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Objectives: Utilizing policy innovation and diffusion theory, this study aims to explain why city governments adopt housing adaptation policies that primarily benefit older people based on the case of China., Methods: The data are drawn from an event history data set of a housing adaptation policy for older people collected from 283 Chinese cities from 2010 to 2018. Piecewise constant exponential models are utilized., Results: The results indicate that cities facing greater internal pressure and a higher political status are more likely to adopt a housing adaptation policy for older people. Policy adoption by neighboring cities could further facilitate this process., Discussion: Policy innovation and diffusion theory provide a useful framework for this study. That is, the Chinese city government's adoption of housing adaptation policy for older adults is initially driven by local needs and then accelerated by interactions among neighboring governments., (© The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Bycatch in fisheries is a major threat to many seabird species. Understanding and predicting spatiotemporal changes in seabird bycatch from fisheries might be the key to mitigation. Inter-annual spatiotemporal patterns are evident in seabird bycatch of the U.S. Atlantic pelagic longline fishery monitored by the National Marine Fisheries Service Pelagic Observer Program (POP) since 1992. A newly developed fast computing Bayesian approximation method provided the opportunity to use POP data to understand spatiotemporal patterns, including temporal changes in location of seabird bycatch hotspots. A Bayesian model was developed to capture the inherent spatiotemporal structure in seabird bycatch and reduce the bias caused by physical barriers such as coastlines. The model was applied to the logbook data to estimate seabird bycatch for each longline set, and the mid-Atlantic bight and northeast coast were the fishing areas with the highest fleet bycatch estimate. Inter-annual changes in predicted bycatch hotspots were correlated with Gulf Stream meanders, suggesting that predictable patterns in Gulf Stream meanders could enable advanced planning of fishing fleet schedules and areas of operation. The greater the Gulf Stream North Wall index, the more northerly the seabird bycatch hotspot two years later. A simulation study suggested that switching fishing fleets from the hindcasted actual bycatch hotspot to neighboring areas and/or different periods could be an efficient strategy to decrease seabird bycatch while largely maintaining fishers' benefit., (© 2021. The Author(s).)

Background: This study seeks to establish the skin barrier dysfunction model at the heel via tape-stripping (TS) by evaluating the skin moisturizing effects., Materials and Methods: Nineteen young, female participated in the study. A sequence of TS was performed at the heel and trans-epidermal water loss (TEWL), stratum corneum (SC) hydration, and surface pH were measured. Following TS, the subjects were divided into three groups: moisturizer, emollient, and overcoat. These agents were applied daily at night, and the skin parameters were measured the next morning for a week., Results: The TEWL value of TS immediately and 5 min after TS were significantly higher than what was obtained before TS, while the SC hydration after TS was significantly lower than what was obtained before TS. However, there were no significant differences in the skin parameters among the three agents on day 7 after application, with the two-way ANOVA showing no interaction among the agents and number of days., Conclusion: The skin barrier dysfunction model at the heel was established by TS in healthy, young adults. However, the physiological function of the skin at the heel did not change drastically and showed no differences even after continuous application for 7 days., (Copyright © 2021 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.)

Background: The non-invasive skin barrier measurements transepidermal water loss, stratum corneum hydration and the skin surface pH are widely used in clinical skin research. Relative and absolute measurement errors of these measurements are unknown in geriatric care settings., Material and Methods: Transepidermal water loss, stratum corneum hydration, skin surface pH and temperature were measured on the volar forearm and lower leg twice by trained raters within a cross-sectional study in ten nursing homes. Intrarater reliability was calculated using the ICC (1,1). Intrarater agreement was analyzed using Bland Altman Plots with limits of agreement., Results: Two hundred twenty-three residents were included and mean age was 84.2 years. The highest ICC was found for transepidermal water loss and skin surface temperature of the leg with 0.95 (95% CI 0.93 to 0.96). The ICC of the stratum corneum was 0.91 (95% CI 0.88 to 0.93) for both investigated skin areas. The measurement of the pH at the lower leg had the lowest ICC with 0.73 (95% CI 0.66 to 0.78). Highest limits of agreement of approximately 8 a.u. were calculated for stratum corneum hydration and lowest limits of agreement of approximately 1 °C were calculated for skin surface pH., Conclusion: Relative measurement errors of transepidermal water loss and stratum corneum hydration were very low indicating that single measurements provide reliable estimates in this population and setting. However, the absolute measurement errors were high for both of these parameters. To increase reliability of skin surface pH we recommend at least two repeated measurements., (Copyright © 2020 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.)

Background: Dental chairs are a vital tool in modern dentistry. Their design has paved the way for increasing improvement in dental treatment. Since the 1900's, the dental chair design has continuously evolved and transformed from manually operated mechanisms to recently automated mechanism, in spite of advancements a common obstacle faced by these wheelchair bound populations in using present dental chair is transfer. Wheelchair users need to be transferred from the wheelchair to other places many times a day. In most of the cases the wheelchair user does not possess the capability of transferring to a dental chair independently. Therefore assistance is needed either from dental clinic staff or from family and friends. This transfer of patients from wheelchair not just requires manpower but also creates unnecessary anxiety among the wheel chair bound patients. Solution: Thus a modified dental chair was constructed which would accommodate the wheelchair bound patients to the dental chair without any transfer. This study highlights the mechanism of action of the modified dental chair.Implication for rehabilitationImprove access among wheelchair bound patients to dental care servicesDecreases anxiety among the disadvantaged population in clinical set up.

