Comparison of cardiovascular screening in college athletes by history and physical examination with and without an electrocardiogram: Efficacy and cost.

BACKGROUND: Preparticipation screening for conditions associated with sudden cardiac death (SCD) is required in college athletes. Previous cost analyses used theoretical models based on variable assumptions, but no study used real-life outcomes. OBJECTIVE: The purpose of this study was to compare disease prevalence, positive findings, and costs of 2 different screening strategies: history and physical examination alone (H&P) or with an electrocardiogram (H&P+ECG). METHODS: De-identified preparticipation data (2009-2017) from Pacific-12 Conference institutions were abstracted for cardiovascular history questions, cardiovascular physical examination, and ECG result. Secondary testing, cardiac diagnoses, return to play outcomes, and complications from testing were recorded. The costs of screening and secondary testing were based on the Centers for Medicare & Medicaid Services Physician Fee Schedule. RESULTS: A total of 8602 records (4955 H&P, 3647 H&P+ECG) were included. Eleven conditions associated with SCD were detected (2 H&P only, 9 H&P+ECG). The prevalence of cardiovascular conditions associated with SCD discovered with H&P alone was 0.04% (1/2454) compared to 0.24% (1/410) when ECG was added (P = .01) (odds ratio 5.17; 95% confidence interval 1.28-20.85; P = .02). Cost of screening and secondary testing with H&P alone was $130 per athlete and in the ECG-added group was $152 per athlete. The cost per diagnosis was $312,407 in the H&P group and $61,712 in the ECG-added group. There were no adverse outcomes from secondary testing or treatment. CONCLUSION: H&P with the addition of ECG is 6 times more likely to detect a cardiovascular condition associated with SCD than without. The addition of ECG improves the cost efficiency per diagnosis by 5-fold and should be considered at college institutions with appropriate resources.

SteeringWheel: A Locality-Preserving Magnification Interface for Low Vision Web Browsing.

Low-vision users struggle to browse the web with screen magnifiers. Firstly, magnifiers occlude significant portions of the webpage, thereby making it cumbersome to get the webpage overview and quickly locate the desired content. Further, magnification causes loss of spatial locality and visual cues that commonly define semantic relationships in the page; reconstructing semantic relationships exclusively from narrow views dramatically increases the cognitive burden on the users. Secondly, low-vision users have widely varying needs requiring a range of interface customizations for different page sections; dynamic customization in extant magnifiers is disruptive to users' browsing. We present SteeringWheel, a magnification interface that leverages content semantics to preserve local context. In combination with a physical dial, supporting simple rotate and press gestures, users can quickly navigate different webpage sections, easily locate desired content, get a quick overview, and seamlessly customize the interface. A user study with 15 low-vision participants showed that their web-browsing efficiency improved by at least 20 percent with SteeringWheel compared to extant screen magnifiers.

Ubiquitous Accessibility for People with Visual Impairments: Are We There Yet?

Ubiquitous access is an increasingly common vision of computing, wherein users can interact with any computing device or service from anywhere, at any time. In the era of personal computing, users with visual impairments required special-purpose, assistive technologies, such as screen readers, to interact with computers. This paper investigates whether technologies like screen readers have kept pace with, or have created a barrier to, the trend toward ubiquitous access, with a specific focus on desktop computing as this is still the primary way computers are used in education and employment. Towards that, the paper presents a user study with 21 visually-impaired participants, specifically involving the switching of screen readers within and across different computing platforms, and the use of screen readers in remote access scenarios. Among the findings, the study shows that, even for remote desktop access-an early forerunner of true ubiquitous access-screen readers are too limited, if not unusable. The study also identifies several accessibility needs, such as uniformity of navigational experience across devices, and recommends potential solutions. In summary, assistive technologies have not made the jump into the era of ubiquitous access, and multiple, inconsistent screen readers create new practical problems for users with visual impairments.

Speed-Dial: A Surrogate Mouse for Non-Visual Web Browsing.

Sighted people can browse the Web almost exclusively using a mouse. This is because web browsing mostly entails pointing and clicking on some element in the web page, and these two operations can be done almost instantaneously with a computer mouse. Unfortunately, people with vision impairments cannot use a mouse as it only provides visual feedback through a cursor. Instead, they are forced to go through a slow and tedious process of building a mental map of the web page, relying primarily on a screen reader's keyboard shortcuts and its serial audio readout of the textual content of the page, including metadata. This can often cause content and cognitive overload. This paper describes our Speed-Dial system which uses an off-the-shelf physical Dial as a surrogate for the mouse for non-visual web browsing. Speed-Dial interfaces the physical Dial with the semantic model of a web page, and provides an intuitive and rapid access to the entities and their content in the model, thereby bringing blind people's browsing experience closer to how sighted people perceive and interact with the Web. A user study with blind participants suggests that with Speed-Dial they can quickly move around the web page to select content of interest, akin to pointing and clicking with a mouse.

A Platform Agnostic Remote Desktop System for Screen Reading.

Remote desktop technology, the enabler of access to applications hosted on remote hosts, relies primarily on scraping the pixels on the remote screen and redrawing them as a simple bitmap on the client's local screen. Such a technology will simply not work with screen readers since the latter are innately tied to reading text. Since screen readers are locked-in to a specific OS platform, extant solutions that enable remote access with screen readers such as NVDARemote and JAWS Tandem require homogeneity of OS platforms at both the client and remote sites. This demo will present Sinter, a system that eliminates this requirement. With Sinter, a blind Mac user, for example, can now access a remote Windows application with VoiceOver, a scenario heretofore not possible.