary alternative in patients requiring emergent vascular access in the hospital emergency department (ED) (eg, resuscitation, shock/septic shock) but is underutilized. This review has 3 objectives: (1) review the evidence supporting the use of IO access; (2) determine the utilization of IO access as described in the literature; and (3) assess the level of specialty society support. Electronic and hand searches were undertaken to identify relevant articles. English-language-only articles were identified. The Cochrane Review methodology along with data forms were used to collect and review data. The evidence evaluation process of the international consensus on emergency cardiovascular care was used to assess the evidence. Studies were combined where meta-analyses could be performed. In levels 2 to 5 studies, IO access performed better versus alternative access methods on the end points of time to access and successful access. Complications appeared to be comparable to other venous access methods. Randomized controlled trials are lacking. Newer IO access technologies appear to do a better job of gaining successful access more quickly. Intraosseous access is underutilized in the ED because of lack of awareness, lack of guidelines/indications, proper training, and a lack of proper equipment. Recommendations/guidelines from physician specialty societies involved in the ED setting are also lacking. Underutilization exists despite recommendations for IO access use from a number of important medical associations peripherally involved in the ED such as the American Academy of Pediatrics. To encourage the IO approach, IO product champions (as both supporter and user) in the ED are needed for prioritizing and assigning IO access use when warranted. In addition, specialty societies directly involved in emergent hospital care should develop clinical guidelines for IO use.

The Transformation of Personal Communications and the Erosion of Traditional Voice Provider Dominance

The paper examines the evolution of personal communications and the implications for traditional switched voice services provided by incumbent local exchange carriers. As the nature of personal communications has evolved and become increasingly competitive, incumbent local exchange carrier dominance of communications through the provision of voice telephony has eroded, and therefore so has the primary rationale for regulating traditional voice telephony. The primary focus of this analysis is residential communications. In particular, mobile and packet-switched broadband technologies have accelerated the adoption of alternative voice access methods for residential consumers, including the adoption of wireless telephony, interconnected Voice over Internet Protocol (VoIP), and competitive switched telephony as alternatives to switched voice telephony provided by incumbent local exchange carriers. In addition to access, mobile and broadband technologies have enabled a shift toward entirely new application-level modes of communication, such as text messaging, instant messaging, email, social networking, computer telephony, and Internet video conferencing. While these shifts in access-based and application-based alternatives have occurred incrementally over many years, the transformations — in the way consumers communicate with each other, plus the associated industry responses and changes industry structure—have been substantial. The analysis measures the magnitude of the consumer shift away from incumbent switched voice. It builds up incrementally a measurement of the shift away from incumbent switched voice, from a very conservative approach focused simply on access technologies to more comprehensive approaches taking into consideration application-level communications alternatives. The most conservative measure examines access choices for primary lines at the household level. It is possible to eliminate the primary line constraint and focus on total lines or connections. Extended to wireless, this is the most generous access-based approach, given multiple wireless connections per household. We next expand the measurement of alternatives to voice to include application-level communications modes. This more comprehensive approach takes into account the ways that technology continues to change the nature of personal communication. For example, there would appear to be greater emphases on time shifting, place shifting, device-shifting, format shifting, multi-party messaging, and integration with online applications and activities. After a discussion of measurement challenges, the analysis utilizes national data to map out the shift in demand for personal communications. In particular we map the extent of demand for communications at the application level by measuring the diffusion of broadband and mobile devices, networks, and applications compared with traditional voice access methods. Once we have developed reasonable measurements to capture the shift to alternative communications methods, we discuss opportunities for assessing wireline voice providers’ competitive responsiveness, taking into consideration the benefits and limitations of traditional measures.

The Future of the Android Operating System for Augmentative and Alternative Communication

Abstract We have experienced one of the most remarkable years in augmentative and alternative communication (AAC). The iPad, along with the iPhone, redefined mobile communications and personal computing technology. In the ensuing 9 months after the iPad's release, more than 50 non-iPad tablets have been developed and demonstrated at the 2011 Consumer Electronics Show and are ready for the consumer market. For the AAC consumer, the proliferation of these mainstream technologies will result in increasingly inexpensive hardware and software, availability of alternative access methods, opportunity to use standard software applications, and availability of applications that meet the specific needs of individual consumers. Because the Android platform is still in its infancy—especially with respect to AAC—we will focus on the potential effects this operating system could have on AAC. We will describe Android, its current offerings, and future possibilities. The emergence of iOS and Android has disrupted the AAC field, transforming the ways that we look at, purchase, and use technology.

Alternative Approach for Endovascular Treatment of Aortic Aneurysms

Endovascular treatment of thoracic aortic aneurysms is limited in patients with small or calcified femoral arteries, with the most serious complication being rupture at the insertion site or distal sections of the artery. To overcome this, an iliac conduit is normally created by surgical exposure. We used an original access in a patient with a thoracoabdominal aortic aneurysm and narrow femoral artery to introduce the endovascular prosthesis directly into the surgically exposed iliac artery by a small laparotomy and abdominal wall tunnel without iliac conduit. The endoprosthesis was easily implanted, and complete hemostasis was achieved with minimal blood loss.

A Study on Possibility of Detecting IEEE802.15.4a Signals for Spectrum Sharing

In March, 2007, IEEE802.15.4a was standardized as a low-rate and low-power UWB system for sensor networks. In general, detection of the IEEE802.15.4a signal is considered to be difficult because of its low transmitting power density and low duty cycle. However, if detecting of the IEEE802.15.4a signal is available, it is possible to avoid interference issues both among the IEEE802.15.4a systems and between the 15.4a and other UWB systems. This letter proposes a simple detection method using non-coherent detectors. The possibility of detecting of the IEEE802.15.4a signal by proposal detection method was examined. By conducting experiments with an emulated 15.4a RF signal, the signal detection probability was examined, and 15.4a signal from the range of about 11 meters in the radius could be detected. From this observation, the CSMA/CA method with detecting the signal in 15.4a system may be applied for alternative access method for 15.4a systems.

Research Investigation of Information Access Methods

This study investigates the satisfaction of library users at Wayne State University who utilize alternative information access methods. The LibQUAL+™ desired and perceived that satisfaction ratings are used to determine the user's ‘superiority gap’. By focusing limited library resources to address ‘superiority gap’ issues identified by each user community, user satisfaction with library personnel and library operations should improve. This study provides library administrators with a guide for a data-based organizational change resulting in improved user access, higher user satisfaction, and increase library operational efficiency.

Safe entry techniques during laparoscopy: Left upper quadrant entry using the ninth intercostal space—A review of 918 procedures

Surgeons performing sophisticated endoscopic operations must be well versed in alternate laparoscopic access methods to address evolving patient expectations and safety requirements. The safety of left upper quadrant laparoscopic entry in patients with prior surgeries and abdominal adhesions was evaluated. Laparoscopic surgery was performed for various indications on patients with prior surgical scars and anticipated risk of adhesions at the primary umbilical port site. All laparoscopies performed from July 1998 through June 2004 were analyzed. Of the 918 laparoscopies, 504 patients (54.9%) were found to have involvement of their umbilicus with adhesions that could have affected the traditional umbilical primary port entry. Left ninth intercostal space was used for Veres needle entry, and the primary trocar was placed in the left upper quadrant space. Of the 504 potentially risky entries, there were two (0.39%) Veres-needle related and zero trocar-related injuries. All surgical procedures were accomplished laparoscopically, and all entries were accomplished by the left upper quadrant entry technique. Therefore left upper quadrant entry technique is a safe and easily learned alternate access technique.