In the June issue of AccessWorld we published a letter from a reader who sought the best ways to help sighted people assist you with computer issues when you use a screen reader like JAWS. Some of our best article ideas come from you, our readers, and this is definitely a topic we felt was worthy of an in-depth look. So keep those ideas coming, and read on as we attempt to offer some useful advice on this often-perplexing topic.

Exploring New Software

You may have received training in using your screen reader, and perhaps Microsoft Office and a few other popular applications, but in nearly any work or school environment there will be other software packages you'll need to learn and use. Unfortunately, the trainer or other individual who is an expert in this new software may know next to nothing about screen readers and how they work.

If you are scheduled to be trained on a new software package for work or school, there's a lot you can do in advance to prepare yourself. Don't wait until that training session to open the software for the first time. If you can, get an advance copy, a guest login, or download the demo if it's available.

If you are preparing for a group training session, contact the training specialist ahead of time. Inform him or her that you will be attending the session and that you will be using the software with magnification, speech, braille, or any combination, depending on your particular circumstances. Inquire if it would be possible for you to preview his or her notes and/or presentation slides. Even if the training is going to be one-on-one it's a good idea to alert the trainer in advance. If you've had a chance to check over the software (see below), compile a list of questions about both access and the application itself, and forward it to the trainer a day or two before your session. It's far more likely that the trainer can answer your concerns if given the opportunity to do a bit of research ahead of time rather than being asked on the spot.

With any new software, use your screen reader's navigation keys to "scope out" the terrain. "Begin with the Tab key, which often moves you from application control to control," suggests Steven Kelley, CVRT, CRC, Vision Rehab Therapist with The Iris Network in Portland, Maine. "Also review the screen from top to bottom using the Up and Down Arrow keys and your screen reader's mouse review keys. Try to construct a mental map of what's where, such as the fact that the last control you reached using the Tab key is actually located near the upper left of the display."

Explore the menu structure. Most applications include a Help tab. Check for a "keyboard commands" option, or perform a Help search for the term.

Alternatively, you can find comprehensive lists of keyboard commands for most popular applications online. Kelley suggests you begin your search at the RNIB keyboard shortcuts guide for help with Windows. Other handy keyboard resources list keyboard shortcuts for the Statistical Package for the Social Sciences (SPSS), and for a Salesforce Console. Perform a search for any other software by entering its name and the term "keyboard shortcuts" into your preferred search engine to find more.

Now that you have a list of keyboard commands, copy and paste the list into a word processing document, or create a braille keyboard guide. "Don't try to memorize the entire list right away," Kelley advises. "Identify which keyboard commands you will use the most as you explore the software and start with those. Add a few new commands every day, or as you need them." Keyboard commands are very much like new vocabulary words. Use them three or four times and they are yours forever.

Many software accessibility issues come from unlabeled graphics and inaccessible controls. Modern screen readers enable you to label these controls with text that makes sense to you. What does that particular control do? If you can't figure it out from context, why not just give it a try and invoke it with your mouse-click hotkey? Review the subsequent screen and you may just be able to determine the button's function. Happily, very few software packages include controls with the unlabeled function: "Blow up this computer and make it never work again."

Get Help Before you Get Help

Most screen reader users are aware that both Apple and Microsoft offer special phone lines dedicated to assisting users of their respective operating systems' accessibility features. Both tend to view their mission in extremely broad terms, however. Both companies have implemented easy ways for their accessibility support representatives to connect to remote computers so they can view the problems and offer solutions. If you are faced with an application screen that does not speak at all, or unlabeled controls you really need to familiarize yourself with, give them a call and ask for help deciphering and labeling.

You can reach the Microsoft Accessibility Answer Desk at: 800-936-5900.

You can reach the Apple Accessibility Hotline at 877-204-3930.

The Be My Eyes remote assistant and BeSpecular mobile app are also useful resources when trying to decipher a confusing screen element or hardware switches and buttons on a new physical device. Be sure to document what you learn as soon as possible. It's amazing how quickly a trio of controls can turn into a game of Three Card Monty, with you left wondering which control is under which button.

Kelley recommends picking a good time for your initial software exploration. "Expect that things are not going to work perfectly the first time," he notes. "Is the beginning of your day the time when you will become the least frustrated, or do you work better at the end of the day when you can more easily put frustrating things aside for the day?"

Lastly, if you're waiting for technical support for help with an application error, document all you can about that error ahead of time. If there is an error message, write down the message text. Can you duplicate the error with a specific series of steps? If so, document those steps so you can demonstrate the error. Use your keyboard's Print Screen key to capture your display and then paste the screenshots into the same document where you write down the steps causing the glitch.

Also note any message text and error number. Do a Google or Bing search for the error. You may be surprised to learn there's a simple fix or workaround that does it require help after all.

Optimize Your Screen

One issue many trainers have, and so do other people who may be helping you, is that they are not viewing the same screen that you are. Remember, screen readers often buffer information and present it in a way that makes it easier for you to access and navigate. "When you say you are near such and such a word, that may just be your text or virtual cursor," says Kelley. "The mouse pointer, which is where the sighted person may be looking, may be on the opposite side of the screen, or even off screen." Luckily, most screen readers offer a way to highlight your work space. For NVDA, you'll need to download and install the Focus Highlight add-on, available from the NVDA Community Addons page. JAWS version 18 Build 2945 for May 2017 and later now offers Visual Tracking, which is turned on by default. macOS VoiceOver users can press CTRL + Option + Command + F10 to toggle a "Caption Panel" on and off.

Lastly, before you begin a training or support session, ensure that the window you're working on is maximized and is the only application window that is open. Otherwise you may be asking someone to help you with a postage-stamp sized window overlapped by several other data windows.

Going One on One

According to Kelley, when it's time for that one-on-one training session, "It's crucial that you find a way to put yourself in the driver's seat of your training session. Introduce your screen reader and how you use it to interact with a computer." Consider offering a brief screen reader demo. Show the trainer how the screen reader works, how you use it to write and edit text, navigate a webpage, fill out forms, and perform other routine tasks.

Select an installed voice and speech rate you feel will be comfortable for your trainer to understand. You may enjoy using Espeak at chipmunk speed, but just as you will become quickly confused and frustrated with a trainer who steps in and starts performing mouse clicks, your trainer will feel equally confused and overwhelmed if the voice you are working with sounds like gibberish to him or her.

Many instructors attempt to teach by demonstration. He or she may grab your mouse and begin clicking hither and yon. Insist that you be allowed to issue the commands, noting. "I learn best when I can work hands-on."

If you haven't already found a list of keyboard hot keys, ask the trainer to help you compile a list. Explore all of the top-level menus and controls with the trainer. "Ask the trainer to help you to develop a mental map of the application interface," Kelley suggests. It's useful to know the control you need to use can be reached with repeated presses of the Tab key. It's even more useful to know you can quickly access that same control by pressing Alt + J, or the CTRL + End key followed by a single Shift + Tab.

"If the control is difficult to locate, ask the trainer to help you move to spots just before and after that control," Kelley advises. "At least now you will know it's somewhere between them."

