Making science accessible for blind and low-vision people, and those with diverse needs.

The May-June 2024 issue of Immunology & Cell Biology contains an Immunology Futures Special Feature on Disability Inclusion in Science. Diverse groups do better in science, yet individuals with disabilities face barriers to accessing education and opportunities within scientific disciplines. The Monash Sensory Science program, led by Professor Jamie Rossjohn and legally blind artist in residence Dr Erica Tandori, has transformed the accessibility for those with blindness, low vision and diverse needs (BLVDN) to experience biomedical data visualization through the form of multisensory scientific communication. The Monash Sensory Science Exhibition, first hosted in 2018 with the support of Monash University and the Australian Research Council, utilizes tactile multisensory and multimodal artworks, interactive displays and multisensory science books for BLVDN participants. In this Special Feature, scientists and researchers involved in the 2023 Autoimmunity Monash Sensory Science Exhibition discuss the novel models and displays designed to improve the scientific understanding of complex autoimmune diseases including rheumatoid arthritis, lupus, celiac disease, psoriasis and type 1 diabetes. This Special Feature aims to inform the inclusive teaching of immunology and raise discussions of how to improve access to all within our scientific institutions.

Helping Blind People Grasp: Evaluating a Tactile Bracelet for Remotely Guiding Grasping Movements.

The problem of supporting visually impaired and blind people in meaningful interactions with objects is often neglected. To address this issue, we adapted a tactile belt for enhanced spatial navigation into a bracelet worn on the wrist that allows visually impaired people to grasp target objects. Participants' performance in locating and grasping target items when guided using the bracelet, which provides direction commands via vibrotactile signals, was compared to their performance when receiving auditory instructions. While participants were faster with the auditory commands, they also performed well with the bracelet, encouraging future development of this system and similar systems.

Inclusive multisensory science and immunology books for blind, low-vision and diverse-needs audiences.

This paper presents interdisciplinary research exploring the development of inclusive multisensory science books, communicating immunology data for blind, low-vision and diverse-needs audiences. The research adopted an inductive theory-building approach, practice-based art methods and music and design methods, leveraging the lived experience of a legally blind artist. The research also involved designers and scientists in a cocreation process, producing books that incorporate tactile artworks, Braille-inspired protein models, image sonification and interaction. Two multisensory book titles, "The Heroes Within You: A Multisensory Exploration of Infection and Immunity" and "My Goodness: A Multisensory Exploration of Nutrition and Immunity", were developed for the Monash Sensory Science 2023 Exhibition Day. The books offer an innovative way to make science and art more accessible and engaging, addressing the limitations of traditional museum methods. Feedback from audiences has been positive, emphasizing the fascination, sensory engagement and ease of understanding. This paper highlights the potential for an interdisciplinary and inclusive approach to science and art, demonstrating the value of multisensory books as tools for science communication. The findings highlight the positive reception of this novel approach and suggest its potential for broader applications, promoting inclusivity and accessibility.

Digital Technology Use Among Older Adults With Vision Impairment.

