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Disability and Rehabilitation: Assistive Technology
ISSN: 1748-3107 (Print) 1748-3115 (Online) Journal homepage: http://www.tandfonline.com/loi/iidt20
Assistive technology provision: towards an
international framework for assuring availability
and accessibility of affordable high-quality
Luc de Witte, Emily Steel, Shivani Gupta, Vinicius Delgado Ramos & Uta
To cite this article: Luc de Witte, Emily Steel, Shivani Gupta, Vinicius Delgado Ramos &
Uta Roentgen (2018) Assistive technology provision: towards an international framework for
assuring availability and accessibility of affordable high-quality assistive technology, Disability and
Rehabilitation: Assistive Technology, 13:5, 467-472, DOI: 10.1080/17483107.2018.1470264
To link to this article: https://doi.org/10.1080/17483107.2018.1470264
© 2018 The Author(s). Published by Informa
UK Limited, trading as Taylor & Francis
Published online: 09 May 2018.
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Assistive technology provision: towards an international framework for assuring
availability and accessibility of affordable high-quality assistive technology
Luc de Witte
, Emily Steel
, Shivani Gupta
, Vinicius Delgado Ramos
and Uta Roentgen
School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom of Great Britain and Northern Ireland;
School of Law, The University of Queensland, St. Lucia, Australia;
School of Health and Wellbeing, The University of Southern Queensland,
Department of Health Ethics and Society, Maastricht University, Maastricht, the Netherlands;
Faculdade de Medicina da
University of S~
ao Paulo, S~
ao Paulo, Brazil;
Research Centre Technology in Care, Zuyd University of Applied Sciences, Heerlen, the Netherlands
Purpose: This is a position paper describing the elements of an international framework for assistive tech-
nology provision that could guide the development of policies, systems and service delivery procedures
across the world. It describes general requirements, quality criteria and possible approaches that may help
to enhance the accessibility of affordable and high quality assistive technology solutions.
Materials and methods: The paper is based on the experience of the authors, an analysis of the existing
literature and the inputs from many colleagues in the field of assistive technology provision. It includes
the results of discussions of an earlier version of the paper during an international conference on the
topic in August 2017.
Results and conclusion: The paper ends with the recommendation to develop an international standard
for assistive technology provision. Such a standard can have a major impact on the accessibility of AT for
people with disabilities. The paper outlines some the key elements to be included in a standard.
äIMPLICATIONS FOR REHABILITATION
Assistive technology is a key element in rehabilitation, but many people have no access to affordable
AT solutions. The recommendations in the paper aim to inform policies, systems and service delivery
procedures on how to improve access to AT across the world.
Received 5 March 2018
Revised 23 April 2018
Accepted 24 April 2018
Assistive technology; service
Assistive technology (AT) is an umbrella term for products and
related services used by persons with disability to enable and
enhance their inclusion in all domains of participation. AT can be
used by people of all ages and with all types of impairment (loco-
motor, visual, hearing, speech or cognition) and all sorts of limita-
tions in activities, and for short or long periods of time. The
combination of products and strategies to meet an individual’s
needs is called an “AT solution”, and is developed via processes of
assessment, trial and adaptation [1,2]. Some AT solutions are simple
and require low-tech devices, others are very expensive and com-
plex. This variety of user groups and the wide range of assistive prod-
ucts and related services make the provision of AT a complex issue.
This complexity is further increased by the fact that the impact of a
particular AT solution depends largely on the aspirations and indi-
vidual characteristics of the user. There is not one AT solution that
fits all; what works for one user might not work at all for another.
When this complexity is placed in the context of the worldwide
increase in the number of persons with disability , and thus,
the number of people who might benefit from AT in their daily
lives, it is obvious that there is a worldwide challenge to develop
policies, provision systems and procedures that assure the avail-
ability and accessibility of affordable high-quality AT for those
who need it. The details of this challenge are different for each
country, but the question is global: how can we assure that as
many people as possible have access to assistive products and
services that optimally support them to participate in society?
This paper outlines the elements of an international framework
for AT provision that could guide the development of policies, sys-
tems and service delivery procedures across the world. It does not
prescribe how AT provision should be organized, but describes
general requirements, quality criteria and possible approaches.
