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Individuals with severe motor impairments often require alternative means to access computers and communication technology. A range of alternative access devices exist; however, most rely on use of a single access modality. While this approach works for some individuals, it can be limiting for others. This study explored the use of a multi-modal prototype (eye-tracking + switch-scanning) on typing performance with a range of individuals with motor impairments. The multi-modal prototype was compared to eye-tracking alone for this study. Results indicated that the multi-modal prototype had significantly slower typing rate but significantly lower total errors compared to eye-tracking alone. Analysis of individual data revealed four subgroups of clinical relevance including individuals that 1) benefit from multi-modal, 2) benefit from eye-tracking, 3) demonstrate learning and 4) demonstrate fluctuating performance. [ABSTRACT FROM AUTHOR]

Im gewerblichen Bereich ist der Einsatz von Elektrofahrzeugen ökologisch und ökonomisch vielversprechend. Die gezielte Förderung der Nutzung erfordert jedoch eine gute Kenntnis der Nutzergruppen und ihren Anforderungen. Der Beitrag basiert auf einer Untersuchung in Aachen, in der Leitungspersonen von Pflegediensten und Taxiunternehmen befragt wurden, die die Integration von Elektrofahrzeugen erwägen. Erhoben wurden Anforderungen an Elektrofahrzeuge und den Ausbau von Ladeinfrastruktur sowie wahrgenommene Risiken und Potenziale. Die Ergebnisse werden in Stakeholderprofile überführt und um ermittelte Informations- und Partizipationsbedarfe sowie Präferenzen für Formate ergänzt. Es werden große Branchenunterschiede deutlich. Beide Gruppen benötigen branchenspezifisch aufbereitete Informationsangebote. Die Wechselbereitschaft bei Pflegediensten ist höher. Die Fahrzeuge sollen auf dem Betriebsgelände nach den Schichten (meist über Nacht) geladen werden, Schnellladen ist nicht erforderlich. Für den Umstieg werden Praxisberichte und eine Übersicht zu Fördermöglichkeiten benötigt. Die Taxiunternehmen sehen mehr Risiken als Potenziale. Sie benötigen schnell ladende Fahrzeuge (im Zweischichtsystem). Entscheidungsrelevant ist die Bereitstellung von Schnellladeinfrastruktur an Taxiständen. Abstimmungsbedarf zur Konfliktvermeidung betrifft die Positionierung am Taxistand, die Nutzungszeiten sowie die Vermittlung ladender Elektrofahrzeuge.

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.

Smart Predict is a novel two-tablet application developed to improve conversational efficiency for people who use augmentative and alternative communication (AAC) devices. The Smart Predict system consists of two distinct applications that were built for use with two Android tablets and/or phones with Bluetooth ® capability. One application is referred to as the AAC User app and the second application is called the Partner app. Smart Predict integrates vocabulary supplementation from communication partners in real-time while persons who rely on AAC generate text and maintain full control to choose words within a word prediction line. Using single-case research designs with adapted alternating treatments under two counterbalanced treatment conditions (AAC User app alone versus AAC User app + Partner app), we examined message efficiency with persons who rely on switch scanning for on-screen keyboards. User experience questionnaires were administered to determine satisfaction and workload, and to provide feedback for future development efforts. Three adults with complex communication needs and motor impairments conversed with research staff about fourteen movie trailers. Characters per minute and switch selections per character produced by the person with complex communication needs and motor impairments were measured during 15-minute interviews to represent communication speed and effort. Results indicate that message efficiency increased with the dual-tablet Smart Predict, indicating faster message generation with the vocabulary supplementation system. User satisfaction increased and perceived effort decreased under the Smart Predict conditions. Given these results within a research and development framework, the Smart Predict concept is a viable feature that could be considered within smart AAC technologies.