Importance: Telehealth has the potential to improve health for older adults, but many access disparities exist, including for those with vision impairment (VI). Objective: To examine the associations between VI and digital technology access measures in US older adults. Design, Setting, and Participants: This was a cross-sectional study that included Medicare beneficiaries 65 years and older. Beneficiary data were obtained from the National Health and Aging Trends Study (NHATS) 2021; data collection was conducted from June 2020 through January 2021. Data were analyzed September 2023. Exposure: VI, measured on categorical (distance and near VI [>0.30 logMAR], contrast sensitivity impairment [CSI; <1.55 logCS], and any VI [distance VI, near VI, or CSI]), and continuous (distance and near acuity [logMAR] and contrast sensitivity [logCS]) scales. Main Outcomes: Self-reported outcomes of digital technology access from the technological environment component of the NHATS. Results: Of the 2822 Medicare beneficiaries (mean [SD] age, 78.5 [5.6] years; 1605 female [54.7%]) included in this study, patients self-identified with the following race and ethnicity categories (weighted percentages): 575 non-Hispanic Black (8.0%), 132 Hispanic (7.0%), 2019 non-Hispanic White (81.7%), and 63 non-Hispanic other race (3.4%), which included American Indian, Alaska Native, Asian, multiracial, Native Hawaiian, Pacific Islander, or other specified race. A total of 1077 of 2822 patients (32.3%) had any VI. In multivariable logistic regression models, older adults with any VI had lower odds of having or knowing how to use a cellphone (odds ratio [OR], 0.58; 95% CI, 0.38-0.88), computer (OR, 0.61; 95% CI, 0.47-0.79), or tablet (OR, 0.68, 95% CI = 0.54-0.85) than peers without VI. In other models, near VI was associated with lower odds of having and knowing how to use a phone (OR, 0.56; 95% CI, 0.36-0.87), computer (OR, 0.57; 95% CI, 0.44-0.75), or tablet (OR, 0.65; 95% CI, 0.52-0.81) compared with no near VI. CSI was associated with lower odds of having and knowing how to use a phone (OR, 0.66; 95% CI, 0.45-0.99) or computer (OR, 0.72; 95% CI, 0.55-0.93) compared with no CSI. Distance VI was only associated with lower odds of having and knowing how to use a cellphone (OR, 0.63; 95% CI, 0.41-0.95). Any VI and individual categorical VI measures were not associated with other outcomes of digital health- and nonhealth-related experiences. Similar associations were noted when vision was examined on a continuous scale. However, worse distance acuity (per 0.1 logMAR) was associated with being less likely to visit with family or friends on a video call (OR, 0.91; 95% CI, 0.84-0.98) and to order or refill prescriptions online (OR, 0.90; 95% CI, 0.83-0.97). Conclusions and Relevance: Results suggest that older US adults with VI were less likely to have access to digital technology than peers without VI, although no differences were noted in the report of digital health- and nonhealth-related activities. These findings highlight the potential for inequities that may arise in telehealth for older adults with VI and the necessity to develop strategies to improve accessibility of telemedicine for all.

Altered grid-like coding in early blind people.

Cognitive maps in the hippocampal-entorhinal system are central for the representation of both spatial and non-spatial relationships. Although this system, especially in humans, heavily relies on vision, the role of visual experience in shaping the development of cognitive maps remains largely unknown. Here, we test sighted and early blind individuals in both imagined navigation in fMRI and real-world navigation. During imagined navigation, the Human Navigation Network, constituted by frontal, medial temporal, and parietal cortices, is reliably activated in both groups, showing resilience to visual deprivation. However, neural geometry analyses highlight crucial differences between groups. A 60° rotational symmetry, characteristic of a hexagonal grid-like coding, emerges in the entorhinal cortex of sighted but not blind people, who instead show a 90° (4-fold) symmetry, indicative of a square grid. Moreover, higher parietal cortex activity during navigation in blind people correlates with the magnitude of 4-fold symmetry. In sum, early blindness can alter the geometry of entorhinal cognitive maps, possibly as a consequence of higher reliance on parietal egocentric coding during navigation.

Crowding under scotopic and photopic vision in albino and normal-sighted participants.

Crowding is a phenomenon in which the ability to recognize an object in a clutter deteriorates. It is, therefore, a fundamental aspect of object recognition and crucial in deciphering resolution. For visually impaired individuals, deficiency in crowding has a tremendous effect on vision and may reflect and predict the amount of deterioration in vision. It is well established that albinos suffer much more from crowding than normally sighted individuals under daylight luminance conditions. However, to our knowledge, this study is the first to investigate crowding in albino participants under low light conditions. In this study, we explored the crowding effect in a group of albino participants (n = 9) and a control group of normally sighted participants (n = 9). Crowding was conducted under daylight (photopic vision) and low light (scotopic vision). We measured the visual acuity threshold under crowding in three-letter spacing (0.5, 1, and 1.5) and compared it to a single target. Results indicate that albino participants experienced stronger crowding than the control under the photopic condition, while crowding under the scotopic condition was apparent in the albino but abolished for the control group. These findings highlight the importance of considering luminance when discussing the visually impaired population in general. In particular, it suggests that crowding in albinism is based on a peripheral-like mechanism and may indicate a cessation in visual development.