Make use of your screen reader's quick navigation keys to move from heading to heading, or from list to list, but don't be afraid to ask the trainer for a unique word or character string that appears near to where you wish to navigate. Then use your screen reader's Find command to move your mouse cursor to that position. If there are unlabeled buttons and other controls, ask the trainer to help you label them. Also remember that often a button that is unlabeled may include its function inside the tag, or at least enough of it to offer up a much-needed clue. For example, an "Export to CSV" image control may be unlabeled, but the tag may include the string "CSV," which is the extension name of a generic spread sheet file. Knowing this, you may be able to use your screen reader's Find command to locate the string and the button it marks.

If you're working over the phone with a trainer or tech support rep, they may inadvertently say something like, "OK start out by pressing the green button." Explain to the support technician that you are sight-impaired and using a screen reader. Offer a brief description of how a screen reader works, and when they reply, "Our application doesn't support a screen reader," assure them that in nearly all cases, the screen reader merely passes the normal program information along—it does not affect the way the application works.

Remember, frustration can go both ways. You may be frustrated that the tech-support person does not understand a screen reader. That support person may be equally frustrated that you don't understand why you cannot work things the way he or she has been trained to assist. "If all else fails, ask to speak to someone else, perhaps a supervisor," advises Kelley.

Offering Help

With all your new computer knowhow, eventually there will come a time when you are asked to help a family member or other sighted person with their computer problems or issues. There are two things to remember here:

1. Their page will not be laid out the same way as yours. What you are accustomed to finding at the end of the bottom of a webpage may actually be on the top right in a different color on theirs. So use control names as much as possible to describe what they need to do, and remember, they may not know that CTRL S saves a document; they are used to doing this with a mouse click.
2. Your screen reader announces the names of the various icons, such as Save, Cut, and Paste. The sighted user will see only graphical icons, and if they are very inexperienced they may not know what each image means. Usually, if you hover the mouse pointer over an icon, a tool tip will appear describing the icon's function. If not, show them how to turn on Narrator or VoiceOver briefly to hear what the icon does.

Although we have focused mostly on computer use, many of these tips, especially the last section above, also hold true for mobile help as well. Show a sighted person how to temporarily turn on VoiceOver or TalkBack, and they may be able to decipher that emoji that's so tiny on the screen, it's difficult to tell if their friend is asking them to "grin and dog it" or "grin and bear it."

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Before the start of Apple's Worldwide Developers Conference (WWDC) on June 5, 2017 in San Jose, California, the rumor mill was busy with speculation. The consensus of expectations appears to have been met, with the announcement, in the two-hour keynote address, of a slew of new operating systems, tools for developers, new Macs, a new iPad, and the HomePod, a stand-alone speaker with Siri capability. The keynote address included demonstrations of the new operating systems and products.

The Keynote began with a video, unfortunately without audio description. Tim Cook, Apple's CEO, welcomed everyone, reaffirming Apple's commitment to developers. There are now 16 million registered developers around the world with three million added just this past year. About 5,300 developers attended this year's WWDC, the largest attendance ever, with attendees from 75 countries. Cook said, "It's really a worldwide conference." This conference included more student developers than ever.

tvOS

There is only one change to tvOS. Amazon Prime Video is coming to Apple TV later this year. It will be included in the TV app. Cook said, "We are so pleased to welcome Amazon to Apple TV." He added, "You'll be hearing a lot more about tvOS later this year."

Apple Watch

Cook said that Apple Watch was the best selling smart watch and is number one in customer satisfaction. He said, "Apple Watch is designed to help you live a healthier life." He then introduced Kevin Lynch, Apple's VP of Technology, who spoke about watchOS4.

Lynch began by introducing three new Watch faces. The Siri face will display relevant information that you need, depending on the time of day. When you raise your wrist, Siri will automatically update the information on the screen. Turning the digital crown will reveal more information. The second new watch face is a kaleidoscope that changes throughout the day. The third face is Toy Story and features Buzz, Woody, and Jessie.

Lynch stated that Activity is one of the most frequently used apps on the watch. With watchOS4, you will receive more personalized activity notifications. Personalized monthly challenges will also be part of the Activity app.

The Workout app has new features. The Quick Start feature is now easier to locate. For swimmers, the watch can now count your laps and provide other information about your swim. New algorithms have been created for high intensity interval training. You can do more than one workout in a single session and it will be tracked.

Two-way data exchange will be possible with some gym equipment. Pair the watch and the watch will send data to the equipment and the equipment will send data to the watch. This will make information more accurate. For example, the watch will send heart rate data to the equipment and the equipment will send information such as speed to the watch. Lynch said that the equipment manufacturers who will support the watch provide 80 percent of the equipment found in gyms today. He added that supported equipment will be available this fall.

Music will be synced automatically to the Apple Watch. There is support for multiple playlists and the watch will choose selections for you. You can have a playlist start playing as soon as a Workout is started.

The Dock has been redesigned and it is easier to get to recently used apps. There is a new News app, which lets you save articles for later to read on your iPhone. There is now a flashlight in the Control Center. The light can be set to blink as a safety light when outside at night. There will be more support for apps running in the background and faster app responsiveness. Native Core Bluetooth will be supported. This improves apps that work with small devices such as glucose monitors.

watchOS4 is a free upgrade and will be available this fall.

Mac

Craig Federighi, Apple's VP for software engineering, spoke about what's new with the Mac. He said, "People are loving Sierra and we love it too, so we wanted to spend this year perfecting it. The question is, what do we call it?" The answer is "High Sierra."

Federighi explained, "High Sierra is all about deep technologies that provide a powerful platform for future innovations on the Mac. But we couldn't help ourselves; we also added some refinements."

According to Federighi, Safari with High Sierra is the fastest Web browser. A new feature, Auto Play Blocking, will be introduced in High Sierra. By default, this feature is active and will automatically block videos that load when you go to a website. It can be disabled if you want to get the videos.

Another useful feature is Intelligent Tracking Prevention. Safari uses machine learning to identify trackers and remove their data. It is not an ad blocker but instead protects your privacy. According to whatis.com, machine learning is a type of artificial intelligence (AI) that provides computers with the ability to learn without being explicitly programmed. Machine learning focuses on the development of computer programs that can change when exposed to new data.

Mail

The search feature is improved. Using Spotlight will show your top hits. When composing an email, there is a split-screen view. Mail will use 35 percent less space on your Mac's drive.

Photos

There are some new features for photos on the Mac. There is improved facial recognition and if you label people in photos, these labels will transfer to all devices. There are also different ways of organizing your photos. More editing options are available. It will be easier to search for specific photos.

The Apple File System (APFS) will be coming to the Mac with High Sierra. Federighi said, "APFS is safe and secure with built-in crash protection and native encryption and it's ultra-responsive." Federighi then demonstrated the speed difference between Sierra and High Sierra in duplicating a video file. High Sierra, with the new file system, performed the operation almost instantaneously. High Sierra will have Metal 2 for significantly improved graphics. Metal 2 will also be used in machine learning.

High Sierra is a free upgrade from Sierra and will be available later this fall.