Background: The International Symbol of Access (ISA) is recognized world-wide for designating and identifying areas which are wheelchair accessible, however its meaning has evolved to include both restricted use and universal accessibility., Objective: This study seeks to investigate the effectiveness of the ISA in representing individuals of all impairment types., Methods: A mixed-method survey was disseminated in the U.S. and internationally to persons without self-identified impairment and individuals of various impairment group types, including mobility, vision, hearing, and cognitive impairments, using convenience sampling (n = 981). Quantitative data was analyzed using ranking patterns and regression analysis. Qualitative data was analyzed using thematic analysis and triangulation., Results: Participants with self-identified mobility impairments rated the ISA more favorably than other disability groups (p = 0.002). In addition, there is a significant correlation between age and effectiveness of the ISA, with participants rating the symbol more favorably as age increases. Common themes included association of the ISA with a mobility impairment, implications for restricted use or reserved space, and physical accessibility., Conclusions: The ISA is not effective in representing individuals with non-mobility impairments and its ambiguous nature leads to confusion for both persons with and without impairment., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Metro suicide can cause tremendous effects on the general public. Platform screen doors (PSDs) have been identified as one of the most effective methods of suicide prevention at metro stations. However, there are few studies focusing on their effectiveness in preventing suicides. In particular, the effect of types of PSDs, including full-height and half-height PSDs, has rarely been assessed and compared., Methods: Based on the suicide data provided by the Shanghai metro operator, the effectiveness of installing different types of PSDs for preventing metro suicides was investigated using a Poisson regression model. Ten-year monthly panel data for 94 metro stations from 2008 to 2017 were used in this study., Results: The number of metro suicides declined by 90.9% after the PSDs were installed at metro stations. In addition, different types of PSDs had different effects on decreasing the number of suicides, and a higher half-height PSD was more effective in preventing suicides. Specifically, full-height PSDs could eliminate metro suicides by completely preventing passengers from entering the track area, while half-height PSDs that were 1.5 m and 1.2 m high could decrease the number of suicides by 79.2% and 60.2%, respectively. Moreover, there was no significant indication that the installation of PSDs at metro stations displaced suicides to railway stations without PSDs (p = 0.706)., Limitation: The potential economic benefits of different types of PSDs were not considered in our study. In addition, we did not examine whether suicide attempters would try to take their own lives by using other methods of suicide., Conclusion: The installation of PSDs, especially full-height PSDs, could be very effective in preventing suicides at metro stations. Although half-height PSDs are less effective than full-height PSDs, increasing the height of half-height PSDs could be an effective way of enhancing their effectiveness in reducing the number of suicides., (Copyright © 2019. Published by Elsevier B.V.)

Objective: To compare the Mobility Enhancement roBotic (MEBot) wheelchair's capabilities with commercial electric-powered wheelchairs (EPWs) by performing a systematic usability evaluation., Design: Usability in effectiveness, efficacy, and satisfaction was evaluated using quantitative measures. A semistructured interview was employed to gather feedback about the users' interaction with MEBot., Setting: Laboratory testing of EPW driving performance with 2 devices in a controlled setting simulating common EPW driving tasks., Participants: A convenience sample of expert EPW users (N=12; 9 men, 3 women) with an average age of 54.7±10.9 years and 16.3± 8.1 years of EPW driving experience., Interventions: Not applicable., Main Outcome Measures: Powered mobility clinical driving assessment (PMCDA), Satisfaction Questionnaire, National Aeronautics and Space Administration's Task Load Index., Results: Participants were able to perform significantly higher number of tasks (P=.004), with significantly higher scores in both the adequacy-efficacy (P=.005) and the safety (P=.005) domains of the PMCDA while using MEBot over curbs and cross-slopes. However, participants reported significantly higher mental demand (P=.005) while using MEBot to navigate curbs and cross-slopes due to MEBot's complexity to perform its mobility applications which increased user's cognitive demands., Conclusions: Overall, this usability evaluation demonstrated that MEBot is a promising EPW device to use indoors and outdoors with architectural barriers such as curbs and cross-slopes. Current design limitations were highlighted with recommendations for further improvement., (Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

The volume and rigor of evidence-based design have increasingly grown over the last three decades since the field's inception, supporting research-based designs to improve patient outcomes. This movement of using evidence from engineering and the hard sciences is not necessarily new, but design-based health research launched with the demonstration that post-operative patients with window views towards nature versus a brick wall yielded shorter lengths of hospital stay and less analgesia use, promoting subsequent investigations and guideline development. Architects continue to base healthcare design decisions on credible research, with a recent shift in physician involvement in the design process by introducing clinicians to design-thinking methodologies. In parallel, architects are becoming familiar with research-based practice, allowing for further rigor and clinical partnership. This cross-pollination of fields could benefit from further discussion surrounding the ethics of hospital architecture as applied to current building codes and guidelines. Historical precedents where the building was used as a form of treatment can inform future concepts of ethical design practice when applied to current population health challenges, such as design for dementia care. While architecture itself does not necessarily provide a cure, good design can act as a preventative tool and enhance overall quality of care.

Purpose: This study aims to identify the potential effects of home renovation on independence promotion of physically disabled Koreans living at home., Method: The method of the study is a survey with a questionnaire; subjects are physically disabled people living at home in rural and urban areas in Korea. The Functional Independence Measure was used to measure changes in subjects' levels of independence., Results: It was expected that if homes were renovated according to individual needs, disabled people's independence level would be increased by one or more level compared to their current daily independence level in their existing homes. In particular, independence levels concerning bathing and locomotion, which are low in existing conditions, were expected to increase significantly with renovation. Such effects on independence level were conspicuous for disabled people in rural area., Conclusion: The results prove the positive effects of home renovations of disabled people's independence, thus providing meaningful academic evidence on home renovations for disabled people. Implication for rehabilitation Korea had a culture where support measures to aid the life independence of disabled persons relied heavily on human services, leading to a lack of diversity in support measures. By closing the gap between the resident's disability and the inadequacy in their prevailing environment, house remodeling can be a crucial intervention for improving the independence of disabled persons in their daily lives. Depending on the nature of their disabilities and their residential arrangements, disabled persons have diverse needs regarding home remodeling. Implementing home remodeling in such a manner that suits the resident's needs is crucial to boosting their independence. Because of this, remodeling personnel must interact with residents prior to the renovation while also strengthening their expertise.

Purpose: The firmness and stability of indoor and outdoor surfacing are critical to the accessibility and safety of all environments for people with mobility impairments and/or who use mobility devices. ASTM F1951 laboratory test procedures include pass/fail criteria for determining playground surface accessibility by comparing the work to propel up a 1:14 (7.1%) grade ramp to that of the test surface in a wheelchair. A portable instrumented surface indenter (ISI) was developed to validate that accessibility results obtained in the laboratory are maintained in the field where the surface is installed and used., Methods: Accessibility measurements have been made on indoor and outdoor surfaces tested in the laboratory using both the ASTM F1951 and the ISI over 13 years. Correlations between these two methods were calculated., Results: A strong correlation has been demonstrated for the sum of the ISI firmness and stability results compared to the sum of the ASTM F1951 straight propulsion and turning results (R 2 =0.9006)., Conclusions: The portable ISI can be used to verify that the firmness and stability of an installed surface in the field correlates to the accessibility results of the surface tested in the laboratory concurrently according to ASTM F1951 and the ISI. Implications for Rehabilitation The Instrumented Surface Indenter (ISI) allows for surfaces in all environments to be tested for firmness and stability, which is critical for wheelchair user safety, especially during rehabilitation when learning to use a wheelchair. The ISI allows for surfaces in all environments to be tested for firmness and stability, which increases access to all indoor and outdoor surfaces, thereby improving the quality of life for people who have mobility impairments and/or use mobility devices, such as canes, crutches, walkers, and wheelchairs. Using the ISI to test the firmness and stability of installed playground surfaces increases access to playgrounds for children with mobility impairments, facilitating developmentally critical peer-play opportunities for children who use mobility devices. Using the ISI to test the firmness and stability of installed playground surfaces increases access to playgrounds for people with mobility impairments, allowing adults who use a mobility device to supervise and play with children in their lives.