The characteristics of sexual behavior in blind men in Ganzhou, China: A cross-sectional study.

Visual stimuli play key roles in influencing men sexual behavior. However, few studies have explored the sexual behavior of blind men. To provide more information about blind men for the study of andrology by surveying the characteristics of their current sexual behavior. A questionnaire-based cross-sectional study design was performed. The questionnaire contained questions regarding demographic characteristics of participants, access to sexual knowledge, perception of the sexual partners' beauty, and sexual arousal. Blind men were interviewed face-to-face by the trained investigator. Complete questionnaires were collected from 54 participants, with an average age of 40.57 ±â€…9.80 years old. Eye diseases were the most frequent cause of blindness. In terms of sexual orientation, all participants were heterosexual. Notably, 90.7% of the participants reported to have had a sexual experience. Among those who had engaged in sexual behavior, 93.6% experienced sexual pleasure and 69.4% had a normal erectile function. Overall, 16.7% of the participants received sex education. The participants obtained sexual knowledge mainly through sounds from mobile phones, peer-to-peer communication, sounds of television and radio. Voice was the most frequent perception of the sexual partners' beauty, followed by figure, skin, and body fragrance. In terms of stimuli of sexual arousal, tactile sensation and auditory sensation in that order were the most frequent stimuli of sexual arousal. Stimuli of sexual arousal in blind men are mainly mediated by sound and touch. Blind men understand their sexual partners' beauty through auditory, tactile, and olfactory sensations. Blind men in Ganzhou lack formal and systematic sex education.

Conveying the pathogenesis of type 1 diabetes to the blind, low-vision and diverse needs communities through sensory stimulation.

To educate members of the blind, low-vision and diverse needs communities on the pathogenesis of the chronic autoimmune disease, type 1 diabetes, members of our team with research expertise in immune-mediated diseases, participated in the 2023 Monash Sensory Science (MSS) Exhibition. Using QR code linked audio commentary, participants were guided through tactile displays demonstrating normal insulin action in the regulation of blood glucose levels and its vital role in providing energy to tissues, followed by displays describing the various stages of the immune system's aberrant attack and the eventual complete destruction of the insulin producing beta-cells of the pancreatic islets in type 1 diabetes. These models conveyed to the participants the huge effect that this autoimmune-mediated disease has on the quality of life of affected individuals including the subsequent lifelong reliance on insulin injections to maintain glucose homeostasis. This MSS Exhibition provided a unique opportunity for our researchers to engage with under-represented members of the community and to raise awareness about such a debilitating and common autoimmune disease.

Improving Walking Path Generation Through Biped Constraint in Indoor Navigation System for Visually Impaired Individuals.

This paper introduces a walking path generation method specifically developed for the Smart Cane, which is a RNA (Robotic Navigation Assistance Device) aimed at enhancing indoor navigation for visually impaired individuals. The proposed approach combines the utilization of a LIPM (Linear Inverse Pendulum Model) and LFPC (Linear Foot Placement Controller) motion primitives to generate walking paths specifically designed for visually impaired individuals. The primary objective is to generate paths that conform to human motion constraints, thereby guaranteeing an efficient and natural navigation experience. Integrating autonomous navigation framework, the Smart Cane facilitates safe and effective guidance for visually impaired participants in the indoor environments. Furthermore, comparative experiments have been conducted to validate the effectiveness of the proposed method, providing evidence of its capability to generate walking paths that conform to human motion constraints. The experiment results indicate that the proposed walking path generation method is a promising solution to enhance the navigation experience of visually impaired individuals.

Estimation of the lost productivity to the GDP and the national cost of correcting visual impairment from refractive error in Kenya.