New Macs

John Terns, VP of hardware engineering, spoke about the new Macs. They will be using Kaby Lake, Intel's newest processor. There are three iMacs: 21-inch, 27-inch, and iMac Pro. The new iMacs will have displays that are 43 percent brighter and they will be able to process a billion colors. They will have more memory, improved graphics performance and much more. There is an entry-level iMac that starts at $1,299. All the iMacs, except the iMac Pro, are now available. The Pro will be available later this year.

There have been changes with the new MacBooks as well, including the Kaby Lake processor. The entry model of MacBook Pro will start at $1,299. MacBook Pros still come in 13-inch and 15-inch. The 13-inch MacBook Air is also improved. All these MacBooks are currently available.

iOS

Tim Cook said that iOS 10 has an industry-leading 96 percent customer satisfaction rate and 86 percent of Apple's customers with iOS devices are using iOS 10. The new operating system is iOS 11. Craig Federighi returned to discuss its new features.

In Messages, there will be an App Drawer so users can easily access messaging apps, stickers, etc. Messages will sync across all devices so if you delete on one device it automatically will be deleted across your other devices. Most recent messages will stay on the device while older undeleted messages will be accessible via iCloud.

Apple Pay will be available at more than 50 percent of retailers in the US by the end of this year. With iOS 11, a new Apple Pay person-to-person payment will be available. Federighi explained, "It's super-simple because it's integrated right into Messages as an iMessage app." Authentication will be through Touch ID. When receiving money, it will go to your Apple Pay Cash Card. You can send money, pay for items or transfer money to your bank with money Cash Card.

Siri will get some new features. It is available in 21 languages in 36 countries. Siri will have a new male and a new female voice. You will be able to type your question for Siri. Another new Siri feature is translation. Siri can now translate from English to Chinese, German, Spanish, Italian, and French and Federighi indicated there will be additional languages in the future. Siri Kit will enable developers to perform more tasks in their apps.

Federighi said, "Siri isn't just a voice assistant, because with Siri intelligence, Siri not only understands your voice, it understands the context, it understands your interest, it understands how you use your device. This allows it to understand what you want next." What Siri learns on one device will transfer to all your devices. Federighi added, "This is kept completely private, only readable to you on your devices."

The Photos app is improved. Apple will be using a new photo format that will allow for less space in the cloud. There will be new ways to organize photos. Better software will help with object identification. There will be new editing options.

The Control Center will be a single page in iOS 11. If using a device with 3D Touch, there will be more options. The Lock Screen and the Notification Center are now combined. Widgets can still be accessed on the left and the camera can be accessed on the right.

The Maps app will include floor plans for many malls and airports and more locations will be added in the future. Nothing was said about indoor navigation or iBeacons. For drivers, Maps will include speed limits and lane guidance. iOS 11 will have a "Do Not Disturb While Driving' feature. If the phone senses you are in a car, you will have the option to use this feature. There is a setting for not driving. If the Do Not Disturb feature is enabled and a text comes to the phone, the sender will get a message that the driver is driving and will contact them later. People can be added who can break through the feature and their texts will appear.

Home Kit will have AirPlay 2, for sending music wirelessly to supported speakers throughout your home. In Apple Music, you will be able to find out what your friends are listing to, if you want that feature enabled.

The App Store will be redesigned. There will be a Today tab featuring apps released that day. Games will be getting a separate tab and all other apps will be in the Apps tab. Apple is also reducing the time it takes for a developer's app to be approved.

Apple is releasing an AR (augmented reality) kit to developers. When AR Kit launches, Apple will be the largest AR platform in the world.

iPad

Apple announced its new 10.5-inch iPad Pro. All iPad Pros will have a faster processor and improved display. iPad Pros will have the same front-facing and back-facing cameras as the iPhone 7. USB-C is supported on the iPad Pro as is fast charging. Both iPad Pros come with at least 64GB of memory. The 10.5-inch iPad Pro with 64GB of memory costs $649. iPads with 256 and 512GB will also be available. These iPads have been shipping since mid-June.

iOS 11 offers special features for the iPad. The dock can hold more apps. On the right side of the Dock there will be "predictive apps" including continuity apps. The dock can be accessed from anywhere. A drag-and-drop feature has been added. You can now flick up or down on the on-screen keyboard to switch from letters to numbers. A new app called Files will be added to the iPad. This app keeps all your files together and of course supports iCloud, but it also supports other storage apps including Dropbox and Google Drive. There are additional features including for Apple Pencil.

HomePod

HomePod is Apple's first stand-alone speaker. It integrates Siri into the speaker and is slightly less than 7 inches tall, with 7 tweeters and a 4-inch subwoofer, all covered by an acoustic mesh. It is powered by the same chip as the iPhone. With six microphones, it can pick up the Siri phrase, "Hey Siri," from anywhere in the room. The HomePod eliminates distortion when the volume is high and it adjusts sound based on room size.

HomePod is designed to work with Apple Music. It will access your Apple Music library including playlists. Siri can perform the usual tasks including setting reminders, sending a text, and giving a weather report. If you have Home Kit enabled, it will interact with Siri and the HomePod to control Home Kit devices. Data is only sent to Apple when Siri is activated.

HomePod will cost $349 and will be available in December.

Conclusion

Apple is introducing many useful features into its operating systems and adding some exciting new hardware. Although accessibility was not discussed at the Keynote, Apple did have sessions for developers about accessibility.

The presenter explained changes needed to make an app accessible with VoiceOver, but there was no clear description of what took place on the screen. The session did contain a lot of useful information.

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In the March issue of AccessWorld, I wrote about an unplanned hospital stay and the lessons I gleaned from that experience. Two surprises ensued: first, I wound up returning for an even longer hospital-and-rehabilitation tour of duty and, second, I found out that many readers wanted to talk about navigating medical situations as people with visual impairments or blindness. Here, then, is what we might consider the second part of the medical adventure, in which I'll share some of my own experience along with what readers and others have to say. The outcome, we hope, will be some useful preparation for all of us for the next stressful medical encounter.

My Repeat Performance

My initial hospital and rehab adventure began with the sudden snapping of my left femur. The bone had been weakened several years earlier by radiation and aggravated eight months earlier by hip replacement surgery. A prosthetic hip is like a ball on a stem. The stem is inserted into the femur, the longest bone in the body. The procedure is akin to threading a peg into a pipe, and my "pipe" was fragile and broke unexpectedly. The repair that was done involved an eight-inch metal plate and several wires. After eight weeks of mobility in a wheelchair, an x-ray determined that the bone was broken yet again, the metal plate was at a very unhealthy angle, and all wires were broken.

The original incident with follow-up hospital stay was in Ohio. The failure was discovered in Florida. Consequently, finding a surgeon in Florida to do the reconstruction was the best plan. I did find a surgeon who specializes in hip and leg reconstructions, and he took my case. Some might find the medical details gruesome and some might find them fascinating. If you are the first sort, skip the next paragraph!

