A Design Framework of Medical Wayfinding Signs for the Elderly: Based on the Situational Cognitive Commonness.

Older people in China have a poor understanding of hospital signage. To address this problem, in this study, we combined the theories of situated cognition and cognitive commonness in order to introduce the three main factors that affect the generation of situational cognitive commonness: composition of the situation, familiarity, and concreteness. We used these theories to construct a methodological framework for the design of geriatric hospital wayfinding signs that were based on situational cognitive commonness. The design of nine healthcare signs for Chinese national standards were used as examples in the study. First, users who were familiar with medical scenarios were asked to draw concrete cognitive conception graphics for the purposes of individual wayfinding targets from both physical and social situations. Next, we coded and grouped the generated graphics based on their situational features in order to extract groups of representative common graphics. Finally, we reorganized the common graphics and developed concrete designs, which were tested by the judgment test. The wayfinding signs designed according to the methodological framework of this study effectively improved the understanding of hospital signage among older Chinese people. This study took geriatric hospital wayfinding signs as the examples to provide a feasible theoretical basis and research reference for symbol design.

An observational study of skier compliance with posted "slow" signs and ski patrollers.

OBJECTIVES: To examine the efficacy of "slow" signs and patroller presence at "slow" signs to reduce speeds of snowsports participants, compared to a condition where no sign or patroller are present, independent of other factors that may contribute to skier slowing (such as prior knowledge, trail convergence, etc.). DESIGN AND METHODS: Snowsports participant speeds were measured on "more difficult" trails using a radar gun at two ski areas with: (1) no-sign - the usual condition for the trail, and (2) slow-sign - a large "slow" sign was posted in the middle of the trail. At one ski area, a third condition was also tested: (3) slow+patroller - a ski patroller stood at the slow sign. Participant equipment type and estimated ability were also recorded. RESULTS: At one ski area, there was no significant difference in speed between conditions. At the second ski area, the differences in mean (SD) speeds were small but significant for the no-sign, slow-sign, and slow+patroller conditions: 10.9 (3.0), 10.3 (2.9), and 9.8 (2.6)m/s. Effects were driven by non-beginner skiers; on average, beginner skiers and all snowboarders were slower than non-beginner skiers and did not adjust their speed in response to the signage conditions. CONCLUSIONS: Reductions in speed for the slow-sign and slow+patroller conditions compared to the no-sign condition were small (0.5 and 1.1m/s) compared to the variation in chosen skier speed reported in other studies. The small differences in chosen speeds make it unlikely that slow sign and patroller presence alone would produce meaningful reductions in collision likelihood or severity of impacts.

Scientometric Analysis of Safety Sign Research: 1990-2019.

The purpose of this paper is to summarize the research themes and hotspots of safety signs research between 1990 and 2019 through the scientometric analysis method. In total, 3102 articles of literature from the Web of Science core database were analyzed by the CiteSpace visualization tool and the results were displayed in mapping knowledge domains. The overall characteristics analysis showed that safety sign is an emerging research field in a rapid development stage-81.4% of the literature works were published in the past ten years, and the United States was in the leading position, followed by China and Canada. The keyword co-occurrence analysis indicated that traffic signs and driving safety were the most popular research topics and have been combined with simulation technology in recent years, whereby individual mental health has been added as an influential factor. The journals and category co-citation analysis showed that the safety signs research involved many subjects, mainly engineering, transportation and public safety. The results indicated that the safety signs research is multi-disciplinary, and it will continue to develop in various scientific domains in the future. The conclusions can provide help and reference for potential readers, as well as help with the sustainable development of safety signs research.

Acquisition of landmark, route, and survey knowledge in a wayfinding task: in stages or in parallel?

According to an influential concept, humans acquire spatial knowledge about their environment in three distinct stages: landmark knowledge is acquired first, then route knowledge, and finally survey knowledge. The stage concept has been challenged by studies which observed that in a wayfinding paradigm, route, and survey knowledge emerge at the same time and; therefore, were seemingly acquired in parallel. However, this experimental evidence is not conclusive because the above studies suffered from a ceiling effect. The present study was designed to overcome the ceiling effect by increasing the complexity of the wayfinding task. We asked 60 young participants to find their way through an urban environment rendered in virtual reality, and assessed their landmark, route, and survey knowledge after each of ten trials. We found that all three types of knowledge gradually increased from the first to the last trial. We further found that correlations between the three types of knowledge increased from trial to trial. This outcome disagrees profoundly with the stage concept, but is compatible with the parallel concept. Specifically, it is in accordance with the view that landmark, route, and survey knowledge are acquired by multiple overlapping and interacting processes: those processes may start out more or less independently in the first trial but, due to common constraints or synergies, may gradually increase their cooperation during subsequent trials.