BACKGROUND: In developing countries such as Kenya, minimal attention has been directed towards population based studies on uncorrected refractive error (URE). However, the absence of population based studies, warrants utilization of other avenues to showcase to the stakeholders in eye health the worth of addressing URE. Hence this study estimated the lost productivity to the Gross Domestic Product (GDP) as a result of URE and the national cost required to address visual impairment from URE in Kenya. METHODS: The lost productivity to the GDP for the population aged 16-60 years was calculated. Thereafter the productivity loss of the caregivers of severe visual impaired individuals was computed as a product of the average annual productivity for each caregiver and a 5% productivity loss due to visual impairment. The productivity benefit of correcting refractive error was estimated based on the minimum wage for individuals aged between 16-60 years with URE. Estimation of the national cost of addressing URE was based on spectacle provision cost, cost of training functional clinical refractionists and the cost of establishing vision centres. A cost benefit analysis was undertaken based on the national cost estimates and a factor of 3.5 times. RESULTS: The estimated lost productivity to the GDP due to URE in in Kenya is approximately US$ 671,455,575 -US$ 1,044,486,450 annually for population aged between 16-60 years. The productivity loss of caregivers for the severe visually impaired is approximately US$ 13,882,899 annually. Approximately US$ 246,750,000 is required to provide corrective devices, US$ 413,280- US$ 108,262,300 to train clinical refractionists and US$ 39,800,000 to establish vision centres. The productivity benefit of correcting visual impairment is approximately US$ 41,126,400 annually. Finally, a cost benefit analysis showed a return of US$ 378,918,050 for human resources, US$ 863,625,000 for corrective devices and US$ 139,300,000 for establishment of vision centres. CONCLUSION: The magnitude of productivity loss due to URE in Kenya is significant warranting prioritization of refractive error services by the government and all stakeholders since any investment directed towards addressing URE has the potential to contribute a positive return.

Uncorrected Refractive Error in the African American Eye Disease Study.

Importance: Refractive error remains the largest cause of correctable visual impairment in the US. Correction of refractive error will reduce visual impairment and its associated morbidity but also improve quality of life and productivity. Objective: To determine the burden of and risk factors (RFs) associated with any uncorrected refractive error (UCRE) and unmet refractive need (URN) in a population-based sample of African American adults. Design, Setting, and Participants: This cross-sectional study, conducted from April 2014 to April 2018, included a population-based sample of self-identified African American participants 40 years and older from 30 contiguous census tracts in Inglewood, California. Participants underwent a complete ophthalmic examination and an in-home-administered questionnaire to assess sociodemographic, lifestyle, biological, medical, and health care and eye care usage RFs associated with UCRE and URN. Measurements of visual acuity (VA) were performed using a standard Early Treatment Diabetic Retinopathy Study protocol. Noncycloplegic automated refraction with supplemental subjective refraction was performed. UCRE was defined as an improvement of 2 or more lines with refraction in the better-seeing eye. URN was defined as an improvement of 2 or more lines with refraction in the better-seeing eye in those persons who were visually impaired. Sex- and age-specific burden of UCRE and URN were calculated, and multiple regression analyses were used to identify independent RFs. Study data were analyzed from May 2018 to December 2023. Exposures: Presence or absence of correctable refractive error. Main Outcomes and Measures: Self-reported sex- and age-specific prevalence of and risk indicators of UCRE and URN. Results: Of the 7957 eligible participants in the African American Eye Disease Study (AFEDS), 6347 (80%) completed both the in-home interview and the clinical examination. Of these, 6337 participants (mean [SD] age, 61 [11] years; 3997 female [63%]) with complete refractive error data were included in the analysis. Refractive error-related correctable visual impairment was present in over two-thirds of participants with visual impairment (68.7%). The overall prevalence of any UCRE was 14.6% (925 of 6337), and the overall prevalence of any URN was 5.4% (URN1 [those with presenting VA of worse than 20/40 in the better-seeing eye but who could achieve 20/40 or better with correction], 157 of 2893; URN2 [those with presenting VA of worse than 20/40 in the better-seeing eye but who could achieve an improvement of 2 or more lines with refractive correction], 155 of 2891). Conclusions and Relevance: Results of this cross-sectional study suggest a high burden of refractive error-associated correctable refractive error in African American adults, making it the leading cause of visual impairment in this population. Providing universal coverage for vision care and prescription glasses is an affordable and achievable health care intervention that could reduce the burden of visual impairment in African American adults by over two-thirds and likely raise the quality of life and work productivity, especially in this vulnerable minority population.