Purpose: The home-based rehabilitation of elderly patients improves their autonomy, independence and reintegration into society. Hence, a suitable environment plays an important role in rehabilitation, as do different assistance technologies. The majority of accidents at home involving elderly people occur in the bathroom. Therefore, the planning of the layout of facilities is important in this potentially dangerous area. This paper proposes an approach towards designing and optimizing the layout of facilities in the bathroom, based on logistical and nonlogistical relationships., Methodology: A fuzzy-based analytical hierarchical process (fuzzy-AHP) is then proposed for a comprehensive evaluation of the alternatives for this layout plan. This approach was applied to the home of a 71 years old female patient, who was experiencing home-based rehabilitation. After the initial designing and optimizing of the layout of the facilities in her bathroom, a plan could then be created for her particular needs., Findings: The results of this research could then enable the home-based rehabilitation of elderly patients to be more effective. Value: This paper develops a new approach to design and optimize the layout of facilities in bathroom for the elderly. Implications for Rehabilitation Develop a new approach to design and optimize the layout of facilities in bathroom. Provide a mathematical and more scientific approach to home layout design for home-based rehabilitation. Provide new opportunities for research, for both the therapist and the patient to analyse the home facility layout.

Purpose: The purpose of this experiment was to examine the impact of disability type and accommodation type on participants' perceptions of the appropriateness of accommodations on university campuses., Research Method: Participants were 223 university students who evaluated the written symptom descriptions of 8 hypothetical university students with disabilities to determine whether a series of 8 different accommodations would be appropriate for them., Results: Perceptions of accommodation appropriateness were impacted by both the type of disability and the type of accommodation under consideration. The results indicated that accommodations for psychiatric disabilities and invisible physical disabilities were less likely to be viewed as appropriate regardless of how well they addressed the symptoms of the disability., Conclusions: Students with psychiatric and invisible physical disabilities may be especially vulnerable to negative peer perceptions if they receive accommodations. These attitudinal barriers make it harder for students with disabilities to integrate into the college social environment. Students with disabilities who do not feel welcome are less likely to self-advocate to acquire the accommodations that they need and are therefore less likely to succeed in their course work. Our results highlight the importance of programs that encourage the integration of students with disabilities and decrease the stigma of disability on campus. (PsycINFO Database Record, ((c) 2018 APA, all rights reserved).)

Background and Objectives: To examine prospective associations of perceived attributes of local destinations and routes with middle-to-older aged adults' 4-year changes in walking for transport (WT) and walking for recreation (WR)., Research Design and Methods: Data were collected from adults aged 50-64 years old, living in Adelaide, Australia. Participants (N = 454) reported weekly frequency of WT and WR at baseline (2003-2004) and follow-up (2007-2008). Attributes of local destinations and routes were based on self-reported measures at baseline and included: proximity to utilitarian and recreational destinations, the number of such destinations within 10 and 11-20 min walk from home, street connectivity, and walking paths. Generalized additive mixed models were used to examine the associations of perceived destination and route attributes with changes in frequency of WT and WR., Results: Higher levels of perceived proximity to utilitarian destinations, reporting a larger number of utilitarian destinations within 10 min walk from home and higher street connectivity were associated with more positive changes in frequency of WT. Higher levels of perceived proximity to recreational destinations and better walking paths were associated with more positive changes in frequency of WR. No curvilinear relationships were observed and baseline frequency of walking did not moderate the associations., Discussion and Implications: Proximity of utilitarian and recreational destinations, well-connected streets, and better walking paths can be supportive of long-term participation in walking among middle-to-older aged adults. Environmental and policy initiatives focusing on such destination and route attributes have the potential to support residents' aging in place., (© The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Engagement in religious and spiritual activities and expression are important to many people. Praying in a mosque is a major component of basic worship for Muslims. Riyadh has a population of more than six million people and more than 17 thousand mosques., Objective: The purpose of this study was to explore wheelchair accessibility of mosques in Riyadh from the perspective of wheelchair users and their caregivers., Methods: A survey was conducted to explore the opinions of wheelchair users and their caregivers regarding wheelchair accessibility of frequently used mosques., Results: Forty-eight wheelchair users and 12 caregivers participated in the study. The main reason for being confined to a wheelchair was a motor vehicle accident (77%). The majority of the participants (84%) indicated that they needed assistance to propel their wheelchairs. Overall, 86% of wheelchair users and 84% of caregivers expressed dissatisfaction with the mosques' accessibility for wheelchair users., Conclusion: Mosques were found not to be accessible for wheelchair users. The current situation forces wheelchair users to pray in isolation in their houses, preventing them from participating in an important part of their faith. Though acts mandating the accessibility of public places for wheelchair users have been promulgated in the Kingdom of Saudi Arabia (KSA), the acts are not implemented in ways which can contribute to a meaningful, tolerable and independent life for wheelchair users.

Walking is a central form of physical activity among older adults that is associated with the physical environment at various scales. This mixed-methods study employs a concurrent nested design to explore objective and perceived environmental characteristics of older adults' local walking routes. This was achieved by integrating quantitative Geographic Information System (GIS) data with qualitative data obtained using the Stanford Discovery Tool (DT). Fifty-nine community-dwelling middle-aged and older adults (14 men and 45 women aged 50+) were recruited in a snowball approach through community centers in the city of Haifa (Israel). Four neighborhood environment themes were identified: pedestrian infrastructure, access to destinations, aesthetics, and environmental quality. Both geometrical traits (i.e., distance, slope) and urban features (i.e., land-uses, greenery) of the route may impact the experience of walking. The findings thus highlight the importance of micro-scale environmental elements in shaping environmental perceptions, which may consequently influence the choice of being active.

