City Government's Adoption of Housing Adaptation Policy Innovation for Older Adults: Evidence From China.

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.

Estructura de las unidades de cuidados intensivos de anestesia: recomendaciones de la Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR) / Structure of the anesthesia intensive care units: recommendations of the Intensive Care Section of the Spanish Society of Anaesthesiology

ANTECEDENTES Y OBJETIVO: Los objetivos de la Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor (SCI-SEDAR) con el presente trabajo son: establecer nuevas recomendaciones adaptando los estándares publicados por el Ministerio de Sanidad y Política Social, y alineadas con las principales guías internacionales, y desarrollar una herramienta de mejora de la calidad y la eficiencia. MATERIALES Y MÉTODO: A lo largo de 2018, 3 miembros de la SCI-SEDAR definieron la metodología, desarrollaron las recomendaciones y seleccionaron al panel de expertos. Debido a la limitada evidencia de buena parte de las recomendaciones y a la importante variabilidad estructural de las unidades de cuidados intensivos de anestesia actuales, se optó por un abordaje Delphi modificado para determinar el grado de consenso. RESULTADOS: Un total de 24 expertos de 21 instituciones constituyeron el grupo de expertos del presente trabajo. Se establecieron 175 recomendaciones sobre 8 apartados, incluyendo 129 con consenso fuerte y 46 con consenso débil. CONCLUSIONES: La SCI-SEDAR estableció las recomendaciones estructurales de las unidades de cuidados intensivos de anestesia que deberán guiar la renovación o la creación de nuevas unidades

BACKGROUND AND OBJECTIVE: In this article, the Intensive Care Section of the Spanish Society of Anesthesiology (SCI-SEDAR) establishes new recommendations based on the standards published by the Ministry of Health, Consumer Affairs and Social Welfare and aligned with the principle international guidelines, and develops a tool to improve quality and efficiency. MATERIALS AND METHOD: Over a 12-month period (2018), 3 members of the SCI-SEDAR defined the methodology, developed the recommendations and selected the panel of experts. Due to the limited evidence available for many of the recommendations and the significant structural differences between existing anesthesia intensive care units, we chose a modified Delphi approach to determine the degree of consensus. RESULTS: The panel consisted of 24 experts from 21 institutions. The group put forward 175 recommendations on 8 sections, including 129 with strong consensus and 46 with weak consensus. CONCLUSIONS: The SCI-SEDAR has established a series of structural recommendations that should be used when renovating or creating new anesthesia intensive care units

Structure of the Anesthesia Intensive Care Units: Recommendations of the Intensive Care Section of the Spanish Society of Anaesthesiology. / Estructura de las unidades de cuidados intensivos de anestesia: recomendaciones de la Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR).

BACKGROUND AND OBJECTIVE: In this article, the Intensive Care Section of the Spanish Society of Anesthesiology (SCI-SEDAR) establishes new recommendations based on the standards published by the Ministry of Health, Consumer Affairs and Social Welfare and aligned with the principle international guidelines, and develops a tool to improve quality and efficiency. MATERIALS AND METHOD: Over a 12-month period (2018), 3 members of the SCI-SEDAR defined the methodology, developed the recommendations and selected the panel of experts. Due to the limited evidence available for many of the recommendations and the significant structural differences between existing anesthesia intensive care units, we chose a modified Delphi approach to determine the degree of consensus. RESULTS: The panel consisted of 24 experts from 21 institutions. The group put forward 175 recommendations on 8 sections, including 129 with strong consensus and 46 with weak consensus. CONCLUSIONS: The SCI-SEDAR has established a series of structural recommendations that should be used when renovating or creating new anesthesia intensive care units.

Sustainable Accessibility: A Mobile App for Helping People with Disabilities to Search Accessible Shops.

People with motor disabilities must face many barriers and obstacles in their daily lives, making it difficult to perform everyday tasks. The purpose of this work is to improve their living conditions by providing an app with accessibility information in an updated, reliable and friendly form. The development of the system integrates national and regional accessibility regulations, architectural aspects, with an extensive field work, and a sustainable software process. The levels of accessibility and the requirements of the application are defined in the first phases of the project. The field work included the evaluation of 357 commercial establishments in the city of Murcia, Spain, showing that only 25% have a good accessibility, 40% are practicable with help, and 35% are inaccessible shops. The proposed system achieves its objectives of being sustainable and helping in the accessibility. Besides, the system can be a great incentive for businesses to improve their accessibility conditions. In conclusion, new technologies must have a much more active role in the promotion of universal accessibility. These tools must also consider the necessary requirements of sustainable development.

A Status of Universal Design in Danish Architectural Policies.

