Bambang Parmanto

Accessibility of Internet websites through time

Using Internet Archives Wayback Machine, a random sample of websites from 1997-2002 were retrospectively analyzed for effects that technology has on accessibility for persons with disabilities and compared to government websites. Analysis of Variance (ANOVA) and Tukeys HSD were used to determine differences among years. Random websites become progressively inaccessible through the years (p<0.0001) [as shown by increasing Web Accessibility Barrier (WAB) scores], while complexity of the websites increased through the years (p<0.0001). Pearsons correlation (r) was performed to correlate accessibility and complexity: r=0.463 (p<0.01). Government websites remain accessible while increasing in complexity: r=0.14 (p<0.041). It is concluded that increasing complexity, oftentimes caused by adding new technology to a Web page, inadvertently contributes to increasing barriers to accessibility for persons with disabilities.

A longitudinal evaluation of accessibility: higher education web sites

Purpose – Using Internet Archives Wayback Machine, higher education web sites were retrospectively analyzed to study the effects that technological advances in web design have had on accessibility for persons with disabilities.Design/methodology/approach – A convenience sample of higher education web sites was studied for years 1997‐2002. The homepage and pages 1‐level down were evaluated. Web accessibility barrier (WAB) and complexity scores were calculated. Repeated measures analysis of variance (ANOVA) was used to determine trends in the data and Pearsons correlation (r) was computed to evaluate the relationship between accessibility and complexity.Findings – Higher education web sites become progressively inaccessible as complexity increases.Research limitations/implications – The WAB score is a proxy of web accessibility. While the WAB score can give an indication of the accessibility of a web site, it cannot differentiate between barriers posing minimal limitations and those posing absolute inacce...

Metric for web accessibility evaluation

A novel metric for quantitatively measuring the content accessibility of the Web for persons with disabilities is proposed. The metric is based on the Web Content Accessibility Guidelines (WCAG) checkpoints, an internationally accepted standard, that can be automatically tested using computer programs. Problems with current accessibility evaluation and the need for a good Web accessibility metric are discussed. The proposed metric is intended to overcome the deficiencies of the current measurements used in Web accessibility studies. The proposed metric meets the requirements as a measurement for scientific research. Examples of large-scale Web accessibility evaluations using the metric are given. The examples cover a comparison of Web accessibility of top medical journal Web sites and a longitudinal study of a Web site over time. The validity of the metric was tested using a large number of Web sites with different levels of compliance (rating categories) to the standard WCAG. The metric, which uses a predetermined simple weighting scheme, compares well to the more complex C5.0 machine learning algorithm in separating Web sites into different rating categories.

iMHere: A Novel mHealth System for Supporting Self-Care in Management of Complex and Chronic Conditions

Background Individuals with chronic conditions are vulnerable to secondary complications that can be prevented with adherence to self-care routines. They benefit most from receiving effective treatments beyond acute care, usually in the form of regular follow-up and self-care support in their living environments. One such population is individuals with spina bifida (SB), the most common permanently disabling birth defect in the United States. A Wellness Program at the University of Pittsburgh in which wellness coordinators supervise the care of individuals with chronic disease has produced remarkably improved outcomes. However, time constraints and travel costs have limited its scale. Mobile telehealth service delivery is a potential solution for improving access to care for a larger population. Objective The project’s goal was to develop and implement a novel mHealth system to support complex self-care tasks, continuous adherence to regimens, monitoring of adherence, and secure two-way communications between patients and clinicians. Methods We developed and implemented a novel architecture of mHealth system called iMHere (iMobile Health and Rehabilitation) consisting of smartphone apps, a clinician portal, and a two-way communication protocol connecting the two. The process of implementing iMHere consisted of: (1) requirement analysis to identify clinically important functions that need to be supported, (2) design and development of the apps and the clinician portal, (3) development of efficient real-time bi-directional data exchange between the apps and the clinician portal, (4) usability studies on patients, and (5) implementation of the mHealth system in a clinical service delivery. Results There were 9 app features identified as relevant, and 5 apps were considered priority. There were 5 app features designed and developed to address the following issues: medication, skin care, bladder self-catheterization, bowel management, and mental health. The apps were designed to support a patient’s self-care tasks, send adherence data to the clinician portal, and receive personalized regimens from the portal. The Web-based portal was designed for clinicians to monitor patients’ conditions and to support self-care regimens. The two-way communication protocol was developed to facilitate secure and efficient data exchange between the apps and the portal. The 3 phases of usability study discovered usability issues in the areas of self-care workflow, navigation and interface, and communications between the apps and the portal. The system was used by 14 patients in the first 6 months of the clinical implementation, with 1 drop out due to having a poor wireless connection. The apps have been highly utilized consistently by patients, even those addressing complex issues such as medication and skincare. The patterns of utilization showed an increase in use in the first month, followed by a plateau. Conclusions The system was capable of supporting self-care and adherence to regimen, monitoring adherence, supporting clinician engagement with patients, and has been highly utilized.

SOVAT: Spatial OLAP Visualization and Analysis Tool

Community health research is practiced with disparate independently used tools that by themselves do not allow for the type of comprehensive and thorough analysis needed for effective public health evaluation. The Spatial OLAP Visualization and Analysis Tool (SOVAT) is a new type of research application for community health assessments. SOVAT integrates into one system many of the necessary characteristics needed to make comprehensive community health decisions. By combining On-Line Analytical Processing (OLAP) with Geospatial Information System (GIS) capabilities, our system can handle large amounts of data, perform geospatial and statistical calculations, and then display this information in both a numerical and spatial view within the same interface. It is anticipated that this unique system will provide researchers with the ability to perform more comprehensive assessments while enabling for more informed public health decisions.