Background: Difficulty ascending ramps and inclines with a manual wheelchair adversely affects the everyday mobility and overall quality of life of manual wheelchair users. Currently, various anti-rollback devices are available to assist manual wheelchair users to ascend ramps and inclines. However, these devices have 2 main shortcomings: restriction to backward motion limiting recovery from an overturning wheelchair, which is a safety concern; and difficulty in engaging/disengaging the device while on the ramp., Objective: To evaluate the functionality and usability of 2 novel wheelchair anti-rollback devices developed to address these shortcomings (prototypes "Wheel" and "Brake")., Design: Cross-sectional., Setting: Rehabilitation research facility., Participants: Twelve adult participants with chronic spinal cord injury., Methods: Participants completed training and tested with both the wheelchair anti-rollback devices on a 7.3-m-long ramp., Main Outcome Measurements: Number of stops, perceived physical exertion, pain, and ease of use of these devices as participants maneuvered their wheelchairs up a 7.3-m ramp were assessed. Participants also evaluated their satisfaction with the usability of both the devices using the Quebec User Evaluation of Satisfaction With Assistive Technology (QUEST 2.0)., Results: Both prototypes evaluated overcame the limitations of the existing anti-rollback devices. Nonparametric statistical tests showed that participants rated both prototypes similarly for the overall functional and usability aspects. However, the participants' satisfactory rating were higher for the prototype "Brake" than for the prototype "Wheel" based on a functional aspect (ie, engaging/disengaging easiness), and higher for Wheel than for Brake, based on a usability aspect (prototype size)., Conclusions: The qualitative and quantitative outcomes of this investigation, based on the usability and functional evaluations, provided useful information for the improvement in the design of both anti-rollback devices, which may allow manual wheelchair users to manage ramp ascent more safely and easily. Further evaluations with a different SCI population is recommended., Level of Evidence: IV., (Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.)

Purpose: We studied whether entrance-related environmental barriers, perceived and objectively recorded, were associated with moving out-of-home daily in older people with and without limitations in lower extremity performance., Methods: Cross-sectional analyses of the "Life-space mobility in old age" cohort including 848 community-dwelling 75-90-year-old of central Finland. Participants reported their frequency of moving out-of-home (daily vs. 0-6 times/week) and perceived entrance-related environmental barriers (yes/no). Lower extremity performance was assessed (Short Physical Performance Battery) and categorized as poorer (score 0-9) or good (score 10-12). Environmental barriers at entrances and in exterior surroundings were objectively registered (Housing Enabler screening tool) and divided into tertiles. Logistic regression analyses were adjusted for age, sex, number of chronic diseases, cognitive function, month of assessment, type of neighborhood, and years lived in the current home., Results: At home entrances a median of 6 and in the exterior surroundings 5 environmental barriers were objectively recorded, and 20% of the participants perceived entrance-related barriers. The odds for moving out-of-home less than daily increased when participants perceived entrance-related barrier(s) or when they lived in homes with higher numbers of objectively recorded environmental barriers at entrances. Participants with limitations in lower extremity performance were more susceptible to these environmental barriers. Objectively recorded environmental barriers in the exterior surroundings did not compromise out-of-home mobility., Conclusion: Entrance-related environmental barriers may hinder community-dwelling older people to move out-of-home daily especially when their functional capacity is compromised. Potentially, reducing entrance-related barriers may help to prevent confinement to the home., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Purpose: Existing research suggests that the decision to grant or deny workplace accommodations for people with disabilities is influenced by a range of legal and nonlegal factors. However, less is known about how these factors operate at the within-person level. Thus, we proposed and tested a multilevel model of the accommodation decision-making process, which we applied to better understand why people with psychological disabilities often experience greater challenges in obtaining accommodations., Method: A sample of 159 Australian adults, composed mostly of managers and HR professionals, read 12 vignettes involving requests for accommodations from existing employees. The requests differed in whether they were for psychological or physical disabilities. For each vignette, participants rated their empathy with the employee, the legitimacy of the employee's disability, the necessity for productivity, the perceived cost, and the reasonableness, and indicated whether they would grant the accommodation., Results: Multilevel modeling indicated that greater empathy, legitimacy, and necessity, and lower perceived cost predicted perceptions of greater reasonableness and greater granting. Accommodation requests from employees with psychological disabilities were seen as less reasonable and were less likely to be granted; much of this effect seemed to be driven by perceptions that such accommodations were less necessary for productivity. Ratings on accommodations were influenced both by general between-person tendencies and within-person appraisals of particular scenarios., Conclusions: The study points to a need for organizations to more clearly establish guidelines for how decision-makers should fairly evaluate accommodation requests for employees with psychological disabilities and disability more broadly. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

Problem: Thailand passed the Persons with Disabilities Empowerment Act in 2007. The Act, which is in compliance with the United Nations Convention on the Rights of Persons with Disabilities , ensures that registered persons with disabilities are entitled to home environment modifications' benefits up to a maximum of 20 000 baht (670 United States dollars); however, the Act's enforcement is still weak in Thailand., Approach: In 2013, researchers developed a home modification programme, consisting of a multidisciplinary team of medical and nonmedical practitioners and volunteers, to modify homes for persons with disabilities. The programme recruited participants with physical disabilities and assessed their functioning difficulties. Participants' homes were modified to address identified functioning difficulties., Local Setting: The project was implemented in four provinces in collaboration with staff from 27 district hospitals located in north-eastern Thailand., Relevant Changes: After the home modifications, all 43 recruited participants reported reduced difficulties in all areas, except for participants with severe degrees of difficulties, such as those reporting being unable to walk and unable to get up from the floor. The participants' quality of life had also improved. The average EQ-5D-5L score, measuring quality of life, increased by 0.203 - from 0.346 at baseline to 0.549 after the modifications., Lessons Learnt: Home modifications in low-resourced settings are technically and financially feasible and can lead to reducing functioning difficulties and improving the quality of life of persons with disabilities. Implementation requires government subsidies to finance home modifications and the availability of technical guidelines and training on home modifications for implementing agents.

Background: The Life-Space Assessment (LSA), developed in the USA, is an instrument focusing on mobility with respect to reaching different areas defined as life-spaces, extending from the room where the person sleeps to mobility outside one's hometown. A newly translated Swedish version of the LSA (LSA-S) has been tested for test-retest reliability, but the validity remains to be tested. The purpose of the present study was to examine the concurrent validity of the LSA-S, by comparing and correlating the LSA scores to other measures of mobility., Method: The LSA was included in a population-based study of health, functioning and mobility among older persons in Sweden, and the present analysis comprised 312 community-dwelling participants. To test the concurrent validity, the LSA scores were compared to a number of other mobility-related variables, including the Short Physical Performance Battery (SPPB) as well as "stair climbing", "transfers", "transportation", "food shopping", "travel for pleasure" and "community activities". The LSA total mean scores for different levels of the other mobility-related variables, and measures of correlation were calculated., Results: Higher LSA total mean scores were observed with higher levels of all the other mobility related variables. Most of the correlations between the LSA and the other mobility variables were large (r = 0.5-1.0) and significant at the 0.01 level. The LSA total score, as well as independent life-space and assistive life-space correlated with transportation (0.63, 0.66, 0.64) and food shopping (0.55, 0.58, 0.55). Assistive life-space also correlated with SPPB (0.47). With respect to maximal life-space, the correlations with the mobility-related variables were generally lower (below 0.5), probably since this aspect of life-space mobility is highly influenced by social support and is not so dependent on the individual's own physical function., Conclusion: LSA was shown to be a valid measure of mobility when using the LSA total, independent LS or assistive LSA.

