The impact of assistive technology in India: Surveys, a wheelchair skills test, and a research methods Delphi

Current assistive technology (AT) provision efforts in less-resourced environments rely on heuristic methods to monitor and improve service provision, instead of evidence-based practice (EBP) which has become standard in well-resourced regions. To introduce EBP methods, and evaluate the impact of technology on the lives of people with disabilities, we collaborated with clinicians at the Indian Spinal Injuries Centre (ISIC). Two studies were conducted using ISIC quality assurance data collected with our assistance. Based on our experience at ISIC, a third study was performed to investigate the challenges to international AT research, and develop strategies to overcome these challenges.The first study was conducted with individuals receiving new AT from ISIC. The data consisted of a baseline PART survey and 6-month and 12-month follow-ups taken with a majority (92%) outpatient population. Thirteen clients completed all three questionnaires. Results showed trends toward increased community participation and life satisfaction over the 12-month period. ISIC is planning to expand its implementation of the PART survey, perhaps online.The second study was conducted with individuals (69% inpatient) who received new wheelchairs from ISIC. The Wheelchair Skills Test and QUEST were administered before and after personal wheelchair provision. Seven clients completed a full set of pre- and post-tests. Trends toward increased skill completion rates, increased skill attempt rates, and slightly increased safety scores were found. QUEST scores increased in the post-test, bringing scores close to values reported in literature.The third study, conducted using a three-round Delphi method online, involved the participation of 13 experts in AT and rehabilitation research with experience working in low- and middle-income countries. During the first questionnaire round, participants were asked to identify domains of research that they considered the most challenging. In the second round, they were asked to rank and categorize the challenges as being either ethical or logistical, and also to suggest strategies to address them. In the final round, participants were asked to critique each strategy on its efficacy. Topics discussed included local collaboration, appropriate tools and techniques, translation, retention, compensation, and funding. Verifying the efficacy of suggested strategies could be the subject of future research

MONITORIA – MECÂNICA DOS SÓLIDOS II

A mecânica dos sólidos cruza os diversos setores da engenharia, com aplicações marcantes. Seus métodos são as projetistas de submarinos; aos engenheiros civis, no projeto de pontes e edifícios; aos engenheiros aeronáuticos; aos engenheiros de minas e aos arquitetos, cada um que tenha interesse em estruturas; aos engenheiros mecânicos e químicos, que sé apoia nos métodos desse assunto para o projeto de máquinas e vasos de pressão; aos engenheiros de materiais e metalurgistas, que precisam de conceitos fundamentais sobre o assunto, a fim de compreenderem como melhorar os materiais existentes, e finalmente, aos engenheiros eletricistas, que necessitam dos métodos do assunto, devido às fases da engenharia mecânica de muitas peças do equipamento elétrico [1]. A disciplina de Mecânica dos Sólidos apresenta uma das mais altas taxas de reprovação nos cursos de engenharias, isso se dá devido as complexidades desta disciplina quando comparadas ao curso de matemática e física ofertado nos últimos anos do ensino médio. Para diminuir as taxas de evasão e melhorar os embasamentos matemáticos e físicos dos discentes nas disciplinas posteriores do curso se faz necessário especial atenção no ensino da mecânica dos sólidos, principalmente fazendo um atendimento personalizado do esclarecimento de dúvidas dos alunos bem como na equiparação dos conhecimentos dentre eles. Partindo dessa problemática, objetivou-se desenvolver grupos de estudos com locais e horários pré- determinados para se acompanhar passo a passo o preparo dos discentes para com a disciplina, identificando suas maiores dificuldades e posteriormente sugerir uma possível solução de modo a dar mais direção em função dos exercícios propostos pelo coordenador da disciplina/projeto e por fim são apresentados os resultados obtidos com o programa de monitoria nas disciplinas de Mecânica dos Sólidos II