Since the femur had broken at exactly the point where it needed to connect to the prosthesis, repairing it at that juncture (as the first surgeon had done) wasn't the best plan. The new surgeon's approach was to tear out the now ten-month-old prosthesis (no easy feat) and replace it with one that had an extended "stem." The typical hip replacement stem, when inserted into the femur, ends near the top of the thigh. My new one ends at mid-thigh. In addition, a cadaver bone was placed over the section of femur most damaged by radiation and fractures (about 2.5 inches). And finally, the entire bone was wrapped in heavy cable to hold it in place.

This second surgery meant spending one week in hospital followed by several in a short-term rehabilitation facility. In Ohio, I had a network of friends who visited every day and kept my spirits high and my focus off medical issues. This time, however, I was in a state where I knew virtually no one and thus had few diversions and no one to help me navigate the unfamiliar human or mechanical terrain.

The night before my surgery, I found genuine solace in Googling the hospital and surgeon. When I found the hospital on a "100 best" list compiled by a major news organization and the surgeon identified as a respected teacher and innovator in his field, my optimism regarding outcome soared!

In the operating room, I made sure everyone knew I wore hearing aids and secured approval to keep them in. I explained that, because I am completely blind, I obtain much vital information by hearing. Without the hearing aids, that would not be possible.

My first day after surgery was spent in the intensive care unit. Once I was aware of my surroundings, I realized that my space wasn't separated from the rest of the unit at all. The only thing between me and staff, visitors, and other patients was a curtain. Consequently, it was impossible for me to distinguish whether people were talking to me or to someone else. It sounds silly, but when you are already vulnerable and unable to move, this kind of thing adds yet another layer of stress and vulnerability.

The one piece of technology I had with me even in ICU was my iPhone. I'm not sure whether I made many calls or sent messages during that phase, but I clearly remember the sense of connection it gave me to have a working phone in my hand.

Once I was returned to the orthopedic floor, I connected my laptop as well.

Because the greatest problems connected with blindness are, as much in a medical facility as anywhere else, mostly related to myth and misunderstanding, I came to appreciate my technology in its ability to function as a bridge to understanding. A nurse or aide or physical therapist who might at first see a blind person as strange will generally relax a bit upon seeing a tablet or smart phone or other device that is so familiar. Being a bit geeky, in other words, was an advantage in this environment.

Of course, my access technology had plenty of practical uses as well. In addition to continuing to do my job after the first few days, my technology solved a variety of small problems.

In the short-term rehab facility, I continued to find random pages of print on the foot of my bed, the chair, the table. Usually, the KNFB Reader app identified these for me as a calendar or note about my recovery plan. When no one responded to my call light (which happened frequently), I took to wheeling myself to the doorway of my room and scanning the hall with TapTapSee to see if there were any staff nearby.

What Others Have to Say

We heard from AccessWorld readers who wanted to use the article to post in medical employee areas or as a handout in college classes. Most importantly, however, we heard from readers who had experienced the "blindness meets medical situation" up close and personally, either for their own health crisis or that of a loved one. The input was unanimous: everyone wants more information on this topic and more of a road map for navigating and advocating in these troubled waters.

One reader who wrote to us was Nancy Irwin, an access technology instructor in South Carolina. Her husband, Billy Irwin, had gone to the emergency room more than once and each time was perhaps more stressful than the one before it. Both Nancy and Billy are blind.

Although they had gone together one of those times, the worst was when he went alone in an ambulance. Upon arrival, Billy was seated in a wheelchair, checked in, and pushed aside. Unclear about his surroundings or what might happen next, he was neglected for three hours. When he vomited on the floor, he says staff was angry with him.

Nancy caught up as soon as she could, and both reported that once he had someone with him, the situation was somewhat diffused. The couple began communicating with one another and others around them. Other patients, they say, became involved in advocating for a guy who was just plain sick, like everyone else waiting, and who needed additional information due to blindness.

When Billy was admitted, trays of food were sometimes delivered without any verbal information announcing the fact.

Both say that the more they interacted with nurses, the more manageable the situation became, but it was never easy.

Ironically, Billy works as an emergency manager for amateur radio operators in the area, disseminating emergency information to police, fire, and medical responders, so he is no stranger to the emergency scene.

"The problem," Billy says, "is that people just have no idea how to deal with a blind person. They need training and they need exposure to real blind people."

The only marginally "accessible" piece of technology made available during Billy's hospital stay was the combination TV remote and call light. The button marked with the braille "n" on the remote was the one that would summon a nurse. Ironically, the remote was not otherwise accessible, but the couple did contact a nurse who spent the time to familiarize them with it.

Lisa Salinger, an access technology trainer and administrative assistant for BlindAlive, has been navigating another kind of medical facility experience. When she realized one morning that her housemate and friend was having a stroke, she called 911. After the hospital stay, her friend was moved to a rehabilitation facility for therapy and Lisa was the family member who came day after day to bring food, encouragement, and companionship. Gradually, Lisa taught at least some nurses and nursing aides how to interact with blind people.

Finding printed menus, calendars, or notes on her friend's bed, Lisa took pictures to read them with her iPhone app.

At times, when there was no one available to assist with a medical procedure in time, Lisa motivated staff to respond by offering the alternate choice that they teach her how to perform the task needed.

Similarly, when Billy Irwin grew tired of waiting for staff to disconnect his IV pole every time he needed to use the bathroom, he found someone to teach him how to disconnect it himself.

Like Lisa and Billy, others find workarounds to getting things done in a medical facility and/or gradually gain the attention and respect of one or two staff members who will provide needed information or hands-on demonstration. Sometimes, though, the "soft" approach isn't sufficient.

Tom Tobin, an Ohio fundraising professional and AccessWorld reader, recalls a time when medical professionals had to be dismissed because there was such a lack of respect. When he was having his insulin pump installed over 20 years ago, the attending physician showed such a lack of regard for the patient's ability to manage and understand his own diabetes that Tom fired him and found another.

That Mind-Body Connection

Every stress-filled example readers have shared with me struck at least one chord with my own experience. From not knowing food was in the room when you are starving, to missing the printed information shouting at you from all directions, to being a visitor and finding the elevator buttons do not have braille on them—each minor frustration interferes with wellness. Healing the body is assisted or hindered by the patient's state of mind, and when a patient feels discounted or ignored due to low vision or blindness, the quality of their care is diminished.

So … what can we do to make interactions with medical facilities more acceptable?

Advocate, Advocate, Advocate

One thing most of us as visually impaired people can do is talk! I was so unprepared for what happened when first transferred from the Florida hospital to the short-term rehab facility that I was temporarily traumatized. I was delivered, via wheelchair, to a room and left. No orientation or familiarization. No assurance of someone coming back in some amount of time. I had no idea where my belongings were, where the call light or the room phone were, or where I was! I wasn't very strong yet nor was I adept at propelling the wheelchair from place to place. Eventually, I reminded myself that I could think, that I needed to be my own cheerleader/advocate and, slowly, tentatively, began moving about the room to explore. Suffice to say, the situation improved from there, but there were many more moments of this variety. The longer I was there, the stronger my conviction that I needed to depend on myself to get what I needed. Usually, this was accomplished with a smile, but sometimes, the gentlest among us need to get a bit tougher. Once I began exploring my environment and getting outdoors (propelling a wheelchair without benefit of white cane is a learning experience in its own right), my attitude improved dramatically. My desire to get out of rehab probably expedited my recovery!