Objectives: To determine the relationship between neighborhood-level socioeconomic characteristics, life-space mobility, and incident falls in community-dwelling older adults., Design: Prospective, observational cohort study with a baseline in-home assessment and 6-month telephone follow-up., Setting: Central Alabama., Participants: Community-dwelling adults aged 65 and older recruited from a random sample of Medicare beneficiaries (N = 1,000)., Measurements: Neighborhood disadvantage was measured using a composite index derived from baseline neighborhood-level residential census tract socioeconomic variables. Data on individual-level socioeconomic characteristics, clinical variables, and life-space collected at baseline were included as covariates in a multivariate model using generalized estimating equations to assess the association with incident falls in the 6 months after baseline., Results: Of the 940 participants who completed baseline and follow-up assessments, 126 (13%) reported one or more new falls in the 6 months after baseline. There was an independent nonlinear association between neighborhood disadvantage (according to increasing quartiles of disadvantage) and incident falls after adjusting for confounders: The lowest quartile served as reference; 2nd quartile odds ratio (OR) = 2.4, 95% confidence interval (CI) = 1.2-4.6; 3rd quartile OR = 1.9, 95% CI = 1.0-3.7; 4th quartile OR = 3.2, 95% CI = 1.7-6.0. Each 10-point decrement in life-space (OR = 1.2, 95% CI = 1.0-1.3) was associated with a higher risk of falls., Conclusion: Greater neighborhood disadvantage was associated with greater risk of falls. Life-space also contributes separately to fall risk. Community-dwelling older adults in disadvantaged neighborhoods, particularly those with limited mobility, may benefit from a more-rigorous assessment of their fall risk by healthcare providers. Neighborhood level socioeconomic characteristics should also be an important consideration when identifying vulnerable populations that may benefit the most from fall prevention programs., (© 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.)

Background: Research has established a need to consider further aspects of the home environment in home modification provision and evaluation. The Dimensions of Home Measure (DOHM) was developed as a self-report outcome measurement tool for home modification practice to meet this need. Its development was informed by a literature review and qualitative exploration which identified six dimensions of the home environment: the physical, social, personal, temporal, occupational and societal dimensions which contribute to one's experience of home. This paper reports the initial evaluation of the validity of the DOHM., Method: The DOHM was completed by 163 community dwelling older adults and people with disabilities. The Rasch measurement model was used to evaluate three aspects of construct validity: rating scale structure, unidimensionality and targeting., Results: The five-point DOHM rating scale function was evaluated using Linacre's (2002) guidelines. The middle rating category did not function well, and this resulted in collapsing the rating scale from five to four points. The unidimensionality of the DOHM's subscales was supported by Rasch-based principal component analysis and item fit analysis. However, hierarchical results of item difficulties revealed significant gaps in each of the DOHM's subscales, indicating that more items will be needed to capture the full range of participant's experiences of home., Conclusion: The DOHM was developed to provide a relevant evaluation tool for home modification practice which comprehensively measures the home environment. This study identified preliminary validity of this tool, with revision and further psychometric validation required., (© 2016 Occupational Therapy Australia.)

In 1998 Molly Follette Story, James Mueller and Roland Mace published the book The Universal Design File; that can be considered the result of a long way, started by Mace in 1985, towards a design approach based on the principles of Universal Design. In 2010 the Centre for Active Design publishes the Active Design Guidelines: Promoting Physical Activity and Health in Design. Between these two milestones, this article offers some ideas about the evolution of the universal approach to design. Assuming that Universal Design approach can present limits, this article aims to reflect on the relationship between universal and particular in developing a theoretical approach to architecture and design, supporting the idea that the wide gray area of the population who need specific access solutions can find answers to their needs only through successive adjustments, time by time plugged on universal solutions. This implies a process of requirement-based retrofitting of existing spaces and goods, to get qualities or perfecting performances otherwise inadequate. From this perspective the project for accessibility should be seen as a never ending process, and not a fix and final product, and Universal Design should be considered as a methodological approach ideally tending towards accessibility as a goal. Having this in mind, the article explores the issues related to how to blend universal and particular in a human centred design strategy, how to combine design actions and awareness by the users to allow an effective mutual adaptation between people and their living environment. The article aims to be further food for thought regarding research to be implemented in future works.

Purpose: Universal design (UD) provides an explanation of good design based on the user perspective, which are outlined through its principles, goals, and related frameworks. The aim of this paper is to provide an overview of the frameworks and methods for UD building evaluations and to describe how close they have come to describing what a universally designed building is., Methods: Evaluation approaches are reviewed from the existing literature across a number of spatial disciplines, including UD, human geography and urban studies., Results: Four categories of UD evaluation methods are outlined, including (1) checklist evaluations, (2) value-driven evaluations, (3) holistic evaluations, and (4) invisible evaluations., Conclusions: A number of suggestions are made to aid research aimed at developing UD evaluation in buildings. (1) Design standards and guidelines should be contested or validated where possible; (2) evaluation criteria should be contextual; (3) it may be more practical to have separate methodologies for contextualising UD to allow for the creation of an evaluating tool that is practical in use. Additionally, there is a difficulty in establishing a clear basis for evaluating how empathetic buildings are without expanding the methodological horizons of UD evaluation. Implications for Rehabilitation For universal design (UD) evaluation to address human need requires methods that are culturally, temporally, and typologically specific. Practical instruments for measuring UD need to be divorced from but contingent upon methods than can address local specificities. The process of evaluation can provide knowledge that can contest or validate the literature based sources such as design guidelines, or standards. UD evaluation requires constant renewal by searching for new, flexible strategies that can respond to socio-cultural change.