The paper is based on an analysis of existing literature in this
field and a consultation of experts from different countries and
parts of the world. A draft version of the paper was discussed at
the GREAT conference in Geneva (Global Research, Innovation and
Education in Assistive Technology) that took place in August 2017
as part of the World Health Organisation’s GATE initiative. Inputs
from that discussion were included in this final version.
Assistive technology as a human right
Public AT provision systems have been in place in many countries
for many years, as part of their national or regional healthcare and
welfare systems. With the publication of the United Nations
Convention on the Rights of Persons with Disabilities (CRPD) an
CONTACT Luc de Witte email@example.com University of Sheffield, School of Health and Related Research, 217 Portobello, Sheffield, S1 4DP United
Kingdom of Great Britain and Northern Ireland
This article was originally published with errors. This version has been corrected. Please see Corrigendum (http://dx.doi.org/10.1080/17483107.2018.1479367)
ß2018 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/),
which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.
DISABILITY AND REHABILITATION: ASSISTIVE TECHNOLOGY
2018, VOL. 13, NO. 5, 467–472
international legal obligation for countries was created.
This convention, among many other things, commits the ratifying
states to enforce appropriate measures to facilitate access to AT sol-
utions for those who need them to improve independence in daily
life and to participate in society on an equal basis with others. The
CRPD has encouraged the development of AT provision systems,
policies and procedures and granted AT the status of a human right.
The CRPD sets standards for ratifying countries to meet while
addressing inclusion of persons with disabilities. It is built on princi-
ples including “respect for inherent dignity, individual autonomy
including the freedom to make one’s own choices”(article 3(a)).
Ratifying states are obliged to “ensure and promote the full realiza-
tion of all human rights and fundamental freedoms for all people
with disabilities”(article 4(1)), including promoting the availability,
More than 170 countries have ratified the CRPD, indicating a
commitment to give effect to the rights it embodies and be
bound by its guidelines. Ratifying states are obliged to harmonize
their relevant national laws and policies with the CRPD. This
would mean designing laws and policies in such a way that they
ensure access to support services including AT for all persons with
disabilities requiring it. This includes older people and people
with a chronic disease. It is a human right that persons with dis-
abilities have access to assistive technology that is affordable and
matched to their needs, in line with the United Nations Universal
Declaration of Human Rights (UDHR) . In particular, the right for
persons with disabilities to access the freedoms identified in the
UDHR, such as the right to not be subjected to degrading treat-
ment, the right to work, and the right to access education, may
be protected through the provision of AT.
Access to affordable Assistive Technology is a human right, with a
foundation in the United Nations Convention on the Rights of People with
Elements of assistive technology provision
The term “Assistive Technology provision”entails everything that
is needed to assure that a person with disability who might bene-
fit from AT actually obtains it and obtains the most appropriate
AT solution for that individual. A key element is the service deliv-
ery process, that is the process through which an individual goes
to obtain an AT solution that meets his or her needs. For optimal
AT provision, however, many other elements are also essential.
These elements include: good quality AT products have to be
available at affordable prices; people –end users and professio-
nals involved –have to know that certain solutions exist; there
have to be professional services providing advice and support;
there have to be policies and procedures to decide about eligibil-
ity for certain solutions and funding mechanisms; there has to be
training on use; there have to be follow-up services; and there has
to be an infrastructure for maintenance and repairs; etc. All these
elements can be organized or arranged in different ways, but they
have to be in place for AT provision to be effective.
The following six paragraphs set out basic requirements and
possible approaches for these elements. The first five elements
can be considered pre-conditions, the sixth is the service delivery
process, which is the key process from a user perspective.
Availability of affordable high quality assistive products
Availability of affordable high-quality assistive products is a ser-
ious problem for many people with disabilities. The market for
assistive products is characterized by relatively small companies,
mostly with a national or regional scope. Exceptions are in the
fields of wheelchairs, prosthetics and orthotics, but even here the
numbers of products sold are insufficient to reach economy of
scale to reduce production costs and lower prices. As a result
most assistive products are expensive, sometimes extremely
expensive. The consequence of this is that, even in high-income
countries, many assistive products are only available to those who
can afford to buy them privately, rather than through a public
provision system. For low- and middle-income countries these
assistive products are simply out of reach. Although everyday ubi-
quitous technologies like smartphones and tablet computers are
becoming more easily available and affordable, and these technol-
ogies increasingly offer assistive solutions, the majority of the
existing products are not within reach for the majority of the peo-
ple with disabilities.