A History of the Radiation Warning Sign.

ABSTRACT: This paper provides a history of the radiation warning sign with a focus on the period from 1946 to 1948. It employs previously unpublished material from the University of California Radiation Laboratory's Health Chemistry Group, the memoirs of John Gifford, and an account by George Warlick. Also considered is an alternative version of the sign's origin described by Cyrill Orly.

Driver eye movements in relation to unfamiliar traffic signs: An eye tracking study.

Traffic signs are an integral part of the traffic control plan and they provide road users with necessary information on the upcoming situation. This paper aims to examine the level of understanding of traffic sign imagery used in different countries and to track participants' eye movement when they encounter unfamiliar signs. Tobii eye tracking glasses were used to track gaze differences between familiar and unfamiliar traffic signs. Our findings show that sign characteristics (such as the amount of information on the sign) and the observer's knowledge of the sign meaning have a significant impact on eye behaviour. Signs containing more information (loaded with more content) and unfamiliar to the participant systematically produced the longest overall and average fixations and gazing duration. Given that longer gaze time for unfamiliar traffic signs presents a potential traffic hazard, we evaluated the need for standardization of traffic signs.

Automated data extraction from historical city directories: The rise and fall of mid-century gas stations in Providence, RI.

The location of defunct environmentally hazardous businesses like gas stations has many implications for modern American cities. To track down these locations, we present the directoreadr code (github.com/brown-ccv/directoreadr). Using scans of Polk city directories from Providence, RI, directoreadr extracts and parses business location data with a high degree of accuracy. The image processing pipeline ran without any human input for 94.4% of the pages we examined. For the remaining 5.6%, we processed them with some human input. Through hand-checking a sample of three years, we estimate that ~94.6% of historical gas stations are correctly identified and located, with historical street changes and non-standard address formats being the main drivers of errors. As an example use, we look at gas stations, finding that gas stations were most common early in the study period in 1936, beginning a sharp and steady decline around 1950. We are making the dataset produced by directoreadr publicly available. We hope it will be used to explore a range of important questions about socioeconomic patterns in Providence and cities like it during the transformations of the mid-1900s.

Examining generalization of motorist yielding at an adjacent crosswalk with variations of the gateway sign configuration.

The gateway sign configuration has been effective at increasing motorist yielding and reducing speeds at crosswalks. A gateway configuration uses in-street signs at a crosswalk on each edge of the roadway and on each lane line. Although this intervention is effective at increasing motorist yielding at uncontrolled crosswalks, the limits of the intervention have yet to be tested. The present study examined if 1) the effects of the gateway intervention on one crosswalk would generalize to an untreated adjacent crosswalk, and 2) if the effects of an offset configuration of signs which partially treated each crosswalk could maximize the effects of that generalization. Experiment 1 showed that less yielding occurred at the untreated crosswalk than at the treated crosswalk, though yielding was higher than baseline. In Experiment 2, results showed that an offset gateway configuration could produce comparable levels of yielding at both crosswalks.

Users' Perceptions of Signage Systems at Three Portuguese Hospitals.

This article is a report on the quantitative data collected from patients, family members, and visitors using the outpatient areas of three hospitals in Portugal. It details the users' views regarding the existing signage and presents suggestions to improve the design and implementation of the signage systems. A questionnaire was used with 1,287 respondents. The results showed that almost all users had a positive opinion regarding the current signage. However, some of the users' answers and observed behaviors indicated that the majority tended to ignore the signs and preferred to ask staff for help. Additionally, when asked for suggestions, many of the respondents were able to point out existing problems that affected their wayfinding. Although the signage was generally evaluated as good, many of the users perceived a variety of problems and, as already mentioned, asked the staff for directions, which results in lost time and hidden costs for the institutions.

Inattentional blindness and information relevance of variable message signs.

It has been suggested that Variable Message Signs (VMS) become less effective at communicating important traffic information when irrelevant information is also displayed on them. The purpose of this study was to examine if practice reading irrelevant information on a VMS influenced compliance with, and memory for a detour message. Thirty-nine participants were randomly assigned to one of three groups who drove a simulated road; one receiving only a detour message on the VMS, one group received irrelevant VMS messages before the detour message, and a third group received the same messages but the detour message was inconsistent with their destination. Of interest were both the participants' compliance with the target detour message, as well as their later recall and recognition of the message. The results suggested that, first and foremost, there was significantly lower compliance with the detour message when it had been preceded by irrelevant messages on the VMS. All of the groups showed reasonably good memory for the detour message. The implications of the present study are that presentation of irrelevant messages, including advertisements and safety slogans, may result in reduced compliance to traffic-relevant messages on VMSs.