Objectives: We investigated the perspectives of people using a wheelchair and their difficulties in accessing dental services., Methods: Our participatory research was on the basis of a partnership between people using a wheelchair, dental professionals, and academic researchers. Partners were involved in a committee that provided advice at all stages of the project. Our team adopted a qualitative descriptive design. Between October 2011 and October 2012 we conducted semistructured individual interviews with 13 adults who lived in Montreal, Québec, Canada, and used a wheelchair full time. We audio-recorded and transcribed verbatim interviews, and we interpreted data using an inductive thematic analysis., Results: Oral health is of heightened importance to this group of people, who tend to use their mouth as a "third hand." We identified successive challenges in accessing dental services: finding a dentist and being accepted, organizing transportation, entering the building and circulating inside, interacting with the dental staff, transferring and overcoming discomfort on the dental chair, and paying for the treatments., Conclusions: Governments, dental professional bodies, dental schools, and researchers should work with groups representing wheelchair users to improve access to dental services.

Background: Making the built environment accessible for all regardless of functional capacity is an important goal for public health efforts. Considerable impediments to achieving this goal suggest the need for valid measurements of acccessibility and for greater attention to the complexity of person-environment fit issues. To address these needs, this study aimed to provide a methodological platform, useful for further research and instrument development within accessibility research. This was accomplished by the construction of a typology of problematic person-environment fit constellations, utilizing an existing methodology developed to assess and analyze accessibility problems in the built environment., Methods: By means of qualitative review and statistical methods we classified the person-environment fit components covered by an existing application which targets housing accessibility: the Housing Enabler (HE) instrument. The International Classification of Functioning, Disability and Health (ICF) was used as a conceptual framework. Qualitative classification principles were based on conceptual similarities and for quantitative analysis of similarities, Principal Component Analysis was carried out., Results: We present a typology of problematic person-environment fit constellations classified along three dimensions: 1) accessibility problem range and severity 2) aspects of functioning 3) environmental context. As a result of the classification of the HE components, 48 typical person-environment fit constellations were recognised., Conclusions: The main contribution of this study is the proposed typology of person-environment fit constellations. The typology provides a methodological platform for the identification and quantification of problematic person-environment fit constellations. Its link to the globally accepted ICF classification system facilitates communication within the scientific and health care practice communities. The typology also highlights how relations between aspects of functioning and physical environmental barriers generate typical accessibility problems, and thereby furnishes a reference point for research oriented to how the built environment may be designed to be supportive for activity, participation and health.

Mobility and parking in urban areas are often difficult for people with disabilities. Obstacles include lack of accessible information on routes, transport alternatives and parking availability, as well as fraud in the use of the specific services intended for these citizens. The SIMON project aims to improve this situation through the integration of different ICT solutions. SIMON is enhancing the European Parking Card for disable people with contactless technologies and integrates mobile solutions to support user unique identification in existing parking areas whilst preserving privacy. SIMON will also promote better mobility solutions for mobility including information, navigation and access to restricted areas.

The paper presents an analysis of prototypes, studies, and applications for the mapping of city accessibility, focusing mainly on sidewalks accessibility. Moreover, it presents the results of two focus groups that we organized both with electric and with manual wheelchairs to attain requirements and insights to design a user-friendly app for the collection and visualization of information about the accessibility of urban pedestrian pathways.

Two separate apps that address the increasingly important issue of accessible housing for senior citizens have been developed in different project settings. One of the apps was developed to facilitate the process for professional raters to assess housing accessibility in the context of individual housing adaptations. The other app was developed for senior citizens to raise their awareness of possible accessibility problems in their current dwelling and in other apartments within the available housing stock. Both apps were developed with a high degree of active user involvement in processes utilizing multiple state of the art methods. The results are two well accepted prototype apps perceived as user-friendly and appropriate for the intended user groups. By combining these two apps, our ambition is for the professional raters to benefit by gaining knowledge of their clients' perceived needs and desires, and for senior citizens to benefit by getting access to a database of professionally rated dwellings. The ultimate goal is the generation of sound knowledge reflecting the needs and desires of senior citizens and professional requirements regarding accessible housing as a means to inform and influence housing provision policies.

Unlabelled: The built environment (BE) impacts on people's disability and health, in terms of overweight, depression, alcohol abuse, poor self-rated health and presence of psychological symptoms; it is reasonable to assume that BE also impacts on participation levels. This paper presents the validation of the COURAGE Built Environment Self-Reported Questionnaire (CBE-SR), an instrument designed to evaluate BE in the context of health and disability. Subjects participating to COURAGE, a cross-sectional study conducted on 10,800 citizens of Poland, Finland and Spain, completed a protocol inclusive of the CBE-SR. Psychometric properties and factor structure were analysed, and factor scores created. Gender differences, differences between persons from different age groups and persons reporting the environment as facilitating, hindering or neutral were calculated. Eight items were deleted so that the final version of CBE-SR comprises 19 items. Cronbach's alpha ranged from 0.743 to 0.906, and test-retest stability was demonstrated for the majority of items. Four subscales were identified: Usability of the neighbourhood environment; Hindrance of walkable environment; Easiness of use of public buildings, places and facilities; and Risk of accidents and usability of the living place. Younger respondents reported their neighbourhood as more usable but perceived walkways as more hindering and public buildings as less easy to use; gender differences were almost inexistent. The CBE-SR is a four-scale instrument with good psychometric properties that measures the person-environment interaction. It is sensitive across age groups and is consistent with the subject's overall judgement of the degree to which the environment is facilitating or hindering., Key Practitioner Message: Poor built environments have a negative impact on the level of a person's participation. However, instruments measuring the person-environment interaction are lacking. The CBE-SR is a valid and reliable instrument that researchers can use to assess the relationships between the intrinsic health state and the objective features of the environment. Understanding this relationship would provide further insight into the need of addressing the individual's functioning either by means of interventions directed to the individual or by making changes to the individual's environment., (Copyright © 2013 John Wiley & Sons, Ltd.)

Unlabelled: A tool to assess the built environment, which takes into account issues of disability, accessibility and the need for data comparable across countries and populations, is much needed. The Collaborative Research on Ageing in Europe (COURAGE) in Europe Built Environment Outdoor Checklist (CBE-OUT) helps us to understand when features of the neighbourhood environment have either a positive or negative impact on the accessibility of neighbourhoods for healthy ageing. The CBE-OUT is composed of 128 items that can be recorded when present in the evaluated environment. Audits were performed in households randomly selected from each cluster of the sample for Finland, Poland and Spain, following precise rules defined by experts. Global scores were computed both section by section and in the overall checklist, rescaling the resulting scores from 0 (negative environment) to 100 (positive). The total number of completed CBE-OUT checklists was 2452 (Finland, 245; Poland, 972; and Spain, 1235). Mean global score for our sample is 49.3, suggesting an environment composed both of facilitating and hindering features. Significant differences were observed in the built environment features of the three countries and in particular between Finland and the other two. The assessment of features of built environment is crucial when thinking about ageing and enhanced participation. The COURAGE in Europe project developed this tool to collect information on built environment in an objective evaluation of environmental features and is a recommended methodology for future studies., Key Practitioner Message: The CBE-OUT checklist is an objective evaluation of the built environment and is centred on technical measurement of features present in the environment and has its foundations in the concepts of disability and accessibility operating in the International Classification of Functioning, Disability and Health (ICF) model. The CBE-OUT checklist can be analysed using both the total score and the single section score, allowing an evaluation of the facilitating or hindering role of the environment and is usable for predictive analysis of ageing trends. The CBE-OUT checklist makes it possible to collect information about the built environment by means of an objective evaluation of environment features and is a recommended methodology for future studies about the built environment., (Copyright © 2013 John Wiley & Sons, Ltd.)