Reducing Variance of Committee Prediction with Resampling Techniques

Algorithms for reducing variance in neural network prediction using committee and resampling techniques bootstrap and cross-validation are presented. Their effectiveness is tested on data sets with different levels of noise and on medical diagnosis data sets. The methods are most effective when the noise level in the data is high or the size of the learning set is small, which consequently produces high variance. The algorithms will not be of much help in cases where the error of prediction is mainly due to bias. An increase in bias is observed due to smaller effective learning size in the bootstrap and crossvalidation committee. The impact of increased bias on the performance ranges from negligible to completely undermining the benefit of reducing the variance.

Development of SOVAT: A numerical-spatial decision support system for community health assessment research

INTRODUCTION The development of numerical-spatial routines is frequently required to solve complex community health problems. Community health assessment (CHA) professionals who use information technology need a complete system that is capable of supporting the development of numerical-spatial routines. BACKGROUND Currently, there is no decision support system (DSS) that is effectively able to accomplish this task as the majority of public health geospatial information systems (GIS) are based on traditional (relational) database architecture. On-Line Analytical Processing (OLAP) is a multidimensional data warehouse technique that is commonly used as a decision support system in standard industry. OLAP alone is not sufficient for solving numerical-spatial problems that frequently occur in CHA research. Coupling it with GIS technology offers the potential for a very powerful and useful system. METHODOLOGY A community health OLAP cube was created by integrating health and population data from various sources. OLAP and GIS technologies were then combined to develop the Spatial OLAP Visualization and Analysis Tool (SOVAT). RESULTS The synergy of numerical and spatial environments within SOVAT is shown through an elaborate and easy-to-use drag and drop and direct manipulation graphical user interface (GUI). Community health problem-solving examples (routines) using SOVAT are shown through a series of screen shots. DISCUSSION The impact of the difference between SOVAT and existing GIS public health applications can be seen by considering the numerical-spatial problem-solving examples. These examples are facilitated using OLAP-GIS functions. These functions can be mimicked in existing GIS public applications, but their performance and system response would be significantly worse since GIS is based on traditional (relational) backend. CONCLUSION OLAP-GIS system offer great potential for powerful numerical-spatial decision support in community health analysis. The functionality of an OLAP-GIS system has been shown through a series of example community health numerical-spatial problems. Efforts are now focused on determining its usability during human-computer interaction (HCI). Later work will focus on performing summative evaluations comparing SOVAT to existing decision support tools used during community health assessment research.

Perspectives on the Evolution of Mobile (mHealth) Technologies and Application to Rehabilitation

Individuals with chronic conditions and disabilities who are vulnerable to secondary complications often require complex habilitative and rehabilitative services to prevent and treat these complications. This perspective article reviews the evolution of mHealth technologies and presents insights as to how this evolution informed our development of a novel mHealth system, iMHere (interactive mobile health and rehabilitation), and other technologies, including those used by the Veterans Administration. This article will explain the novel applications of mHealth for rehabilitation and specifically physical therapy. Perspectives on the roles of rehabilitation professionals in the delivery of health care using mHealth systems are included. Challenges to mHealth, including regulatory and funding issues, are discussed. This article also describes how mHealth can be used to improve patient satisfaction and delivery of care and to promote health and wellness.

VISYTER: Versatile and Integrated System for Telerehabilitation

The versatile and integrated system for telerehabilitation (VISYTER) is a software platform for developing various telerehabilitation applications. VISYTER has been designed to take into account the environments and requirements of rehabilitation services. The requirements considered in the platform design include minimal equipment beyond what is available in many rehabilitation settings, minimal maintenance, and ease of setup and operation. In addition, the platform has been designed to be able to adjust to different bandwidths, ranging from the very fast new generation of Internet to residential broadband connections. VISYTER is a secure integrated system that combines high-quality videoconferencing with access to electronic health records and other key tools in telerehabilitation such as stimuli presentation, remote multiple camera control, remote control of the display screen, and an eye contact teleprompter. The software platform is suitable for supporting low-volume services to homes, yet scalable to support high-volume enterprise-wide telehealth services. The VISYTER system has been used to develop a number of telerehabilitation applications, including a remote wheelchair prescription, adult autistic assessments, and international physical therapy teleconsultations. An evaluation of VISYTER for delivering a remote wheelchair prescription was conducted on 48 participants. Results of the evaluation indicate a high level of satisfaction from patients with the use of VISYTER. The versatility and cost-effectiveness of the platform has the potential for a wide range of telerehabilitation applications and potentially may lower the technical and economic barriers of telemedicine adoption.

Homepage not enough when evaluating web site accessibility

Purpose – The purpose of this paper is to determine if the homepage of a web site is representative of the whole site with respect to accessibility.Design/methodology/approach – The paper presents an intraclass correlation (ICC) between homepage web accessibility barrier (WAB) scores and the WAB scores of web site levels 1 through 3 for 33 popular web sites.Findings – The paper finds that the homepage is not sufficient to detect the accessibility of the web site. ICC of the homepage and average of levels 1‐3 is 0.250 (p=0.062) and ICC of levels 1, 2, and 3 is 0.784 (p<0.0001). Evaluating the homepage and first‐level pages gives more accurate results of entire site accessibility.Originality/value – This is first study correlating homepage accessibility with web site accessibility.