The effect of billboard design specifications on driving: A driving simulator study.

Research on the effect of advertising billboards on road safety has accumulated over the past seven decades, but has led to inconclusive data, which prevent clear-cut conclusions. To enhance road safety, it was suggested that researchers should shift their efforts to exploring which billboard characteristics are distracting by nature. This line of research may promote the establishment of concrete guidelines for the least distracting permissible billboards. A previous study classified billboards into three clusters: 1. Loaded (colorful billboards with small quantities of graphic elements and large quantities of text); 2. Graphical (colorful billboards with large quantities of graphic elements and small quantities of text); and 3. Minimal (billboards with few or no graphic elements, few colors, and a small amount of text). The current study systematically explores the effect of these three clusters on drivers' performance in a driving simulator. Eighteen participants drove in scenarios which systematically manipulated the following variables: the perceptual load on the road, the perceptual load on the sides of the road, location of preplanned critical events, and the presence of billboards from each one of the three previously identified clusters. The findings show that the presence of billboards from the Loaded and Minimal clusters significantly compromised road safety in various experimental conditions. However, the presence of billboards from the Graphical cluster significantly affected drivers' performance only in one experimental condition. The conclusion, for the time being, is that Graphical billboards, which include a large quantity of graphic elements with few or no textual elements, are the least harmful while driving.

Optimal design alternatives of advance guide signs of closely spaced exit ramps on urban expressways.

Advance guide signs for exit ramps along urban expressways are increasingly critical, enhancing safety and mobility by improving the flow of vehicles exiting urban expressways. However, research has devoted scant attention to advance guide signs for exit ramps. This study aimed to identify and propose optimal design alternatives for exit ramp advance guide signs for different types of exit spacing. This study conducted a driving simulation experiment consisting of five design alternatives of advance guide signs and two exit ramp spacing variation. Eight indicators were measured. The repeated-measure analysis of variances (ANOVA) and the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) were performed for the influence analysis and efficiency evaluation of different schemes. Influence analysis results showed better design alternatives in five schemes of advance guide signs, enabling drivers to more easily locate destination exits and change lanes fewer times, in addition to reducing drivers' need to decelerate, and improving traffic flow in the key influence range of destination exit ramps. The percentage of drivers successfully locating the destination exits also increased with optimal design alternatives of advance guide signs. When the exit ramp spacing tightened, on the other hand, drivers had to make more lane changes and accelerate and decelerate more frequently in the key influence range. As a result, a lower percentage of drivers successfully located destination exits. Efficiency evaluation results were also obtained. In tight spacing, three advance guide signs are recommended to be placed at 1 km, 0.5 km and 0 km prior to the beginning of the tapered deceleration lane. If conditions are limited, at least two advance guide signs should be used. With greater spacing, four advance guide signs are recommended, located at 2 km, 1 km, 0.5 km, and 0 km prior to the beginning of the tapered deceleration lane. If road conditions are limited, three advance guide signs should be used.

Patient satisfaction with antiretroviral therapy services and associated factors at Gondar town health centers, Northwest Ethiopia: an institution-based cross-sectional study.

BACKGROUND: The Human Immunodeficiency Virus (HIV) with which over 37 million peoples are living is the leading cause of morbidity and mortality worldwide. The rapid expansion of antiretroviral treatment has dramatically reduced HIV related deaths and transmissions. Patient satisfaction could be an indispensable parameter used to measure patients' desired fulfillment by the services. Hence, this study aimed to determine the level of patient satisfaction with antiretroviral therapy services and determinants at Gondar town health centers. METHODS: An institution-based cross-sectional study was conducted from November 1 to 30, 2018. The systematic random sampling technique was used to select 663 HIV/AIDS patients on antiretroviral therapy follow-ups. Data were collected using a pretested interviewer-administered questionnaire and patient medical document reviews. Summary statistics such as means, medians and proportions were calculated and presented in the form of tables, graphs, and texts. Bivariate and multivariable logistic regression analysis was fitted and adjusted odds ratio (AOR) with a 95% confidence interval (CI) was computed to assess the strength of association. Variables with p-value 0.05 at multivariable logistic regression considered significant determinants of patient satisfaction. RESULTS: The overall patient satisfaction with antiretroviral therapy services was 75.4% (95%CI, 71.9 to 79%). Patients' age 38-47 years (AOR = 5.90, 95%CI: 3.38,10.31) and ≥ 48 years (AOR = 2.66, 95%CI:1.38,5.12), absence of signs and directions to ART clinic (AOR = 0.53,95%CI:0.35,0.82), Azezo health center (AOR = 2.68,95%CI:1.47,4.66) and Teda health center (AOR = 4.44,95%CI:1.73,11.30), and travel that took more than 1 h (AOR = 0.56;95% CI:0.32,0.97) were determinants of patient satisfaction with the services. CONCLUSION: The overall patient satisfaction with antiretroviral therapy service was lower than the national target of 85% with the marked difference among health centers. Older age, absence of signs and directions to ART clinics, and longer travel from home to health centers were factors influencing patient satisfaction with antiretroviral treatments. This suggests that further improvement of accessibility is likely needed to increase patient satisfaction.