DETC2009-86734 A LOW-COST TOOL FOR GATHERING AND INTERPRETING THE MOBILITY NEEDS OF WHEELCHAIR USERS IN INDIA

ABSTRACT Collecting and interpreting customer needs using traditional product development tools can be difficult or impossible when there is a large geographic, cultural, or social gap between the customer and product designer. As part of a project to design an electric powered wheelchair (EPW) for Indians with disabilities, we piloted a new approach to gather and interpret customer needs. First, we distributed cameras to manual wheelchair users at the Indian Spinal Injury Center in New Delhi, India, and asked subjects take photos and write descriptions of accessibility barriers in and around their homes. The film was then processed; photos were de-identified and integrated into an internet-based questionnaire. Individuals with expertise in wheelchair use and design, and home modifications were recruited to participate in the questionnaire where they identified and ranked the accessibility barriers in each of 50 images which were randomly selected from the full database. Thirty cameras were received, yielding approximately 500 photos which were integrated into the questionnaire. A total of 72 subjects from 8 countries participated in the questionnaire. Using cluster analysis, we developed unique groupings for accessibility barriers based on their severity and prevalence. These groupings provided valuable and relevant information to develop and prioritize the design specifications of the EPW

PROJETO DE MONITORIA DA DISCIPLINA MECÂNICA DOS SÓLIDOS I DA FACULDADE DE ENGENHARIA DE MECÂNICA - 117

O objetivo do presente estudo é apresentar os benefícios alcançados resultante da monitoria acadêmica empregada por meio da disciplina Mecânica dos Solidos I, ministrada no curso de Engenharia de Mecânica da Universidade Federal do sul e Sudeste do Pará. Os monitores, através de um plano de atividade de atuação, juntamente com o professor intervêm prestando auxílio aos discentes, seja na resolução de exercícios, pesquisa bibliográfica com intuito de enriquecer aquilo que foi visto em sala e ajuda com os projetos da disciplina. A execução do plano de atividade pelos monitores em colaboração com o docente e os discentes apresentou-se bastante satisfatória tendo em vista que houve uma diminuição favorável do índice de reprovação dos alunos na disciplina de mecânica dos sólidos I, em relação as turmas anteriores

Development and use of the generic WHO/CDC logic model for vitamin and mineral interventions in public health programmes

Abstract Objective Nutrition interventions are critical to achieve the Millennium Development Goals; among them, micronutrient interventions are considered cost-effective and programmatically feasible to scale up, but there are limited tools to communicate the programme components and their relationships. The WHO/CDC (Centers for Disease Control and Prevention) logic model for micronutrient interventions in public health programmes is a useful resource for planning, implementation, monitoring and evaluation of these interventions, which depicts the programme theory and expected relationships between inputs and expected Millennium Development Goals. Design The model was developed by applying principles of programme evaluation, public health nutrition theory and programmatic expertise. The multifaceted and iterative structure validation included feedback from potential users and adaptation by national stakeholders involved in public health programmes' design and implementation. Results In addition to the inputs, main activity domains identified as essential for programme development, implementation and performance include: (i) policy; (ii) products and supply; (iii) delivery systems; (iv) quality control; and (v) behaviour change communication. Outputs encompass the access to and coverage of interventions. Outcomes include knowledge and appropriate use of the intervention, as well as effects on micronutrient intake, nutritional status and health of target populations, for ultimate achievement of the Millennium Development Goals. Conclusions The WHO/CDC logic model simplifies the process of developing a logic model by providing a tool that has identified high-priority areas and concepts that apply to virtually all public health micronutrient interventions. Countries can adapt it to their context in order to support programme design, implementation, monitoring and evaluation for the successful scale-up of nutrition interventions in public healt

Global prevalence and disease burden of vitamin D deficiency: a roadmap for action in low- and middle-income countries.

Vitamin D is an essential nutrient for bone health and may influence the risks of respiratory illness, adverse pregnancy outcomes, and chronic diseases of adulthood. Because many countries have a relatively low supply of foods rich in vitamin D and inadequate exposure to natural ultraviolet B (UVB) radiation from sunlight, an important proportion of the global population is at risk of vitamin D deficiency. There is general agreement that the minimum serum/plasma 25-hydroxyvitamin D concentration (25(OH)D) that protects against vitamin D deficiency-related bone disease is approximately 30 nmol/L; therefore, this threshold is suitable to define vitamin D deficiency in population surveys. However, efforts to assess the vitamin D status of populations in low- and middle-income countries have been hampered by limited availability of population-representative 25(OH)D data, particularly among population subgroups most vulnerable to the skeletal and potential extraskeletal consequences of low vitamin D status, namely exclusively breastfed infants, children, adolescents, pregnant and lactating women, and the elderly. In the absence of 25(OH)D data, identification of communities that would benefit from public health interventions to improve vitamin D status may require proxy indicators of the population risk of vitamin D deficiency, such as the prevalence of rickets or metrics of usual UVB exposure. If a high prevalence of vitamin D deficiency is identified (>20% prevalence of 25(OH)D 1%), food fortification and/or targeted vitamin D supplementation policies can be implemented to reduce the burden of vitamin D deficiency-related conditions in vulnerable populations