A Little Help From Your Friends

There was a stark contrast between my hospital experience in Ohio, where I had the support of friends, and the one in Florida, where I was pretty much alone. If you know ahead of time that you are going to be in a hospital or medical facility, try to line up support from family and friends in advance. Even a casual friend or acquaintance will look out for your individual needs more than relying exclusively on staff who have dozens of other patients needing attention.

Use Your Technology

I kept my iPhone with me at all times and usually my laptop or braille notetaker as well. This kind of technology can serve as tangible evidence that you are more like than unlike the medical staff with whom you are interacting. Asking about any technology in the room was beneficial, too. As the Irwins pointed out, once they found someone willing to provide a verbal/tactile tour of the remote, they were able to enjoy TV shows and thus connect in another way with staff as well.

Explain Those Techniques

When I began using a walker in physical therapy, I asked when I could use it on my own time, in order to build strength and practice. For several days, my request was denied. Finally, I realized it was blindness related. The therapist was afraid to allow me to practice walking without assistance for fear I would crash into a wall or trip over a chair. Patiently, tediously, I explained how I navigate a familiar environment. I had to demonstrate repeatedly—"I touch the wall to confirm my location …" and "I touch the door frame before turning to confirm that I am allowing sufficient space for the walker and me …" and so on. I found myself explaining frequently about muscle memory and echolocation, but the payoff was improved interaction with medical professionals and decisions based on recovery rather than misconceptions about blindness.

Use Your Power

You or your insurance company is paying for your care. If the care is compromised by misunderstandings about your ability as a person who is blind, change it. If your cellular service was inadequate, you would change companies. If a medical situation becomes absolutely untenable, change it as well.

Rx Round-up

Being in a medical facility where others control many of your simplest activities is stressful for everyone. Adding blindness to the mix increases confusion on both sides: the patient with the visual impairment needs additional information and the medical professional often come to the bedside with ill-conceived notions of a blind patient's capabilities. There is a profound need for training in these facilities. Perhaps some readers will pick up this challenge and initiate trainings in their communities. In the meantime, be your own advocate, take a friend or family member if possible, and depend on your technology to keep you connected and help bridge the gap between you and your medical team.

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For anyone reading this article, the phrase "back to school" is likely to be rich in associations—going to a new school, taking new classes, finding the right classroom on the first day of the new school year. For blind students, making sure they have textbooks available in an accessible format is definitely part of the challenge of starting a new year. As I reflect on my own back-to-school experiences spanning many years, I can't help thinking about how much the landscape has changed with regard to textbook accessibility. Technology has made more textbooks available to the blind than at any other time, and in a variety of formats. Today, it is easy to transport reading material without needing to carry a heavy backpack full of braille volumes—yes, I did that as a high school student. Today, braille, electronic, and audio material can coexist with ease, often in the same electronic file.

In this article, we will take a brief look at the various options available to blind students, and provide some resources for locating these materials.

Learning Ally: Having Someone On Your Side When You Need Accessible Textbooks

For 70 years, the non-profit organization known today as Learning Ally has provided recorded textbooks for thousands of students who have a print disability. Back in the late 70s, I actually remember receiving textbooks from what was then known as RFB (Recording for the Blind, and later RFB&D, Recording for the Blind and Dyslexic) on reel-to-reel tape. All of the young people reading this may want to Google that phrase later. When I was in college during the 80s, I vividly recall boxes of cassettes containing many hours of recorded audio and, in some cases, volunteers playing musical excerpts on a piano in order to get the material across to me in an accessible manner. All descriptions were vividly—sometimes painstakingly—described, as was the case for charts and graphs. There is probably no way to know how many thousands of hours have been put in by volunteers all across the United States, reading everything from literature to complex scientific reference books aloud.

Eventually, books were moved to electronic formats, and it is now possible to download content to a specialized player or app that can handle DAISY content, or via the mobile apps provided by Learning Ally. Along with recorded audio, it is sometimes possible to read the text of the book as well, and all Learning Ally books are marked up in such a way that students can navigate by page, section, and subsection within a book. This is most helpful when needing to quickly look up material. Gone are the days of switching out cassettes and fast-forwarding to the desired content within a textbook.

Membership in Learning Ally costs $135 per year, but it may be possible to receive assistance if you are unable to pay the cost of membership.

Accessible Textbooks in PDF Format

For the past 20 years or so, I have taught a Music Appreciation class at a local community college. While some of the textbooks I have used over that time have been available from Learning Ally, others have not been. Also, if a textbook is available, it is often not the latest edition of the book. This may work for a student, although it is not ideal, since page references change from edition to edition, and material is updated, added, and deleted over the years. For me as an instructor, it was necessary for me to always use the latest edition of the textbook I was teaching from, so I reached out to the publishers, and requested an electronic copy of the text. Almost always, I was provided with PDF (Portable Document Format) files of the text. PDF files are commonly used because the format makes it possible possible to package text and images in files that are not terribly large. While this is great for the sighted community, PDF files can be challenging for people with visual impairments.

In a best-case situation, the blind student will receive PDF files that have been marked up in such a way that text does not appear out of place—columns being run together, or picture captions inserted in odd places—and material hyperlinked to other parts of the text, or the Internet. Often, however, PDF files will not be properly formatted for the best reading experience with a screen reader. In this case, the student will have to make the best of the situation. If the text is clear, and if pictures are properly captioned, then the lack of hyperlinks may be only an inconvenience. If text is out of order, and certain parts of the text such as the buttons on a diagram of a piece of electronic equipment are not labeled, things can get a bit more complicated.

Sometimes, a PDF file will contain an image of the text in a book, but not the actual text itself. Think of taking a picture of a grocery list, rather than typing the list into the notes application of your phone. In this case, OCR (optical character recognition) software may be required to convert the image in the PDF file into text that can be read by a screen reader. Today's OCR software, whether specialized for the blind or mainstream, is increasingly able to produce quality results from an image such as that found in a PDF file.

I have found book publishers to be quite willing to assist me in obtaining electronic copies of their text, when they became aware that I was blind, and why I needed the textbook in electronic format. Often, publishers offer their books in a format that must be read by software they provide. This software is often not accessible to screen readers, and the publishers must be made to understand the problem. This sometimes takes time and patience. Remember to be clear, concise, and courteous when talking to textbook publishers. You may be the first blind person with whom the representative on the other end of the line has ever spoken.

Obtaining Textbooks From Bookshare

For years, Bookshare has been a place where blind people have been able to obtain books of all types, including textbooks for students. In the beginning, Bookshare received books from volunteers who scanned and proofread books that were then placed on the website. Today, although volunteer scanners and proofreaders are still a vital part of the service, many works are now obtained directly from the publisher. It is also possible to request books that can be scanned, proofread, and placed on Bookshare to be enjoyed by all.

It costs $75 to join Bookshare for the first time, and $50 per year thereafter, but students can use the service for free as long as they are in school.

Bookshare provides ebooks in a variety of formats including DAISY, electronic braille files, and EPUB, which allows for easy reading of books on any number of mobile devices, both mainstream and blindness-specific. Bookshare books are text only, and do not contain an audio option.