Can point-of-sale nutrition information and health warnings encourage reduced preference for sugary drinks?: An experimental study.

Point-of-sale (POS) interventions that prompt consumers to more critically evaluate sugary drinks could encourage reduced consumption of these drinks and reinforce public health campaign messages. This study tested whether: (i) POS nutrition information and health warnings about sugary drinks promote healthier drink choices and (ii) impacts of prominent POS signs on drink choices vary based on participants' self-reported prior exposure to a sugary drink public health campaign. In an online experiment, 3034 Australian adults aged 18-59 years who were past-week sugary drink consumers were randomly assigned to one of five POS signage conditions (no signage (control); sugar content of specific beverages; Health Star Rating of specific beverages; generic text health warning about sugary drinks; generic graphic health warning about sugary drinks) and shown their randomly assigned POS sign alone, then alongside a drinks product display and asked to select which drink they would choose to buy. The proportion selecting a sugary drink was significantly lower among participants who viewed either the sugar content (29%), Health Star Rating (33%) or graphic health warning (34%) signs compared to those who saw no sign (43%). These effects held for participants who did not recall previously seeing the campaign; however, for participants with self-reported prior exposure to the campaign, POS signs did not promote significant reductions in sugary drink choices. POS signage has the potential to shift consumers away from choosing sugary drinks and could complement mass media campaigns by reaching people who may not otherwise be exposed to sugary drink public health messages.

Effects of Semantic Congruence on Sign Identification: An ERP Study.

OBJECTIVE: The purpose of this study was to investigate the effects of semantic congruence and incongruence on sign identification by using event-related potentials (ERPs). BACKGROUND: Sign systems have crucial roles in public spaces and traffic facilities. Poorly designed signs can easily confuse pedestrians and drivers and reduce the efficiency of public activities and urban administration. METHOD: Thirty-one participants completed a sign identification experiment independently in a laboratory setting. Experimental materials were selected from GB/T 10001, a Chinese national recommendation standard that is officially named Public Information Graphical Symbols for Use on Signs. All ERP data were processed using MATLAB 13b, and behavioral data were analyzed using Stata 14. RESULTS: N170, P200, N300, and N400 components were induced during semantic processing. Statistical analysis revealed that semantic congruence has a main effect on N300 in the frontal region and has a main effect on N400 at FZ in the frontal region, CPZ in the parietal-central region, and PZ in the parietal region. Amplitudes of N300 induced by picture-word matching were considerably different between the two experimental conditions at electrodes FZ and FCZ. Amplitudes of N400 were significantly larger in the incongruent condition than in the congruent condition. CONCLUSION: The study demonstrated that N300 and N400 are promising indicators for measuring semantic congruence in future sign design. APPLICATION: Our findings provide ERP indicators for measuring the semantic congruence of sign design, which can be easily applied to improve the efficiency of sign design and sign comprehension.

Dementia Friendly Hospital Design: Key Issues for Patients and Accompanying Persons in an Irish Acute Care Public Hospital.