An additional problem is that the AT market is not an open
market, in the sense that end users generally have very little
choice. Decisions are made by intermediary bodies like insurance
companies or municipalities, or by donor-driven organizations and
projects, but very rarely the user directly. This creates a market in
which there are clear needs but users without direct purchasing
power. Additionally, procurement of AT products is often out-
sourced to third parties. While bulk procurement of assistive prod-
ucts by governments, insurance companies or other agencies can
reduce time, effort and costs, it increases the distance between
end users’needs and outcomes and purchasing decisions.
According to a global study quoted in In a WHO and USAID
(United States Agency for International Development) Joint paper
 53% of the countries surveyed in 2005 had not initiated pro-
grams relating to AT provision. In these countries, AT provision
occurred via non-governmental organizations (NGOs), with limited
reach and a narrow scope of assistive products (e.g., wheelchairs
or prosthetics). In a way this fragments the market and masks part
of the needs in society. States should take responsibility for devel-
oping national policies on AT provision, including policies on
manufacturing and trade of assistive products.
With the publication of the Priority Assistive Products List
(APL), the WHO has set a minimum standard for assistive products
that should be available in all countries . Companies should be
strongly encouraged to produce and sell high-quality assistive
products on this list at the lowest possible prices without compro-
mising on quality standards. For some assistive products, this will
require research into new production techniques and supply chain
efficiencies, including local production to shorten the delivery
chain and save costs for transport etc. Such research should be
supported. In countries without production capabilities arrange-
ments for easy trading and import tax wavers should
The availability and affordability of assistive products can be strongly
stimulated by challenging companies to produce and sell high quality
products from the WHO Priority Assistive Products List (APL) at affordable
prices, and by stimulating research into new production techniques,
including local production of proven technologies.
States should develop national policies on AT provision, including a policy
on manufacturing and trade of assistive products. Establishing an
international authority that can support states in this area and can exert
pressure on states should be considered.
An important development is that mainstream technologies,
with the smartphone and the tablet computer as most obvious
examples, offer features that allow them to function as assistive
products. This has opened a whole new market of apps and other
digital products developed for specific populations of people with
468 L. DE WITTE ET AL.
disability. Examples include navigation support apps for persons
who are visually impaired, speech operated environmental control
systems that run on a smartphone and augmentative and alterna-
tive communication (AAC) apps. These applications have the
potential to become available to large user groups at very low pri-
ces, although buying mainstream technologies is often not within
reach of people with disability.
The use of mainstream technologies as a generic platform for specific
assistive products and services should be strongly encouraged.
A specific area that deserves attention is that of self-provision.
Very often people develop assistive products themselves with very
simple and cheap means. Such products can be very effective. It
would be worthwhile to disseminate information about such
cheap solutions and to develop guidelines/tips for making them.
This might contribute to a more accessible provision system.
To be able to benefit from any AT solution people must know of
its existence. This implies that information systems are key to any
AT provision system. Such information should be available to end
users as well as professionals involved. Effective awareness raising
is challenging, and information provision should be considered as
an on-going dialog rather than a one-off transaction. The number
of assistive products and related services is large (many thou-
sands) and growing exponentially as a result of developments in
technology. The challenge is not only to provide information
about the existence of particular assistive products, but also about
their quality, usability, effectiveness and availability. And prefer-
ably such information is neutral/independent (not influenced by
commercial or other interests) and supported by research evi-
dence that is based on user experiences.
In Europe, there has been a long-term investment in providing
information about assistive products. This has led to the European
Assistive Technology Information Network (EASTIN) search engine,
which connects websites from a number of European countries
and makes the information publically available to end users and
professionals. In the United States of America a similar database
exists: AbleData, and also Australia has such a database: National
Equipment Database. It is a major challenge to keep this informa-
tion updated. Many of the underlying national websites are under
continuous threat of being closed. In most countries such informa-
tion systems are not available. And in some countries, especially
in rural area, the concept of information through a website is still
non-existent. Here, information dissemination needs to be done
through community based channels in print or verbally. States
should take the responsibility for such information systems and
ensure their availability and quality.