In 2009, Denmark ratified the Convention on the Rights of Persons with Disabilities and thereby acknowledged that Denmark, through policies, plans and programmes, is to work for equal opportunities for persons with disabilities and promote Universal Design in the development of standards, guidelines and e.g. architectural policies. An architectural policy is an acknowledged tool for enhancing the quality of buildings and their surroundings. An important quality of architecture is the ability to include everybody, regardless of gender, sexuality, ethnicity, culture or disability. In 1994, 2004 and again in 2014, Denmark published a national architectural policy. Inclusion as an architectural quality was included, but the focus and terminology changed with every new policy. Based on a desk study about architectural policies, this paper presents how Universal Design is included in Danish municipal architectural policies. On a local level, 34 of 98 Danish municipalities have formulated an architectural policy. None of the architectural policies applies Universal Design, but a few operate with the concept of accessibility, primarily focusing on accessibility for all. This paper discusses how the absence of Universal Design in the architectural policies can be interpreted and how Universal Design can be introduced into future policies.

Improving Pool Fencing Legislation in Queensland, Australia: Attitudes and Impact on Child Drowning Fatalities.

Four-sided, non-climbable pool fencing is an effective strategy for preventing children from drowning in home swimming pools. In 2009, the Queensland Government introduced legislation to improve the effectiveness of pool fencing. This study explores community attitudes towards the effectiveness of these legislative changes and examines child (<5 years) drowning deaths in pools. Data from the 2011 Queensland Computer-Assisted Telephone Interviewing (CATI) Social Survey include results from questions related to pool ownership and pool fencing legislation. Fatal child drowning cases between 1 January 2005 and 31 December 2015 were sourced from coronial data. Of the 1263 respondents, 26/100 households had a pool. A total of 58% believed tightening legislation would be effective in reducing child drowning deaths. Pool owners were more likely to doubt the effectiveness of legislation (p < 0.001) when compared to non-pool owners. Perceptions of effectiveness did not differ by presence of children under the age of five. There were 46 children who drowned in Queensland home pools (7.8/100,000 pools with children residing in the residence/annum) between 2005 and 2015. While pool owners were less likely to think that tightening the legislation would be effective, the number of children drowning in home swimming pools declined over the study period. Drowning prevention agencies have more work to do to ensure that the most vulnerable (young children in houses with swimming pools) are protected.

How available to European children and young people with cerebral palsy are features of their environment that they need?

BACKGROUND: The UN Convention on the Rights of Persons with Disabilities requires accessibility to the physical and social environments. However, individuals with cerebral palsy (CP) have many difficulties in accessing the environment they need for functional independence and social inclusion. AIMS: To examine the availability of environmental features which children with CP need for optimal participation, and whether availability changed for them between ages 8-12 and 13-17 years. METHODS: The sample is the 594 children with CP, born 31/07/1991-01/04/1997, who took part in the SPARCLE study at age 8-12 (SPARCLE 1) and again at 13-17 years (SPARCLE 2). Participants were randomly sampled from population registers of children with CP in eight European regions; one further region recruited from multiple sources. Data about environment were captured with the European Child Environment Questionnaire (60 items). Differences in availability of environmental features between childhood and adolescence were assessed using McNemar's test; differences between regions were assessed by ranking regions. Differences in availability between regions were assessed by ranking regions. RESULTS: For seven environmental features significantly (p<0.01) fewer individuals needed the feature in SPARCLE 2 than in SPARCLE 1, whilst for two features more individuals needed the feature. Nine features in SPARCLE 1 and six features in SPARCLE 2 were available to less than half the participants who needed them. Eight features showed significantly (p<0.01) higher availability in SPARCLE 2 than in SPARCLE 1 (enlarged rooms, adapted toilet, modified kitchen and hoists at home, adapted toilets and lifts at school, an adequate vehicle, grants for home modifications) while none showed significantly lower availability. The relative rankings of the better and less good regions persisted from the age 8-12year age group to the 13-17year age group. CONCLUSIONS: Needed environmental features are unavailable to many children at ages 8-12 and 13-17 years. This lack of availability is more pronounced in some regions than others, which probably results from their policy, legislative and statutory frameworks.

Improved Housing Accessibility for Older People in Sweden and Germany: Short Term Costs and Long-Term Gains.