A 12-year follow up survey of childhood blindness at schools for the blind in Cambodia.

BACKGROUND: Cambodia is a low-income country in South East Asia with a population of 15.5 million people of whom 4.9 million (38%) are under the age of 16. The causes of childhood blindness in Cambodia have not been investigated since the first survey of schools for the blind done in 2009 by our group. Given the large demographic and economic shifts in Cambodia since 2009 it is important to determine if these causes have changed in order to ensure intervention programmes are appropriately targeted. The purpose of the present study is to investigate the prevalence of causes of childhood blindness at schools for the blind in Cambodia. METHODS: Students between the ages of 5 and 16 years who were attending schools for the blind in Cambodia were examined by a consultant paediatric ophthalmologist and had clinical photographs taken. Distance visual acuity was measured using a logMAR tumbling E chart and the WHO definitions of blindness and severe visual impairment were used. The examining ophthalmologist recorded the anatomical site and aetiology of vision loss using the WHO Prevention of Blindness eye examination record for children. Collected data were compared to a previous survey from 2009. RESULTS: Data from 73 students were included for analysis. The most common anatomical location of abnormality causing vision loss was the cornea (n = 20, 33.9%) followed by the lens and retina (n = 11, 18.64% each). Hereditary factors (n = 29, 49.15%) and childhood diseases (n = 27, 45.76%) were the most common aetiological causes of childhood blindness. The majority (71.19%) of childhood blindness was avoidable. The present study did not demonstrate 0a significant difference in the causes of childhood blindness compared to 2009. CONCLUSIONS: Corneal pathologies continue to represent the most common cause of vision loss amongst the surveyed population and the majority of causes of childhood blindness continue to be avoidable. These findings will facilitate the development of evidence-based targeted interventional programmes in Cambodia.

Prevalence and causes of blindness and distance visual impairment in Chinese adult population in 2022 during the COVID-19 pandemic: a cross-sectional study.

This cross-sectional study aims to investigate the prevalence and causes of visual impairment (VI) and blindness in Jiangsu Province, China in 2022 during the COVID-19 pandemic. Participants (n = 13,208, aged 18-93) underwent comprehensive ocular examinations. The prevalence and causes of binocular VI (presenting visual acuity [VA] ≥ 20/400 and < 20/63 in the better eye) and blindness (presenting VA < 20/400 in the better eye) were assessed according to the World Health Organization (WHO) criteria. The estimation of refractive error prevalence was conducted using the following classification: myopia ≤ - 0.50 diopters (D), high myopia ≤ - 6.00 D, hyperopia ≥ 0.50 D, and anisometropia ≥ 1.00 D. The overall prevalence of binocular VI and blindness was 21.04% (95% confidence interval [CI] 20.35-21.74%) and 0.47% (95% CI 0.37-0.60%). The highest prevalence of binocular VI was in the population aged 18-24 years old (46.29%, [95% CI 44.30-48.28%]), those with education at university and above (43.47%, [95% CI 41.93-45.02%]), students (54.96%, [95% CI 52.73-57.17%]). Uncorrected refractive error (URE) was the leading cause of presenting binocular VI (93.40%) and blindness (50.79%). The prevalence of myopia was 54.75% (95% CI 53.90-55.60%). Actions are needed to control URE and myopia within the adult Chinese population, with a particular emphasis on the younger, well-educated demographic.

Auditory Spatial Bisection of Blind and Normally Sighted Individuals in Free Field and Virtual Acoustics.