It is essential that countries assure that neutral/independent evidence
based information about AT and related services is available for end users
and professionals. The WHO priority assistive products list (APL) provides a
good starting point for developing such national information systems and
the structure of the EASTIN website provides a useful framework to
Professional services, advice and support
Information about assistive products is necessary but insufficient
to ensure adequate AT provision. Developing an individual AT
solution (which is the device plus related support and services,
such as training for the user to safely and effectively operate a
given product) requires high level professional knowledge and
skills. Not only knowledge of the available assistive products and
how to use them, but also knowledge and skills to assess the
needs and ambitions of the individual, and about the way AT
interacts with other support or treatment a person may need.
There is no specific discipline trained for this task, except for the
field of prosthetics and orthotics. AT is not frequently enough a
major topic in the training of healthcare professionals, and differ-
ent healthcare professionals have different scope and depth
across assistive products. Occupational therapists probably have
the best basic training to play a role in AT provision and service
delivery, but in many countries, this discipline does not exist or
only in very low numbers. Only some countries offer postgraduate
courses in AT provision, resulting in a serious lack of expertise and
skills available in most countries. Developing training programs
for professionals to work in this field is fundamental to improving
AT provision and service delivery worldwide. Professional organi-
zations like AAATE, RESNA and ARATA can play an important role
in developing such programs.
It is very important to increase the quantity of AT advisors. The
traditional way of training them in formalized education systems
will take many years. Therefore, others approaches to training
should be applied, for example building on the “train the trainer”
principle in which existing AT advisors are trained to train col-
leagues around them about the principles of AT. Such pyramid
like structure of training may improve awareness and access to AT
and service delivery worldwide, especially in low- and middle-
It is essential that training programmes for professionals to work in the
field of AT are developed and become available worldwide. In connection
to this, the development of an accreditation system for AT experts might
be considered. Professionals involved may be healthcare professionals but
also social and community workers and, in settings where these are not
available, non professional people, for example supported by online tools
If there are professionals with sufficient knowledge and skills, it
is essential that they are able to offer independent advice and
support. In most countries, such independent advice does not
exist. The available professionals are directly linked to and work
on behalf of the commissioning body and sometimes to the
manufacturer of certain assistive products. Ideally people would
have access to independent centres of expertise, where they are
assessed and receive professional advice.
Each country should assure the availability of independent centres of
expertise where people can get high quality advice and support in the
process of obtaining AT. In Italy a good example of a network of such
centres exists. This could serve as a model.
All professionals involved in AT service delivery, including clini-
cians and technicians, should have clearly described roles and
responsibilities and their competencies should be embedded in
international standards of education and training that define core
Eligibility and funding mechanisms
Many people with disability who would benefit from AT do not
have the means to pay for it themselves. This is particularly true
in low- and middle-income countries, but also in high-income
countries for expensive and complex products. In most cases,
there will be a need for some kind of financial support. According
to the earlier mentioned WHO&USAID Joint Paper  in 2005,
about one-third of the countries surveyed had not allocated finan-
cial resources for developing and providing assistive products or
associated services. In those countries where there is an allocated
budget, the financing policies may vary from covering full cost of
ASSISTIVE TECHNOLOGY PROVISION 469
AT to partial costs of a limited list of assistive products. In some
countries, there is the possibility of having a personal budget or a
voucher system, that give users choice within a specified price
and/or assistive product range.
A key policy issue in relation to funding mechanisms is decid-
ing who is eligible for obtaining AT and determining the range
and extent of funding. This is a very complicated issue. In contrast
to the intentions of the CRPD most countries rely on medical defi-
nitions and diagnostic criteria to determine eligibility .
Developing eligibility models that start from a functional perspec-
tive and the individual ambitions and context of a person to par-
ticipate in society is a major challenge to improve AT provision
worldwide. The ICF framework  offers a starting point that can
be used to operationalize (parts of) these models, and some inter-
esting instruments have been developed that could play a role in
this (e.g. WHODAS 2.0  and the Impact-s tool ), but a gen-
eric decision model does not exist yet. Such a model would help
to distribute available resources in a fair and equitable way to
those who need them most, irrespective of the funding mechan-
There is a need for generic models to support decision-making on
eligibility of AT devices and services that start from a functional
perspective and the ambitions of the individual to participate in society,
instead of medical criteria. The development of such models should
Infrastructure for maintenance and repair
Appropriate infrastructures to support the use of AT for persons
with disabilities are required to ensure that products and services
continue to meet the needs of the user. In education, for example,
a voice-output device is of no use to a student with a communi-
cation impairment if it is broken or if the batteries have run out.