There are few studies of built environment associations with physical activity and weight status among older women in large geographic areas that use individual residential buffers to define environmental exposures. Among 23,434 women (70.0 ± 6.9 yr; range = 57-85) in 3 states, relationships between objective built environment variables and meeting physical activity recommendations via walking and weight status were examined. Differences in associations by population density and state were explored in stratified models. Population density (odds ratio [OR] =1.04 [1.02, 1.07]), intersection density (ORs = 1.18-1.28), and facility density (ORs = 1.01-1.53) were positively associated with walking. Density of physical activity facilities was inversely associated with overweight/obesity (OR = 0.69 [0.49, 0.96]). The strongest associations between facility density variables and both outcomes were found among women from higher population density areas. There was no clear pattern of differences in associations across states. Among older women, relationships between accessible facilities and walking may be most important in more densely populated settings.

Background: Motor vehicle collisions and pedestrian injuries in areas where schools are located are public health problems in Durban., Objective: To evaluate the effect of traffic calming humps on the number and severity of incidences of collisions and injuries in the Chatsworth and KwaMashu residential areas of the eThekwini Municipality., Methods: The evaluation used an observational interrupted time-series study design, with data obtained from the eThekwini Traffic Authority for roads constituting the routes to 34 schools for 2 years prior to and following the implementation of road humps (excluding the intervening year of implementation). A non-probability convenience sample of 19 schools with 39 roads in Chatsworth and 15 schools with 24 roads in KwaMashu was selected., Results: The traffic calming humps improved safety in both areas with respect to the severity of collisions. Serious pedestrian-vehicle collisions (PVCs) dropped by 23% and 22%, while fatal collisions decreased by 68% and 50% in Chatsworth and KwaMashu, respectively. The median annual PVC rate/km of road/year decreased from 1.41 to 0.96 (p=0.007) and from 2.35 to 1.40 (p<0.001) in Chatsworth and KwaMashu, respectively. There was a 1.6% reduction in the median number of fatal or serious PVCs after implementation in Chatsworth (p=0.03) while in KwaMashu, although the number of collisions decreased, the median number increased by 9% (p=0.07)., Conclusions: Traffic calming has been shown to be effective in reducing the number of PVCs but needs to be supported by additional measures to further improve the safety of pedestrians.

Walking outdoors is often difficult or impossible for many seniors and people with disabilities during winter. We present a novel approach for conducting winter accessibility evaluations of commonly used pedestrian facilities, including sidewalks, street crossings, curb ramps (curb cuts and dropped curbs), outdoor stairs and ramps, building and transit entrances, bus stops, and driveways. A total of 183 individuals, aged 18-85 completed our survey. The results show that cold weather itself had little impact on the frequency of outdoor excursions among middle-aged and older adults while the presence of snow and/or ice on the ground noticeably kept people, especially older adults at home. The survey found that the key elements decreasing winter accessibility were icy sidewalks and puddles at street crossings and curb ramps. While communities have recognized the need to improve snow and ice removal, little attention has been paid to curb ramp design which is especially ineffective in winter when the bottom of the ramps pool with rain, snow, and ice, making it hazardous and inaccessible to nearly all users. We conclude that investigations of alternative designs of curb ramp are needed.

The purpose of this research is to examine the ways bicycles swerve off sidewalks onto roads under various conditions. Seven students, five males and two females participated in an experiment on a road with a 100-cm wide sidewalk. Footage of each participant on a bicycle evading obstacles such as a utility pole and pedestrian were taken with a video camera, while a front-wheel view of the path taken by the bicycle was recorded simultaneously with a digital camera. Twelve experimental conditions were used for each participant, consisting of all the combinations of (1) three obstacle types, (2) the side (left or right) to which the bicycle went to avoid the obstacle, and (3) two weather conditions. Based on the two recorded scenes, the path was then analyzed from the viewpoint of how the bicycle swerved to avoid hitting the obstacle. We found that the conditions of riding a bicycle with an umbrella caused a larger swerve to avoid the obstacle than those conditions when the rider did not have an umbrella. In particular, the condition in which the obstacle was a pedestrian who also had an umbrella caused the largest swerve. Furthermore, the distance required to become aligned with the sidewalk when the obstacle was a pedestrian walking toward the cyclist was longer than that for other obstacles. The swerve width data showed interesting results, including a tendency for swerve width to be wider when the obstacle was a utility pole compared with other obstacles.

Surface characteristics of a cross slope can impact the ease with which a manual wheelchair (MWC) user propels across a surface. The purpose of this research was two-fold. Phase I of this research surveyed MWC users to identify cross slope scenarios that they reported to be more difficult to traverse compared to other common driving obstacles. Our survey results showed that, overall, cross slopes were harder to propel across than narrow and manual doors, and cross-slopes in inclement weather conditions were equal or more difficult than gravel and rough-surfaces. Cross slopes with severe angles and those with compound angles (slope with cross-slope) were the most difficult to traverse. Phase II focused on identifying the responses (e.g., avoid, explore alternative, experience a sense of insecurity, no effect) people had when viewing pictures of various cross-slopes scenarios (e.g., narrow space, compound angles, extreme weather) that wheelchair users encounter. These results showed that people reported that they would avoid or feel insecure on some cross-sloped surfaces, like the weather, that are not within our control, others, like compound angle and curb-cuts on slopes, that can be addressed in the construction of pathways or sidewalks.

The enforcement of accessibility today has faced several difficulties, such as intervention in historic buildings that now house public services and cultural activities, such as town halls, museums and theaters and should allow access, on equal terms to all people. The paper presents the application of a method for evaluating the spatial accessibility conditions and their results. For this, we sought to support the theoretical foundation about the main issue involved and legislation. From the method used--guided walks--it was possible to identify the main barriers to accessibility in historic buildings. From the identified barriers, possible solutions are presented according to the four components of accessibility: spatial orientation, displacement, use and communication. It is hoped also that the knowledge gained in this research contributes to an improvement of accessibility legislation in relation to the listed items.