Literacy skills can assist in the navigation and enjoyment of adult life. For individuals who have reached adulthood without strong literacy skills, opportunities for continued literacy learning are few. Redesigning AAC technologies to support literacy skill development could extend literacy learning opportunities for adults with developmental disabilities who have limited speech. The current preliminary study evaluated an AAC technology feature designed to support literacy development. The study used a multiple probe across participants design. Three adults with Down syndrome who had limited speech and only basic decoding skills participated. Results suggest the participants made modest gains in decoding accuracy after interacting using the AAC app with the literacy supportive feature, though performance was highly variable. Results also offer emerging evidence that, for two participants, some generalization to encoding performance may have also been achieved. Results showed that, for all the participants, interacting using the literacy supportive feature increased their reading confidence. Altogether, the study's results show preliminary evidence that the feature can support adults with Down syndrome in their ongoing literacy learning, though access to formal instruction is still critical. Future research is needed to continue to explore this and other AAC technology redesigns to increase learning opportunities for the people who use the technology every day to communicate.

Purpose: Literacy skills are foundational to participation in adolescent and adult life, and decoding skills (i.e., sounding out to read words) are critical to literacy learning. Literacy also increases communication options for individuals with developmental disabilities who use augmentative and alternative communication (AAC). Yet, current AAC technologies are limited in their support of literacy development (especially decoding skills) for the individuals with developmental disabilities who require them. The purpose of this study was to conduct a preliminary evaluation of a new AAC feature designed to support decoding skills., Method: Three individuals who had limited functional speech and limited literacy skills, specifically two adolescents and one young adult with Down syndrome, participated in the study. The study used a single-subject, multiple-probe, across-participants design., Results: All three participants demonstrated increases in reading performance, including decoding of novel words. High variability in performance was observed, however, and no participant reached reading mastery. Still, analysis reveals that for all participants, interacting using the new app feature increased reading., Conclusions: These results offer preliminary evidence that an AAC technology feature that provides models of decoding (upon selection of AAC picture symbols) can support individuals with Down syndrome in building decoding skills. While not intended to replace instruction, this initial study offers initial evidence in its efficacy as a supplemental avenue for supporting literacy in individuals with developmental disabilities who use AAC.

The field of augmentative and alternative communication (AAC) has witnessed significant changes since its inception. AAC services are now considered for a much greater number of individuals with complex communication needs and there are many more AAC options available as communication supports, including a proliferation of technologies. The scope and options for communication within society have increased substantially to include a wide array of digital and social media. Individuals with complex communication needs have increased expectations for participation and engagement across a full range of environments-education, employment, family, healthcare, and community living. Despite these advances, there remain critical challenges that must be addressed. This paper discusses key advances in the AAC field, delineates challenges, and discusses future directions to address these challenges, specifically as they relate to research and development to enhance AAC interventions and technologies for individuals with complex communication needs and their families.

This pilot study examined the initial effects and estimated effect size of a computer-based simulation education program on certified nursing assistants' level of assistance when dressing nursing home residents with dementia and on residents' dressing performance. Nine dyads, assigned to either the experimental or control group, completed the study. Both groups received a traditional 1-hour education module delivered by a research assistant. The experimental group was then instructed to undertake an additional 2-hour intervention using a video simulator that enabled nursing assistants to practice level of assistance skills. The appropriateness of dressing assistance from nursing assistants and residents' dressing performance was measured before and 6 weeks after the intervention. The results showed that the two groups did not significantly differ in either appropriate levels of dressing assistance (P = .42) or residents' dressing performance (P = .38). A lack of effort by some assistants to properly assist residents and low statistical power may explain the lack of significance. The effect sizes of the experimental intervention on appropriate levels of dressing assistance and resident dressing performance were 0.69 and 0.89, respectively. Incorporating a strategy to improve motivation should be considered in future studies.

A considerable increase in several heat shock proteins (HSPs) amount in Acholeplasma laidlawii cells has been revealed after temperature rising of liquid culture; and the quantity of small HSP, named p17, was increased in a hundred of times. The p17 protein was isolated and identified as HSP of alpha-crystallin type (alpha-HSP). It became possible as a result of sequencing of 15 amino acids from N-terminal of the p17 polypeptide chain, followed by revealing of a corresponding open reading frame (ORF) in a completely sequenced genome of A. laidlawii PG 8A. Computer-based search for homologous ORFs in all 17 genomes of Mycoplasmataceae family (the mycoplasmas themselves) that had been completely sequenced to date, gives negative result. But among the representatives of Mollicutes (mycoplasma) class, the genes coding alpha-HSPs were found in two Phytoplasma species (Phytoplasmataceae family) and the acholeplasma examined (Acholeplasmataceae family). It supposed that presence or absence of alpha-HSPs in microorganisms might be connected with the fact that representatives of Acholeplasmataceae and Phytoplasmataceae families inhabit principally in plant tissues in contrast to majority of Mycoplasmataceae family, that inhabit animal and human tissues, i. e. use ecological niches with relatively constant temperature.