This is an all too common scenario for AT users. A structure incor-
porating a schedule for maintenance and a mechanism for repair
of devices is needed to ensure optimal performance for the user.
The use can often play an important role in maintenance and
repair. This should be part of the advice and training on delivery
of an AT device.
At service delivery systems and models
The service delivery process is informed by the national legisla-
tion, existing policies and the elements described in the five previ-
ous paragraphs. In a study analysing AT provision and service
delivery in 16 European countries in 1994, seven essential steps in
AT service delivery were identified. Although organized in very
different ways, these steps could be found in all participating
countries. In 2013, the AAATE published a position paper in which
these same steps were mentioned as still relevant and adequate
. These seven steps are: (1) initiative –first contact; (2) assess-
ment –evaluation of needs; (3) typology of the AT solution –
choosing the appropriate type of AT; (4) selection –selecting the
specific device; (5) authorization for financing –obtaining funding;
(6) delivery –getting the device to the user; (7) management and
follow up –continued support . There is recognition that all
seven steps are important to achieve the functional outcome
desired for AT use, but they are not consistently used in prac-
For the development of service delivery processes the seven steps identified
by the AAATE can serve as a structuring framework.
The aim of AT provision is generally to maintain an individual’s
functioning and independence and to facilitate participation,
giving less emphasis to remediation of impairments [15–17]. Cook
and Polgar  give 5 principles that should guide AT provision:
1. The process is person centered and not product of ser-
2. The outcome is enablement of participation in
3. An evidence-informed process is used;
4. AT provision is conducted in an ethical manner;
5. AT services are provided in a sustainable manner.
Although these principles do not give direct clues for service
delivery practice, they are important quality criteria for service
delivery policies and processes.
The aforementioned position paper of the AAATE sets out six
general quality criteria for AT service delivery. These criteria were
developed from a European study, but are also applicable to other
countries and settings. They are:
Accessibility. A service delivery system is accessible when no
one is excluded from the services or in any other way discrimi-
nated against. It is essential that the system is driven by user
needs and that funds are available to remove financial barriers.
People should know that there is a service delivery system, that
assistive products exist, and where to go to access the system. It
should be easy to obtain appropriate AT solutions without
unnecessary delay. Elements of accessibility are the scope of the
system (who is eligible), its simplicity, the availability of informa-
tion to the public, financial barriers and costs for the user,
duration of the process and the complexity of procedures.
Competence. Professionals involved must have the knowledge
and skills needed to properly meet the user needs. Competence is
about the availability of knowledge, skills and experience neces-
sary to serve the client. Elements are the educational level of pro-
fessionals, the possibilities for further education, the use of
protocols and standards, the availability of information and the
possibility to learn from feedback.
Coordination. A service delivery system needs to be coordi-
nated on three levels: within the primary process “around”an
individual client (with often different professionals being
involved), during the various steps in the process for an individual
client, and in relation with other policies and processes regarding
AT or other forms of support for the individual.
Efficiency. A service delivery system is efficient when it is able
to achieve the best AT solution for the highest number of users,
using the available resources in the shortest time and at the low-
est cost. Elements of efficiency are complexity of procedures and
regulations, duration of the process, control of the system over
the process, mechanisms able to control the costs and effective-
ness, and delegation of decision-making power to the appropriate
level of competence.
Flexibility. A service delivery system is flexible when it is able
to respond to different needs of users, when it is able to adopt
new technologies in an easy way and when researchers and
developers get support for their work, coordinate their work,
cooperate and communicate with users, designers, producers and
utilize new technology to meet needs.
User influence. Users should be involved in all aspects of a ser-
vice delivery system and in their own service delivery process.
Lack of user involvement exposes the risk of wrong or ineffective
intervention, abandonment of assistive products provided and
waste of resources. User influence indicators include the presence
and strength of user organizations, the availability of legal protec-
tion of the user’s rights, the involvement of users at a policy level,
user empowerment during the individual assessment, communica-
tion with the user in the service delivery process and the influ-
ence of the user on decisions in the process.