OBJECTIVES: Research was conducted to investigate the impact of the hospital environment on older people including patients with dementia and their accompanying persons (APs). The article presents key research findings in the case study hospital. BACKGROUND: For many patients, the hospital is challenging due to the busy, unfamiliar, and stressful nature of the environment. For a person with dementia, the hospital experience can be exacerbated by cognitive impairment and behavioral or psychological symptoms and can therefore prove to be a frightening, distressing, and disorientating place. METHOD: The findings are based on a stakeholder engagement process where the research team spent approximately 150 hr observing within the hospital, administered 95 questionnaires to patients and/or APs, and conducted 12 structured interviews with patients and APs. A thematic analysis was employed to analyze and generate key themes emerging from the process. RESULTS: Themes were grouped into overarching issues and design issues across spatial scales. CONCLUSION: This research confirms the negative impact of the acute hospital setting on older people with cognitive impairments including dementia and delirium. The multiple perspectives captured in this study, including most importantly people with dementia, ensure that stakeholder needs can be used to inform the design of the hospital environment. The research points to the value of understanding the lived experience of the person with dementia and APs. The voices of patients, particularly persons with dementia and their APs, are a crucial element in helping hospitals to fulfill their role as caregiving and healing facilities.

Motivational signage increases stair usage on a Hispanic serving institution.

Objective: Stair climbing is considered a good physical activity. Motivational signage has been successful in promoting stair usage in various settings. This study was to investigate the effects of motivational signage on stair usage in a Hispanic serving institution. Participants: A total of 31,067 pedestrians were observed from February to March 2013. Methods: Stair usage was monitored for 9 h per day each week at phase 1 (baseline), 2 (intervention), and 3 (post-intervention). Results: Overall, participants' stair usage was higher during phase 2 (49.0%) and phase 3 (48.0%), compared with phase 1 (39.7%). The participants during phase 2 and 3 were more likely to use the stairs compared to participants during phase 1, regardless of floor level (3-story or 4-story building), status (student or staff/faculty), and time of day (7:30-10:29, 10:30-13:29, or 13:30-16:30) (p < .001). Conclusion: Motivational signage can effectively encourage more stair usage, and hence promote healthy behavior in a predominantly Hispanic-serving institution.

Implementing the Lever Sign in the Emergency Department: Does it Assist in Acute Anterior Cruciate Ligament Rupture Diagnosis? A Pilot Study.

BACKGROUND: Within the emergency department (ED) setting, anterior cruciate ligament (ACL) rupture is commonly misdiagnosed, leading to improper treatment and potential meniscal injury and total joint replacement. Utilizing traditional clinical tests to diagnosis ACL rupture leads to the correct diagnosis in about 30% of cases. The lever sign is a new and effective clinical test used to diagnose ACL rupture with 100% sensitivity. OBJECTIVE: We aim to study if the lever sign used in the ED setting is more sensitive to diagnose ACL rupture than traditional tests. METHODS: Patients between 12 and 55 years of age were examined utilizing either traditional methods or the lever sign. Diagnostic findings in the ED were compared with those of a sports medicine specialist using magnetic resonance imaging as the diagnostic standard. A survey was given to ED providers to collect data on diagnosis and physician confidence in diagnosis. RESULTS: The sensitivity of the lever sign was 100% (94.7% accuracy, 93.75% specificity), whereas the sensitivity of the anterior drawer/Lachman test was 40% (87.5% accuracy, 100% specificity). Physician confidence in diagnosis was higher utilizing the lever sign vs. the anterior drawer/Lachman test at 8.45 (±1.82) compared with 7.72 (±1.82) out of 10, respectively. There was no statistically significant association between diagnostic accuracy with either test and level of training of the ED provider. CONCLUSION: Implementation of the lever sign in the ED setting resulted in a higher sensitivity, higher physician confidence in screening test diagnosis, and a decrease in the number of undiagnosed ACL ruptures.

Signage Interventions for Stair Climbing at Work: More than 700,000 Reasons for Caution.

Increased stair climbing reduces cardiovascular disease risk. While signage interventions for workplace stair climbing offer a low-cost tool to improve population health, inconsistent effects of intervention occur. Pedestrian movement within the built environment has major effects on stair use, independent of any health initiative. This paper used pooled data from UK and Spanish workplaces to test the effects of signage interventions when pedestrian movement was controlled for in analyses. Automated counters measured stair and elevator usage at the ground floor throughout the working day. Signage interventions employed previously successful campaigns. In the UK, minute-by-minute stair/elevator choices measured effects of momentary pedestrian traffic at the choice-point (n = 426,605). In Spain, aggregated pedestrian traffic every 30 min measured effects for 'busyness' of the building (n = 293,300). Intervention effects on stair descent (3 of 4 analyses) were more frequent than effects on stair climbing, the behavior with proven health benefits (1 of 4 analyses). Any intervention effects were of small magnitude relative to the influence of pedestrian movement. Failure to control for pedestrian movement compromises any estimate for signage effectiveness. These pooled data provide limited evidence that signage interventions for stair climbing at work will enhance population health.