Purpose: To study the ocular histopathologic features in eyes of children with fatal suspected child abuse., Design: Retrospective case series., Participants: One hundred eighteen autopsy cases of known or suspected child abuse., Methods: The ocular autopsy and histopathologic features of a cohort of consecutive cases of known or presumed child abuse submitted by Maryland's Office of the Chief Medical Examiner or Johns Hopkins Hospital to the Wilmer Eye Pathology Laboratory were tabulated., Main Outcome Measure: Ocular hemorrhage or structural abnormality., Results: Retinal hemorrhage was present in 44% of cases. Circumferential folds with macular schisis cavities were present in 23% of cases and were bilateral in half of those cases. Peripapillary scleral hemorrhage was present in 38% of cases, and subdural hemorrhage was present in the distal optic nerve in 46% of cases. Hemosiderin was present in 27% of cases., Conclusions: Intraretinal hemorrhages, circumferential macular folds with schisis cavities, peripapillary scleral hemorrhages, and subdural hemorrhages are common pathologic findings in cases of fatal known or suspected child abuse. Their presence on autopsy should raise the suspicion of shaking or blunt nonaccidental trauma.

Evidence for A. J. Fridlund's (e.g.. 1994) "behavioral ecology view" of human facial expression comes primarily from studies of smiling in response to positive emotional stimuli. Smiling may be a special case because it clearly can, and often does serve merely communicative functions. The present experiment was designated (a) to assess the generalizability of social context effects to facial expressions in response to negative emotional stimuli and (b) to examine whether these effects are mediated by social motives, as suggested by the behavioral ecology view. Pairs of friends or strangers viewed film clips that elicited different degrees of sad affect, in either the same or a different room; a control group participated alone. Dependent variables included facial activity, subjective emotion, and social motives. Displays of sadness were influenced by stimulus intensity and were lower in all social conditions than in the alone condition. Unexpectedly, social context effects were also found for smiling.

Purpose: The prognosis for patients with ophthalmomyiasis Interna posterior is variable. In many patients the larva remains in the eye for years without inducing inflammation or loss of vision. Sometimes, however, the migrating larva involves the macula and optic nerve and results in permanent visual loss or even blindness., Methods: Our patient presented with sudden painless loss of vision in the right eye that was caused by ophthalmomyiasis interna posterior. Hemorrhage of the optic nerve head suggested that the fly larva had entered the vitreous cavity from the optic nerve head. Subretinal tracts were sequelae of the subretinal migration of the organism. Sequential photographs documented the fly larva migration into the optic nerve head head from the vitreous cavity. The organism was removed by pars plana vitrectomy and retinectomy., Results: In spite of the successful removal of the first stage fly larva, the visual acuity remained poor because of optic nerve atrophy., Conclusion: We suggest early removal of fly larvae to prevent damage and visual loss in cases of ocular myiasis interna posterior.

In a simple salts medium, monolayers of IEC-6 intestinal cells achieved concentrations of unmetabolized formycin B (an analog of inosine) about 6-fold higher than in the medium. Rates of formycin B influx were a saturable function of Na+ concentrations in the medium. Although IEC-6 cells possess sites with high affinity for nitrobenzylthioinosine, a potent inhibitor of equilibrative (facilitated diffusion) nucleoside transport systems in certain cell types, the inhibitor had only minor effects on formycin B uptake in IEC-6 cells, but reduced efflux of the analog from these cells. These findings indicate the joint presence in IEC-6 cells of nucleoside transporters of two types, one that is concentrative and Na+-dependent, and another that is sensitive to nitrobenzylthioinosine and apparently equilibrative.