470 L. DE WITTE ET AL.
The six quality criteria for AT service delivery and the principles described
by Cook & Polgar may serve as building blocks for a quality assurance
framework for AT service delivery.
Effects, costs and economic impact of AT and
It is widely acknowledged that AT can have a dramatic positive
impact on people’s lives. This can be illustrated through a simple
thought-experiment in which one imagines the consequences if
all people who wear spectacles or hearing aids would have to
hand them in. In the scientific literature, however, not much is
known about the impact and cost-effectiveness of AT. Although
there are some studies [18,19], this has been a neglected field for
many years. This is partly due to the fact that AT is not acknowl-
edged as a major separate issue in most healthcare and welfare
systems, but is also due to the complexity of evaluating the
impact of AT. AT is almost always provided alongside other inter-
ventions like treatment, education or other forms of support, mak-
ing it difficult to extract the specific added value of AT. More
importantly, the effects of AT are individual and depend largely
on the ambitions, capabilities and personal context of the user.
This complexity creates a challenge for research into the effects
and costs of AT. Such research is, however, extremely important
to support the development of evidence-guided AT provision sys-
tems. The emphasis should be on evaluating existing AT.
Research into the (societal) impact and costs of AT is essential for the
development of evidence-guided AT provision systems and service delivery
processes. Such research should be strongly stimulated through specific
funding calls and as part of existing research funding streams.
Towards an international standard for AT provision
It is time to develop an AT provision standard. Without a standard
method or tool to connect services and outcomes, there is a lack
of comparable data for AT, leading to problems in assessing the
impacts of current policies and developing new ones.
Development of an internationally relevant, evidence-based infra-
structure for AT services is critical to advancing all aspects of the
global priority research agenda regarding AT. By delineating the
key elements of AT services and how they interact, a process
standard for AT provision would define a standard of practice
with benchmarks to assess quality of services, provide the basis
for educational curriculum and certification, and enable the collec-
tion of data to assess the impact of AT for policy decision making.
Establishment of core quality performance indicators for AT provi-
sion will support efficient and effective services by optimizing
decision-making. How services are provided will be governed by
national legislation, specific regulations and cultural expectations.
There are established processes for developing and appraising
international standards and several authors from different coun-
tries have published proposals to guide the scope and content
[20,21]. Such a standard should be based on interdisciplinary con-
ceptual and process models and adopt a common “language”.An
AT process standard should assure the user remains central to all
activities, enable interdisciplinary interaction, recognize the value
of considering pre-interventions which may mitigate the AT serv-
ices needed, be applicable to any type or level of disability, and
address the factors which influence user satisfaction with or aban-
donment of AT. A standardized framework for AT service provision
would allow for the insertion of existing and evolving perform-
ance standards at both the individual and organizational level.
It would function as a platform to develop and support further
strategies and resources to improve AT provision worldwide.
The development of an international AT standard could be
achieved in collaboration with the WHO and a recognized stand-
ards regulatory body, in partnership with international AT net-
works and associations like AAATE, RESNA, ARATA and RESJA.
To further drive and support the development of good AT provision
policies, provision systems and service delivery procedures, an international
AT provision standard should be developed.
This paper is based on the inputs of many experts in the field of
assistive technology. We are especially grateful for the comments
of the following colleagues on earlier versions of this paper:
Yasmin Garcia Mendez, Mexico; Liem Nguyen, Australia; Peter
Ngomwa, Malawi; Pam Enderby, UK; Rajendra Prasad, India; Dusan
Simsik, Slovakia; Sharmini Constantinescu, Canada; Yvonne
Heerkens, Netherlands; Sam Simpson, UK; Linda Elsaesser, USA;
Dianne Chambers, Australia.
The authors declare they have no competing interests.
Luc de Witte http://orcid.org/0000-0002-3013-2640
Emily Steel http://orcid.org/0000-0003-4124-3351
Shivani Gupta http://orcid.org/0000-0002-3300-6850
Vinicius Delgado Ramos http://orcid.org/0000-0002-4566-6637
Uta Roentgen http://orcid.org/0000-0002-3580-2332
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