Sound localization is an important ability in everyday life. This study investigates the influence of vision and presentation mode on auditory spatial bisection performance. Subjects were asked to identify the smaller perceived distance between three consecutive stimuli that were either presented via loudspeakers (free field) or via headphones after convolution with generic head-related impulse responses (binaural reproduction). Thirteen azimuthal sound incidence angles on a circular arc segment of ±24° at a radius of 3 m were included in three regions of space (front, rear, and laterally left). Twenty normally sighted (measured both sighted and blindfolded) and eight blind persons participated. Results showed no significant differences with respect to visual condition, but strong effects of sound direction and presentation mode. Psychometric functions were steepest in frontal space and indicated median spatial bisection thresholds of 11°-14°. Thresholds increased significantly in rear (11°-17°) and laterally left (20°-28°) space in free field. Individual pinna and torso cues, as available only in free field presentation, improved the performance of all participants compared to binaural reproduction. Especially in rear space, auditory spatial bisection thresholds were three to four times higher (i.e., poorer) using binaural reproduction than in free field. The results underline the importance of individual auditory spatial cues for spatial bisection, irrespective of access to vision, which indicates that vision may not be strictly necessary to calibrate allocentric spatial hearing.

Evaluation of the test-retest and inter-mode comparability of the Impact of Vision Impairment questionnaire in people with chronic eye diseases.

PURPOSE: The main objective of this study is to assess the test-retest and inter-administration mode reliability of the Impact of Vision Impairment profile (IVI), a common patient-reported outcome measure (PROM) for people with chronic eye diseases. METHODS: The IVI was administered to adult patients with stable, chronic eye diseases two to four times per participant (average intervals between administrations 12 to 20 days; maximum two phone interviews, paper administration, electronic administration) by two trained interviewers. Rasch models were fit to the data. Intra-class correlation coefficients (ICCs), mean differences and Cronbach's alpha between test-retest administrations (two phone interviews) and inter-mode comparisons were calculated. RESULTS: Two hundred-sixteen patients (mean age 67 ± 12 years, 40% male) were included in the study. The IVI met all psychometric requirements of the Rasch model, and the division into the domains of functional items (IVI_F) and emotional items (IVI_E) corresponded to the German validation study. ICCs (all for IVI_F and IVI_E, respectively) for the retest administrations were 0.938 and 0.912, and 0.853 and 0.893 for inter-mode comparisons phone/paper, 0.939 and 0.930 for phone/electronic, and 0.937 and 0.920 for paper/electronic (all p < 0.01). Mean differences (all for IVI_F and IVI_E, respectively) for the retest administrations were 2.8% and 0.7% and ranged from 2.0% to 6.2% and from 0.4 % to 4.9% between administration modes. Cronbach's alpha ranged from 0.886 to 0.944 for retest and inter-mode comparisons. CONCLUSION: Due to the high test-retest reliability and the almost equally high comparability of different modes of administration of the IVI, the study endorses its use as a robust PROM to capture vision-related quality of life. Our results further support the use of the IVI as an endpoint in clinical trials and may simplify implementing it in both clinical trials or real-world evidence generation by offering multiple administration modes with high reliability.

Which rehabilitation initiatives can effectively improve participation in an educational setting for visually impaired and blind adolescents? A systematic review.

BACKGROUND: Visually impaired and blind adolescents fare poorly in educational attainment compared to adolescents without vision impairment. Rehabilitation holds the potential to compensate for the hindrances that the impairment causes. Many rehabilitation initiatives exist. However, the efficacy of these initiatives remains uncertain. This systematic review assessed which rehabilitation initiatives improve participation in an educational setting for visually impaired and blind adolescents. METHODS: PubMed, Embase, Scopus, Cinahl, and Cochrane library databases were searched. Only primary studies as randomized controlled trial (parallel group or crossover), cohort studies, case-control studies, qualitative studies, and case-studies were included. Data on the study characteristics, visual impairment, type of intervention, research question, main findings, and implications for practice were extracted from the papers. Critical appraisal was performed using the Critical Appraisal Checklist for Qualitative Research and the Checklist for Quasi-Experimental Studies both from the Joanna Briggs Institute. The data extraction and the critical appraisal were performed independently by two reviewers. RESULTS: A total of 10 studies with visually impaired and blind adolescents were considered eligible, from an original search result of 3210 studies. In the thematic analysis we identified a heightened focus on different means for studying by making the curriculum content more accessible by applying different audio, tactile, or electronic devices (n = 8). A minor focus in the identified studies (n = 2) was placed on the impact of support from the environment on the development of literacy, for example the support from teachers or parents. Outcome parameters representing more diverse rehabilitation initiatives have not been adequately investigated in the literature. The scientific evidence that we identified was based on few publications with contradictory results and some studies were of questionable quality, limiting the applicability of their findings. CONCLUSIONS: Overall, the review identified a gap in the evidence regarding rehabilitation initiatives for visually impaired and blind adolescents that enables participation in an educational setting. The overall quality assessment of the 10 studies identified several risks of bias, for which reason the current scientific evidence does not qualify as a basis for decision making, leaving the adolescents in a heightened risk to fall even further behind in the educational system. Further high quality randomized controlled trials are required to establish high-quality evidence.