Other Resources for Obtaining Accessible Textbooks for People Who Are Blind

Although not primarily intended for this purpose, the National Library Service's BARD (braille audio reading and download) site sometimes contains books that are used in the school setting. Books on music, psychology, and computers are just a few possible topics. It is likely that the latest edition of a textbook might not be available, but there might be enough useful material available to get a student started in the right direction.

It is sometimes possible to find books in hard-copy braille from places such as BARD. When I was in college, I found an agency that produced braille volumes for me at a nominal cost. The problem I found was that the books took up a lot of room, and became out-of-date in just a few years. I personally would not spend a lot of money having books produced in braille today, unless it was a topic such as math that I really wanted to be able to explore in a way that only hard-copy braille would allow.

One of the textbooks I used when teaching my music appreciation class used VitalSource, a provider of eTextbook content to distribute their book to me. I eventually obtained the book in PDF format, so I didn't use the site for long. My brief experience was quite pleasant, however. I was able to move around the book with no problem, and content was hyperlinked in a way that provided easy access to the Internet and other parts of the text.

Amazon, Google, and Apple are all actively providing electronic texts on a daily basis, and each of those companies is showing an increased commitment to, and understanding of, the needs of those who have a print disability. It would definitely be worth checking out any or all of these options when looking for an accessible electronic textbook.

How to Find Accessible Electronic Textbooks

With so many accessible textbook options available these days, it is important to have a resource that will pull all of this information together in one place, making it possible to find out whether a textbook is available in an accessible format, and where the book can be obtained. The Louis database from the American Printing House for the Blind is one such resource. It is possible to easily search the database for a desired textbook. Detailed search results are provided, ensuring that you are in fact looking at information related to the book you are interested in. You can view the book's table of contents, see what formats are available—sound, braille, etc.—and know where to go in order to obtain the title.

The Bottom Line

Although it is still possible to come across a needed textbook that is not available in an accessible format, it is less likely today than at any other time. Publishers, content providers, and the blind community are all working together to make as many titles accessible to the blind as possible. If I were to go back to school today, I would be less stressed about trying to find available accessible textbooks than I would have been a few years ago. If the professional staff who work at schools across the country and the students with visual impairments who attend those schools are willing to work together, they should be able to work out the necessary accommodations to access required printed material. When those materials are not available, publishers will hopefully be willing to do their part to meet the needs of the visually impaired student.

Here's hoping that any future updates to this article are able to provide even more resources for obtaining accessible textbooks for students with visual impairments.

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Dear AccessWorld readers,

I know the students out there may not be ready to hear these words, but it's time to think about the start of a new school year.

New classes, new instructors, class projects, presentations, tests, new people, and maybe even a new school or moving away to college bring about uncertainty and new challenges. Uncertainty is not necessarily a bad thing. This time of year can be exciting, too, especially if you prepare in advance.

Pursuing an education can be difficult under the best of circumstances, and doing so as a person with vision loss can increase the challenge.

For the students in our readership: you must take personal responsibility for your education, and you must be your own advocate. It is very important to prepare in advance, speak to instructors, and tell those you'll be working with exactly what types of accommodations will best meet your needs. Your education will have a tremendous impact on every aspect of the rest of your life, so it's crucial that you do everything you can to get the most out of your studies.

Good planning prevents poor performance! It's never too early to begin planning for the next school term, whether you're in elementary school or graduate school. Acquiring and learning to use the mainstream and access technology that best suits your situation, registering as early as possible for classes, obtaining reading lists, and searching out alternative formats should be done as soon as you can. Waiting until the last minute is a recipe for disaster.

It has become an AccessWorld tradition for the July issue to be our "Back to School" issue. So, this month the AccessWorld team once again focuses on providing valuable information and resources for students, parents, teachers, and professionals in the vision loss field to help make educational pursuits less stressful and more enjoyable. We are excited to bring you the information in this issue, and we sincerely hope you will find it useful. We at AccessWorld also understand that you can't study every minute. There must be time for friends, leisure activities, and a little gaming competition, so please check out Jamie Pauls' article on accessible gaming in this issue (just for those times when you are waiting for class to start, of course).

Additionally, be sure to check out past "Back to School" issues from AccessWorld. The July issues of 2010, 2011, 2012, 2013, 2014, 2015, and 2016 all contain information that can still be pertinent today. When reading these past "Back to School" issues, I encourage you to start with a 2010 article I co-authored, Educational Resources and Tips from AFB's Information and Referral Center.

An extremely relevant portion of that article with very usable information is incorporated below.

FAQs from the Desk of AFB's Information and Referral Specialist

Question: What should I tell my instructors about my visual impairment?

Answer: It is important to speak with your instructors as soon as you know you are going to be in their class. Many students with vision loss fear speaking to their instructors, worrying he or she will not believe they can complete the course work due to ignorance about the capabilities of people with vision loss.

Try to schedule meetings with all of your instructors as soon as possible. It is best if you talk about your vision loss openly and honestly. Instructors may fear asking questions, not wanting to offend you. As a student, you have to be proactive, explaining how you accomplish tasks. It may be beneficial to bring your assistive technology and adaptive products to this meeting, explaining how these devices will help you. For example, you could say something to the effect of, "This is my laptop with screen-magnification software, and this is an electronic magnifier. When I place the textbook under the camera, all of the material is enlarged. I have some usable vision, so I am able to read the textbook, complete written work, and view the syllabus using this equipment. Using my laptop's screen magnification software, I am able to write term papers and use the Internet to conduct research. I wanted to show you this equipment in order to assure you I can handle the material in this class and I am serious about doing well."

You could also direct your instructor to AFB's website and to other websites on vision loss if he or she would like further information. You should then ask for an overview of the class structure. Will he or she write on the board or use an overhead projector? Will he or she use PowerPoint slides or hand out a good deal of printed material? Will there be in-class assignments or pop quizzes? What is the structure of tests? Will there be off-campus field trips? Knowing answers to these types of questions will help you to better prepare for the class.

Question: What types of services does a Disabled Student Services (DSS) office offer?

Answer: Most colleges have a DSS office, which can vary from school to school in the scope of services offered. The DSS office may offer people to assist with taking notes in class, personal readers, proctors for tests, or someone to assist you in a science lab. However, personal assistants are sometimes in short supply or are not skilled in the material covered in your particular class. This is especially true for subjects such as music, science, math, and higher levels of every subject, where technical terms are commonplace.

The DSS office may also have some assistive technology for loan, such as braille notetakers or video magnifiers. The DSS office can also assist with legal matters, such as if a student is experiencing discrimination. They may also be able to transcribe textbooks into large print or braille, or make tactile diagrams.

In addition to the DSS office, many college departments have hired graduate or teaching assistants who offer student support as part of their job description. You may also want to check with your school's tutoring center. Many tutors are willing to serve as a reader rather than as an actual tutor.

You may choose to find someone on your own and pay for their services. Sometimes the vocational rehabilitation department in your state will give you a stipend for readers. You can advertise for help in the school newspaper, at the career services center, and on bulletin boards in dorms and other places on campus. You may also want to seek help from volunteer groups, such as local places of worship, the local Lion's Club, women's groups, and campus service fraternities.