Adherence to Antimicrobial Inhalational Anthrax Prophylaxis among Postal Workers, Washington, D.C., 2001

In October 2001, two envelopes containing Bacillus anthracis spores were processed at the Washington, D.C., Processing and Distribution Center of the U.S. Postal Service; inhalational anthrax developed in four workers at this facility. More than 2,000 workers were advised to complete 60 days of postexposure prophylaxis to prevent inhalational anthrax. Interventions to promote adherence were carried out to support workers, and qualitative information was collected to evaluate our interventions. A quantitative survey was administered to a convenience sample of workers to assess factors influencing adherence. No anthrax infections developed in any workers involved in the interventions or interviews. Of 245 workers, 98 (40%) reported full adherence to prophylaxis, and 45 (18%) had completely discontinued it. Experiencing adverse effects to prophylaxis, anxiety, and being <45 years old were risk factors for discontinuing prophylaxis. Interventions, especially frequent visits by public health staff, proved effective in supporting adherence

An integrated infant and young child feeding and small-quantity lipid-based nutrient supplementation programme in the Democratic Republic of Congo is associated with improvements in breastfeeding and handwashing behaviours but not dietary diversity.

Integrating small-quantity lipid-based nutrient supplements (SQ-LNS) into infant and young child feeding (IYCF) programmes can increase consumption of essential nutrients among children in vulnerable populations; however, few studies have assessed the impact of integrated IYCF-SQ-LNS programmes on IYCF practices. A 2-year, enhanced IYCF intervention targeting pregnant women and infants (0-12 months) was implemented in a health zone in the Democratic Republic of Congo (DRC). The enhanced IYCF intervention included community- and facility-based counselling for mothers on handwashing, SQ-LNS, and IYCF practices, plus monthly SQ-LNS distributions for children 6-12 months; a control zone received the national IYCF programme (facility-based IYCF counselling with no SQ-LNS distributions). Cross-sectional preintervention and postintervention surveys (n = 650 and 638 in intervention and control areas at baseline; n = 654 and 653 in each area at endline, respectively) were conducted in mothers of children 6-18 months representative of both zones. Difference in differences (DiD) analyses used mixed linear regression models. There were significantly greater increases in the proportion of mothers in the intervention (vs. control) zone who reported: initiating breastfeeding within 1 hr of birth (Adj. DiD [95% CI]: +56.4% [49.3, 63.4], P < 0.001), waiting until 6 months to introduce water (+66.9% [60.6, 73.2], P < 0.001) and complementary foods (+56.4% [49.3, 63.4], P < 0.001), feeding the minimum meal frequency the previous day (+9.2% [2.7, 15.7], P = 0.005); feeding the child in a separate bowl (+9.7% [2.2, 17.2], P = 0.01); awareness of anaemia (+16.9% [10.4, 23.3], P < 0.001); owning soap (+14.9% [8.3, 21.5], P < 0.001); and washing hands after defecating and before cooking and feeding the child the previous day (+10.5% [5.8, 15.2], +12.5% [9.3, 15.6] and +15.0% [11.2, 18.8], respectively, P < 0.001 for all). The enhanced IYCF intervention in the DRC was associated with an improvement in several important IYCF practices but was not associated with a change in dietary diversity (minimum dietary diversity and minimum acceptable diet remained below 10% in both zones without significant differences between zones). The provision of fortified complementary foods, such as SQ-LNS, may be an important source of micronutrients and macronutrients for young children in areas with high rates of poverty and limited access to diverse foods. Future research should verify the potential of integrated IYCF-SQ-LNS to improve IYCF practices, and ultimately children's nutritional status