The present work demonstrates, through a case study, the importance of theoretical knowledge in practical application of spatial accessibility in order to guarantee equal conditions for all people in the movement and use of space. Initially there was a literature review on the accessibility of space and how design in a accessible way. Next, we show one makeover proposal in one public school that wants to provide access to people with disabilities. This makeover was done and so we could evaluate the buildings changes through the method of accompanied walk with two people. Finally we present the main results and discussions.

Restriction of behavioral opportunities and uneven use of space are considerable welfare concerns in modern broiler production, particularly when birds are kept at high densities. We hypothesized that increased environmental complexity by provision of barrier perches would help address these issues by encouraging perching and enhancing use of the pen space across a range of stocking densities. 2,088 day-old broiler chicks were randomly assigned to one of the following barrier and density treatment combinations over four replications: simple barrier, complex barrier, or control (no barrier) and low (8 birds/m(2)), moderate (13 birds/m(2)), or high (18 birds/m(2)) density. Data were collected on focal birds via instantaneous scan sampling from 2 to 6 weeks of age. Mean estimates per pen for percent of observations seen performing each behavior, as well as percent of observations in the pen periphery vs. center, were quantified and submitted to an analysis of variance with week as the repeated measure. Barrier perches, density and age affected the behavioral time budget of broilers. Both simple and complex barrier perches effectively stimulated high perching rates. Aggression and disturbances were lower in both barrier treatments compared to controls (P<0.05). Increasing density to 18 birds/m(2) compared to the lower densities suppressed activity levels, with lower foraging (P<0.005), decreased perching (P<0.0001) and increased sitting (P = 0.001) earlier in the rearing period. Disturbances also increased at higher densities (P<0.05). Use of the central pen area was higher in simple barrier pens compared to controls (P<0.001), while increasing density above 8 birds/m(2) suppressed use of the central space (P<0.05). This work confirms some negative effects of increasing density and suggests that barrier perches have the potential to improve broiler welfare by encouraging activity (notably by providing accessible opportunities to perch), decreasing aggression and disturbances, and promoting more even distribution of birds throughout the pen space.

Grant Macdonald, managing director at supplier of mechanical and electronic door locks, Codelocks, examines some of the important issues for healthcare estates and facilities personnel considering how best to protect parts of a healthcare facility--large or small--given the need to minimise costs and not "over-specify" on security, while simultaneously ensuring that patients, staff, and hospital property, are safeguarded.

Given the growing evidence of the influence of the environment on older adult health, the need to design and implement effective environmental policy around healthy and vital aging is urgent. This article describes issues amenable to improvement through policy change, evidence supporting specific policy approaches and outcomes, and promising strategies for implementing those approaches. Key areas of focus are neighborhood design and safety, housing, transportation, and mobility. Strategies to build capacity for policy change are also addressed. Our goals are to foster greater attention to environmental change in support of healthy aging and to illuminate directions for policy change.

Background: Setting physical barriers, for example platform screen doors (PSDs), has been proven to be effective in preventing falls onto railway tracks, but its cost-effectiveness is not known. For economic evaluation of public health interventions, the importance of including non-health factors has been noted despite a lack of empirical studies. This study aimed to investigate the effectiveness and cost-effectiveness of PSDs, which are installed in part of the Hong Kong railway system, for preventing railway injuries., Methods: Data on railway injuries from 1997 to 2007 were obtained from the railway operators. Poisson regression was used to examine the risk reduction. Two incremental cost-effectiveness ratios (ICER) were calculated to assess the cost-effectiveness based on (1) disability-adjusted life years (DALYs) only and (2) DALYs with potential fare revenue and passengers' waiting time lost due to railway circulation collapse., Results: The PSD installation has effectively reduced railway injuries (adjusted 5-year average percentage change: -68.8%, p<0.0001) with no apparent substitution effect to the other platforms observed. To be cost-effective, the cost of gaining a healthy life year (ICER) should not exceed three times the per capita GDP (US$74,700). The PSD installation would only be cost-effective if the loss of fare revenue and passengers' waiting time, in addition to DALY, were included (ICER: US$65,400), while the ICER based on DALY only would be US$77,900., Conclusion: The challenges of complexity for economic evaluation appear in many community-based health interventions. A more extensive perspective for exploring other outcome measurements and evaluation methods to reflect a fair and appropriate value of the intervention's cost-effectiveness is needed.

This study was designed to investigate the effects of three countermeasures--landscaping, building a fence and prohibitive signs--on the frequency of trespassing, which in this case means crossing the track at places where it is forbidden. At each location the official route was no more than 300 m away. The main results showed that the effect of each countermeasure on the frequency of trespassing was statistically significant. Specifically, the fencing reduced trespassing by 94.6%, followed by landscaping (91.3%) and prohibitive signs (30.7%). The majority of illegal crossings were committed alone and the persons trespassing were mostly adults and men. In addition, the results demonstrated some tendencies of how the effects of the selected countermeasures can vary with the characteristics of the trespassers. The main implication of this study is that the building of physical barriers such as landscaping or fencing is recommended for reducing trespassing. However, if the required resources are not available or the site is not suitable for such measures, the use of prohibitive signs is recommended. Further, there is a need to tailor the countermeasures to the characteristics of the trespassers in order to ensure that the most appropriate countermeasures are applied., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

PURPOSE.Accessibility standards for wheeled mobility devices currently use a 1.5 m turning circle, designed to accommodate manual wheelchairs. Scooters are less manoeuvrable than wheelchairs, so allowing a full turning circle would require too much space. Instead, we propose using a rectangle that provides space for a three-point turn. Here, we determine the area requirements of this approach. METHOD. For rectangular 'rooms' of varying aspect ratios, we measured the minimum dimensions in which two four-wheeled scooters (the Celebrity-X and Fortress-1700), which combine good outdoor performance with reasonable indoor manoeuvrability, could enter the space, perform a three-point turn and exit. Moveable Styrofoam walls defined each 'room', and a doorway was located either near the corner of the space or in the middle of one wall. 'Room' size was decreased until our expert driver could no longer perform the manoeuvre. RESULTS. Compared to the area required for a turning circle, 42-54% savings were achieved. Relative to existing requirements, 53-95% more space is required to accommodate the Celebrity-X; 173-223% increases are necessary for the Fortress-1700. CONCLUSIONS. When accommodating four-wheeled scooters, our proposed three-point turn definition would require more space than the current standards, but considerably less than if a full turning circle were used.