The physical housing environment is important to facilitate activities of daily living (ADL) for older people. A hindering environment may lead to ADL dependence and thus increase the need for home services, which is individually restricting and a growing societal burden. This study presents simulations of policy changes with regard to housing accessibility that estimates the potential impact specifically on instrumental activities of daily living (I-ADL), usage of home services, and related costs. The models integrate empirical data to test the hypothesis that a policy providing funding to remove the five most severe environmental barriers in the homes of older people who are at risk of developing dependence in I-ADL, can maintain independence and reduce the need for home services. In addition to official statistics from state agencies in Sweden and Germany, we utilized published results from the ENABLE-AGE and other scientific studies to generate the simulations. The simulations predicted that new policies that remove potentially hindering housing features would improve I-ADL performance among older people and reduce the need for home services. Our findings suggest that a policy change can contribute to positive effects with regard to I-ADL independence among older people and to a reduction of societal burden.

Rethinking ADA signage standards for low-vision accessibility.

Americans With Disabilities Act (ADA) and International Code Council (ICC) standards for accessible buildings and facilities affect design and construction of all new and renovated buildings throughout the United States, and form the basis for compliance with the ADA. While these standards may result in acceptable accessibility for people who are fully blind, they fall far short of what they could and should accomplish for those with low vision. In this article I critique the standards, detailing their lack of evidence base and other shortcomings. I suggest that simply making existing requirements stricter (e.g., by mandating larger letter size or higher contrasts) will not ensure visual accessibility and therefore cannot act as a valid basis for compliance with the law. I propose two remedies. First, requirements for visual characteristics of signs intended to improve access for those with low vision should be expressed not in terms of physical features, such as character height and contrast, but rather in terms of the distance at which a sign can be read by someone with nominally normal (20/20) visual acuity under expected lighting conditions for the installed environment. This would give sign designers greater choice in design parameters but place on them the burden of ensuring legibility. Second, mounting of directional signs, which are critical for effective and efficient wayfinding, should be required to be in consistent and approachable locations so that those with reduced acuity may view them at close distance.

Standards for Accessible Medical Diagnostic Equipment. Final rule.

The Architectural and Transportation Barriers Compliance Board (Access Board or Board) is issuing accessibility standards for medical diagnostic equipment. The standards for medical diagnostic equipment (MDE Standards) contain minimum technical criteria to ensure that medical diagnostic equipment, including but not limited to, examination tables, examination chairs, weight scales, mammography equipment, and other imaging equipment used by health care providers for diagnostic purposes are accessible to, and usable by, individuals with disabilities. The MDE Standards will allow independent entry to, use of, and exit from the equipment by individuals with disabilities to the maximum extent possible. The MDE Standards do not impose any mandatory requirements on health care providers or medical device manufacturers. However, other agencies, referred to as enforcing authorities in the MDE Standards, may issue regulations or adopt policies that require health care providers subject to their jurisdiction to acquire accessible medical diagnostic equipment that complies with the MDE Standards.

Workplace accommodations for employees with disabilities: A multilevel model of employer decision-making.

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

[The Evaluation of the German Federal Law of Equal Treatment of Disabled Persons]. / Die Evaluation des Behindertengleichstellungsgesetzes Rechtliche Aussagen und empirische Ergebnisse zur Barrierefreiheit im Bereich der gesetzlichen Krankenkassen.

The German federal law of equal treatment of disabled persons (Behindertengleichstellungsgesetz des Bundes, BGG) came into effect in 2002. An evaluation of this law was required by the national plan of action for the implementation of the United Nations Convention on the Rights of Persons with Disabilities (CRPD). Project evaluation objectives were to estimate whether the needs of disabled persons were being met and whether the instruments proved to be adequate for fulfilling the aims of the law. Jurisprudential analyses in combination with surveys were used for this research. It was found that the BGG still lacks adequate publicity. Its impact, however, was assessed as positive. Results also indicate that there might be some shortcomings with regard to accessibility. For a closer examination, however, more data focusing on accessibility in the context of health care and rehabilitation is.

Americans With Disabilities Act (ADA) Accessibility Guidelines for Transportation Vehicles. Final rule.

The Architectural and Transportation Barriers Compliance Board (Access Board or Board) is issuing a final rule that revises its existing accessibility guidelines for non-rail vehicles--namely, buses, over-the-road buses, and vans--acquired or remanufactured by entities covered by the Americans with Disabilities Act. The revised guidelines ensure that such vehicles are readily accessible to, and usable by, individuals with disabilities. The U.S. Department of Transportation (DOT) is required to revise its accessibility standards for transportation vehicles acquired or remanufactured by entities covered by the Americans with Disabilities Act (ADA) to be consistent with the final rule.

Equalization and Participation for All: Swedish Disability Policy at a Crossroads.