Question: Where can I get textbooks in alternate formats?

Answer:American Printing House for the Blind offers the Louis Database, where you can search for agencies that carry your textbooks in alternate formats. Recordings for the Blind and Dyslexic offers textbooks from preschool to the doctoral level. You can get them on audio cassette or the Daisy format, which works with Daisy audio book players.

The Bookshare website offers textbooks for primary, secondary, undergraduate, and post-graduate study. Recently, Bookshare began offering students with documented legal blindness free access to its collection, waiving the usual $150 fee.

Project Gutenberg offers a smaller collection of books, mostly classics, which could come in handy for students taking a literature or classics class.

Many works of literature, especially classic short stories and poems, can be found using a search engine. While in college, I was able to locate online versions of pieces such as "The Raven" by Edgar Allen Poe, "Stopping by Woods on a Snowy Evening" by Robert Frost, and "To Build a Fire" by Jack London.

The Library of Congress is another great place to search for novels and poetry for your English classes. You can find audio cassettes, braille-ready electronic files, and digital audio versions of the works you need.

You can also purchase the print copy of a textbook, and scan them yourself using optical character recognition software, such as Openbook or Kurzweil. Even if you cannot locate a particular textbook, check for earlier editions; usually the changes from edition to edition are minimal.

You can even order a completely different textbook on the same subject. I have done this for Physics classes as most general physics books cover the same topics. I could look up something such as "calculating velocity" and learn the same material as my classmates. I have even searched the Internet for topics covered in my textbooks, such as locating boiling and melting points for chemical compounds.

You could also contact the book's publisher and request an electronic version, which, by law, the publisher should send you. This process, however, can be time consuming as you sometimes must verify your disability. So, attempt to find the names of textbooks you will be using during the upcoming school tern as early as possible.

Question: How do I take notes in class?

Answer: Several methods may be employed. You may choose to use a personal notetaker employed by the DSS office or ask a classmate to take notes for you. You could also use a laptop or electronic notetaker. Students with low vision can use a portable video magnifier. You could use 20/20 pens, which create a bold line. You could also try using bold or raised-line paper. Another method is using an audio recorder, either a separate piece of hardware, or one that is built into your laptop or electronic notetaker.

Question: How do I complete in-class work, such as pop quizzes or worksheets?

Answer: You can handle in-class work in several ways. If the assignment or quiz is short, you can stay after class and have the instructor read it to you. The instructor may allow you to use an electronic version on your laptop or notetaker. Be sure to bring your portable video magnifier to class if you have enough usable vision to take assignments and quizzes in this manner. Some people with vision loss, even though they cannot read print, learn the print alphabet, allowing them to use raised-line paper for short assignments. I've done this for short multiple-choice quizzes.

Question: How do I handle taking tests?

Answer: You could contact the DSS office and use one of the office's personal readers. Some DSS offices will transcribe tests into braille, convert them to electronic format, or reproduce them in large print. Another option is using a video magnifier if you have enough usable vision. Many low-vision students have difficulty reading Scantron sheets, and choose to write directly on the test itself or on a separate sheet of paper. Some instructors will give a visually impaired student the test on a USB drive or via e-mail, allowing him or her to use a laptop or notetaker to answer the questions. This is especially handy for essay questions, which can be difficult to answer by dictating to a proctor or writing under a video magnifier.

Question: What about classes of a more visual nature, such as those in the fields of science, engineering, and math?

Answer: Several agencies have created adapted products for the science, technology, engineering, and math fields, including braille and large-print periodic tables of the elements; raised-line drawings of the human body systems; talking and large-font calculators; raised- and bold-line graphing paper; large-print and braille rulers, yardsticks, and tape measures; braille protractors, 3-D representations of shapes for geometry, and raised-line drawing kits.

The color video magnifier is great for viewing specimens, such as the veins on leaves, the wings of insects, and details on rocks and shells. You can label lab equipment, such as measurement marks on beakers and test tubes, with large-print or tactile labels, allowing you to perform lab experiments using this glassware independently. Some lab work may not have a logical way to be performed independently. For these circumstances, students who are visually impaired may choose to use a lab assistant. The instructor knows the student with vision loss is responsible for telling the assistant what to do, such as stating the amount and type of compound to pour into a beaker. The assistant may also describe color changes, temperature readings on the thermometer, and weights on the balance scale. The lab assistant does not write lab reports, take tests, or do any of the written work submitted for the course. This is the responsibility of the student.

Some adaptive lab equipment is also available, such as talking thermometers, voltmeters, micrometers, color identifiers, and balance scales. The Independent Laboratory Access for the Blind project is one source for such equipment. Some microscopes have the ability to connect to a monitor, displaying specimens under the microscope lens onto the monitor's screen. This allows for much larger magnification and eliminates the need for the student with low vision to focus the microscope lens by looking through the lens, which can be quite an eye strain.

Question: What if I do not have the funds to purchase assistive technology?

Answer: The vocational rehabilitation department in your state may purchase assistive technology, such as video magnifiers, electronic notetakers, or laptops. Your school or a local public library may have an assistive technology room for visually impaired students to use. Check with local agencies for the blind or teachers of the visually impaired to see if you can borrow equipment.

Community groups, such as the Lions Club, may offer grants. The National Federation of the Blind (NFB) has implemented a technology loan program with a low interest rate, and the Association of Blind Citizens (ABC) offers an assistive technology fund.

The following organizations distribute low-cost computers with adaptive technology, either a screen reader or screen magnifier, included:

Texas Center for the Visually Challenged
11330 Quail Run
Dallas, Texas 75238
Phone: 214-340-6328
Fax: 972-495-5344
E-mail: boblang@airmail.net

The Used Low Vision Store offers myriad assistive technology for a reduced cost.

Question: Where should I look for scholarships?

Answer: There are a vast number of scholarships for college students, and some are geared specifically for persons with vision loss. Check with local and national agencies for the blind, such as the NFB and the American Council of the Blind chapters. Also, note that AFB offers scholarships to students pursuing higher education; visit our website to learn more.

Question: Where on the AFB website can I find useful information about college-related issues?

Answer: You can use the search option on our main site to locate information, or browse the FamilyConnect website, which has a section specific to college students under the "transition to independence" link. Here you can read articles such as "Caitlin's Top Ten Rules for Incoming Freshman" and "College Life Begins."

Our CareerConnect website also contains a wealth of information about employment. At first glance, this content may not seem suitable for persons pursuing an education (as opposed for those looking for careers), but the mentor database in particular will be of great assistance. I know from personal experience because I located mentors in the science fields, specifically chemistry, physics, and biology, in order to ask questions about adapting laboratory material. So, please take time to review the AFB main website, FamilyConnect, and CareerConnect. Great information is literally at your fingertips!

We on the AccessWorld team wish you good luck and good planning as you head back to school!

Sincerely,
Lee Huffman
AccessWorld Editor-in-Chief
American Foundation for the Blind

Dear AccessWorld Editor,

This letter is in response to Deborah Kendrick's June article entitled, Introducing Blind Alive and Eyes-Free Fitness: Fitness Is More Than Meets the Eye.