Evaluation of three pedestrian phasing with audible pedestrian signals configurations in Quebec City (Canada): an exploratory study of blind or visually impaired persons' sense of safety, preferences, and expectations.

PURPOSE: This exploratory study aimed to evaluate the preferences, expectations, and sense of safety of blind or visually impaired persons regarding three types of pedestrian phasing with audible pedestrian signals configurations that exist in Quebec City (Canada). These include: 1) exclusive phasing with non-directional audible pedestrian signals; 2) exclusive phasing with directional audible pedestrian signals; and 3) concurrent phasing with directional audible pedestrian signals. METHODS: Thirty-two blind or visually impaired persons were asked to complete a survey. Their preferences and expectations regarding audible pedestrian signals were documented through a series of simulations. Their sense of safety regarding the three existing configurations were also documented. Subsequently, semi-directed, individual interviews with 11 of the individuals who had completed the survey were conducted to build off the collected information. RESULTS: No formal consensus regarding many of the issues discussed were established as participants' responses varied too significantly. However, findings suggest that the exclusive phasing with directional audible pedestrian signals configuration is perceived to be the safest option by the participants. CONCLUSION: This study may have practical implications on the design of intersections (e.g., selection of a type of pedestrian phasing with audible pedestrian signal) and the training of blind or visually impaired pedestrians.IMPLICATIONS FOR REHABILITATIONThe addition of audible pedestrian signals to pedestrian signals heightens the sense of safety of blind or visually impaired persons.This study may have practical implications on the design of intersections with audible pedestrian signals and the selection of a type of audible pedestrian signals based on intersection characteristics.Since many participants reported a lower sense of safety when faced with concurrent phasing, it is recommended that more intensive orientation and mobility interventions be provided to blind or visually impaired pedestrians who use this type of traffic signals.Educating road users about blind or visually impaired pedestrians appears also essential.

Role of visually impaired in screening of diseases and the way forward.

The role of visually impaired individuals in disease screening can be significant and beneficial. While visually impaired people may have limitations related to their sight, they can still contribute to and participate in various aspects of disease screening owing to their heightened senses, especially touch. It is important to recognize that each visually impaired individual's capabilities and preferences may vary, and their involvement in disease screening should always be voluntary and based on their comfort level. However, by creating an inclusive environment and addressing accessibility barriers, visually impaired individuals may be specially empowered to engage in disease screening, particularly of the breast.

The use of magnets for the nonvisual construction of syntax-based tangible object assemblies by individuals who are blind or visually impaired.

Many students have difficulty in mastering syntax when programming. To alleviate this problem, the Scratch programming language was developed to have a visual block-based drag and drop code editor, where the shapes of the blocks and animation are used to make the syntax intuitive. To similarly make syntax intuitive to individuals who are blind or visually impaired (BVI) using tangible code blocks, a method needs to take into account perceptual processing differences between the senses and implementation differences between the physical and virtual world. The studies in this paper examined the effectiveness of using localized reciprocal shape information in combination with magnetic attraction for providing intuitive feedback about syntax. Supplementing the use of localized reciprocal shape constraints with magnetic attraction increased the accuracy and perceived ease of use by blindfolded BVI users to detect whether blocks successfully connected and, therefore, represented a code segment with valid syntax. This did not appear to change significantly with changes in the size and weight of the blocks, although stronger magnetic connections appeared preferred. We also introduced a "stopper" design to allow for code blocks to have exceptions to the regular syntax rules, while not adding complexity to the majority of code blocks.