The political line in Swedish disability policy advocates the use of generalized solutions in order to fit potential needs of the largest possible group of people and, where needed, special solutions to bridge the remaining gap between the generalized level of accessibility and additional individual needs. This is referred to as the disability perspective (DP). The DP has embraced two tracks: one that pertains to generalized solutions that promote an overall high level of accessibility and usability, and another one that pertains to different types of individual support for people with disabilities. The present study is a self-reflective inquiry on key issues for the development of future disability policies. Five experts entered a discussion about the pros and cons concerning the DP. This confirmed or refuted assumptions, dilemmas, themes as well as reoccurring patterns in the political viva voce procedure that has formed the contemporary disability policy. Over the course of time, the experts believed that the DP had nurtured a belief that there is a dichotomy. This may have created an imbalance in the relation between the DP and policies such as those concerning healthcare and social care. With a clearer focus on interdependence, the experts saw synergies between needs for assistive technology, assistive products and the requirements for the built environment.

Deregulation of the Building Code and the Norwegian Approach to Regulation of Accessibility in the Built Environment.

Deregulation is on the political agenda in the European countries. The Norwegian building code related to universal design and accessibility is challenged. To meet this, the Norwegian Building Authority have chosen to examine established truths and are basing their revised code on scientific research and field tests. But will this knowledge-based deregulation comply within the framework of the anti-discrimination act and, and if not: who suffers and to what extent?

How to Solve Dilemmas Arising from the Idea of Improving Physical Accessibility in Relation to Aesthetics and Architectural Heritage.

The Norwegian state has been working for more than fifteen years on various ways of improving accessibility for the general public. An important part of this work has been to develop new legislation and other forms of formal guidelines to reduce physical barriers. The new Anti-Discrimination and Accessibility Act, Obligation to ensure general accommodation (universal design), came into force January 2009, and introduces some complicated dilemmas, especially when it states: "When assessing whether the design or accommodation entails an undue burden, particular importance shall be attached to the effect of the accommodation on the dismantling of disabling barriers, the necessary costs associated with the accommodation, the undertaking's resources, whether the normal function of the undertaking is of a public nature, safety considerations and cultural heritage considerations." What is an "undue burden" in relation to architectural visual qualities and to the historical heritage expressed in buildings and townscapes? This paper will look into these dilemmas by discussing specific cases from some cities in different countries. What kinds of procedure are suitable and decisive when it comes to these complicated questions? Is this a task exclusively reserved for professionals, or should the voice of lay people be heard and taken into consideration? By presenting examples from architecture and landscape architecture, I will show how universal design even can be implemented in old buildings and environments. The paper will argue for more focus on procedures than just physical solutions. The procedures should be based on accepted principles for changing historical monuments, such as wholeness, readability, reversibility and sustainability.

Universal Design Criteria in Standards and Codes About Accessibility of Built Environments in Brazil.

This paper includes some criticism in analysis of the development and implementation of the national standards for accessibility of the built environment in Brazil, i.e., the NBR9050. Currently, the 2015 version of it resembles an encyclopaedia including a variety of exotic contributions gathered historically from different sources; however, that characteristic makes it work like a puzzle that keeps alive prejudices about users' needs and disabilities. Besides, there are conflicts between recommended ideas and previous requirements from older versions. The definition of Universal Design has been published since 2004, but there is still no indication of how to make the principles work in practice. Therefore, it is very hard for city officials to assess quality of environments, and professionals have serious constraints to explore their skills further while addressing users' diversified needs. Certainly, the current NBR9050 requires further editorial work. Nevertheless, an important decision is necessary: it is important to organize information so that readers may identify in each topic whether Universal Design application can be achieved or whether the proposed technical solution may lead to construction of limited spatial adaptation and reach only some poor accommodation of users with uncommon needs. Presenting some examples in context of socially inclusive environments, the newer revised version of NBR9050 is necessary to explain about pitfalls of bad design of accessibility for discriminated disabled users. Readers should be able to establish conceptual links between the best ideas so that Universal Design could be easily understood.

Vexatious Litigants and the ADA: Strategies to Fairly Address the Need to Improve Access for Individuals with Disabilities.

This Article addresses the need to reform the ADA to prevent vexatious litigation and to promote the underlying goals of the Act. Part I of this Article introduces the topic of vexatious litigation and the importance of remedying the effects of exploitation of the ADA. Part II provides an overview of the ADA and its efforts to increase accessibility to individuals with disabilities, emphasizing the provisions of the Act that create incentives to engage in vexatious litigation. Part III examines and analyzes the judiciary's response to vexatious litigation under the ADA, and sanctions that have been issued to limit exploitation. Finally, Part IV provides recommendations to reform the ADA and state disability law counterparts, suggests corrective actions to address vexatious litigation, and identifies methods to promote equality for individuals with disabilities.