Yes, Blind Alive and Eyes Free Fitness demonstrate what's possible for personal fitness. The different routines and programs enable anyone with even the slightest interest to pull up a chair and begin working out. Even advance fitness buffs or yoga masters may learn alternative methods to achieve their goals or learn something new.

However, this comment aims to point out another service for the blind to embark on a life of fitness: UnitedInStride.com. Developed by the Massachusetts Association of the Blind and Visually Impaired in 2015, United In Stride is a platform linking visually impaired runners and sighted guides. Why workout alone at home when you can head off onto a trail with a new friend?

I never thought of myself as a runner, rather running was just something I did. After my visual impairment, the simple activity of tying my shoes and heading off for a three-mile run disappeared. Yes, treadmills provide the opportunity to run, but it's not the same as feeling the breeze cooling off your skin, or [having the chance to come] across another runner and start an impromptu race.

United In Stride resolves the treadmill monotony by opening up a world of sighted guide volunteers. If you [haven't run] with a sighted guide or if you know a sighted individual interested in being a sighted guide, the most common guiding methods are a click away.

The platform possesses two weaknesses. The first stems from the number of members. Simply put, we as visually impaired sporting advocates need to reach throughout our communities and urge our [visually impaired] peers and sighted friends to consider signing up. It's free, and you never know who you might meet. The second is more of a personal preference situation. UnitedInStride.com is solely Web-based, so no corresponding app or synchronization with Facebook or Strava [is available]. Though the site is accessible, it's not accessible to a sizable population of users that predominantly rely on mobile device apps or who just do not want to sign up for membership on another website. I received this criticism while discussing [visually impaired] running with a local disability and athletics group, and it's pretty valid.

It's my hope that by increasing awareness of Blind Alive and UnitedInStride, we may demonstrate to ourselves and the greater world the joys and possibilities of visually impaired fitness.

Thank you for your assistance,

Timothy Hornik

Dear AccessWorld Editor,

Deborah Armstrong's letter, published in the June issue, was spot on. She described the issues one has working with a sighted helper: "that green arrow" and "click on the button in the upper right corner." She writes well and has a handle on the irritations of trying to ride this cyber bull without a saddle.

The iPhone book sounds interesting, but in a couple months it's on to iOS 11. Who can ever keep up! Anna Dresner is certainly smart and writes well. But who can keep up? Can't Apple simply develop an iOS every other year? It's the worm in the iPhone.

Thank you

David Faucheux

Dear AccessWorld Editor,

My name is Ella, and I am a legally blind academic. I am writing to ask a question for a couple of colleagues. They are sighted, but wish to develop an app that can be used to read papers (i.e., PDF journal articles) aloud, as a way of keeping up with the literature. I'll paste part of their email to me below:

The basic premise is to come up with a program that is able to read academic papers and translate them into podcasts that could be listened to instead of read. Obviously this is not as straightforward as with most types of text, because there are so many bits of papers that you would not want read (figures, citations, etc.). So, the program would need to use machine learning to discriminate between different parts of the paper and select the ones that you want to have read to you (e.g., you could just listen to abstracts). Ideally this would all be packaged in a slick app that could be used on an iPhone, etc.

Do you know of anything similar? Can you suggest any support for developing such a tool, or do you have any suggestions?

I look forward to hearing from you.

Sincerely,

Ella

Response from AccessWorld Associate, Aaron Preece

Hello Ella,

From my research, there are apps that can read documents using understandable text-to-speech, but it does not appear that a technology exists that can differentiate between various text elements without prior markup. For example, the apps Capti Narrator and Voice Dream Reader support the reading of documents using text-to-speech. In fact, this page from Voice Dream's website details how someone uses the app to read journal articles; see the review from "Jde05346."

The Victor Reader Stream hardware book reader allows users to hide certain content such as footnotes or page numbers in DAISY format (a markup format for accessible books) if these elements have been indicated in the text. See section 3.6 in the Victor Reader Stream user guide for information on this topic.

It appears that in order to take advantage of such features, the book or article would need to be marked up beforehand; I have not found a piece of software or service that can use machine learning to intelligently markup an unformatted document. That being said, apps such as those referenced above would allow someone who is completely sighted to listen to print material without the need for a screen reader.

ZoomText Update Now Available

A free update for ZoomText 10.1, version 10.11.9, is now available. This update provides the following enhancements and fixes:

• Support for activating ZoomText 10.1 with ZoomText 11 serial numbers
• Fix for typing extended ANSI characters using ALT + Number pad keys
• Fix for proper display and reading of special Czech/Slovak characters in AppReader and DocReader
• Faster downloads for future updates that are provided via the ZoomText 10.1 Update Wizard

Note: Since this is a focused update for key customer needs, it is only being released as an update via a full installer for "Single-User" licenses. Additional build types will be considered and produced if warranted.

To get the 10.11.9 single-user update, go to the product updates page on the ZoomText website.

Amazon Announces Availability of Audio Described Content through Amazon Video

Amazon has been on a real tear lately improving the accessibility of its various products and services. In the May issue of AccessWorld , we described how now you can read Kindle books on your PC using the free NVDA screen reader. We also outlined several new enhancements the company has incorporated into the VoiceView screen reader for its accessible Fire TV devices. We noted at the time that we were still waiting for the big daddy of streaming video accessibility—audio description. Well, it's finally here, and at the time of this writing, audio description was available on more than 100 movies from studios such as Disney, Lionsgate, NBC, Paramount, and Warner Brothers.

Many of these titles are available only for rental or purchase from Amazon, but their initial library of described titles includes 10 popular Amazon Original TV shows available free with a subscription to Amazon Prime—see more news about Amazon Prime below. You can view and search an updated list of video titles which include audio descriptions by going to Amazon's website.

Audio description is available on Fire TV and tablets, and using the Prime Video app for iPhone and Android.

To enable audio description, access the "Subtitles and Audio" menu on your device during playback. Select the "English- audio description." option from the "Subtitles and Audio" menu. Press Close and audio description will begin immediately. You should only have to do this once; subsequent videos should begin with audio description enabled by default.

If you need further assistance with audio description, contact Amazon at 866-216-1072 and ask for a digital representative.

Prime Video is an add-on service available to subscribers of Amazon Prime. The service costs $99 per year, but if you are on government assistance, you may be eligible for a discounted no-contract rate of $5.99 per month. Learn more at Amazon's website.

Yahoo Announces a More Accessible Yahoo Mail

Recently, Yahoo unveiled its most accessible Yahoo Mail to date, in a new desktop experience that includes better inbox customization, streamlined organization, rich compose, improved search, and rich preview. Yahoo Mail has been completely redesigned from the ground up, to better ensure all users, including those with disabilities, can enjoy its e-mail service. As part of the upgrade, users can take advantage of threaded message viewing, stationery, animated gifs, emoji, and more, via:

• Full-featured access for NVDA and VoiceOver screen reader users
• Options for light-sensitive and low-vision users
• Improved layouts for use with high magnification
• Full keyboard navigation for alternative input devices