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.

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.

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.

An approach for evaluating the effectiveness of traffic guide signs at intersections.

Traffic guide signs play important roles in people's daily lives. However, the effectiveness and performance of traffic guide signs at intersections are significantly impacted by many factors, such as the types of information on traffic signs, their information volume and comprehensibility, the behavioral attributes of drivers, the geometric features of roadways, and weather and visibility conditions. When deploying traffic guide signs, efforts are needed to clarify whether the installation of a traffic guide sign is warranted. In this study, a generic approach is developed to examine and evaluate the effectiveness of traffic guide signs using simulation experiments. A traffic guide sign evaluation method (TGSEM) is developed and illustrated using examples of traffic guide sign schemes in suburban Beijing. The questionnaires showed that most drivers feel that the current traffic guide signs in suburban Beijing are insufficient and need to be rectified. Then, simulation experiments were conducted. Based on subjective experiments, the ergonomic evaluation model (DCI, the abbreviation of demand, comprehension, and information volume) was obtained. Of the four schemes, scheme 3 was shown to be the most popular. During driving simulation experiments, the analyses of average speed, standard deviation (SD) of speed, average acceleration, standard deviation of acceleration, travel time, braking frequency and throttle power showed that scheme 2 had a better impact on drivers' behavioral data. Finally, Grey relational analysis showed that scheme 2 has the highest degree of correlation and can be recommended to traffic management departments. The experimental tests and analysis results revealed that the TGSEM is suitable. The proposed approach provides a generic framework with which to assess the performance of traffic guide signs and their effectiveness at intersections, including their experimental design, data analysis, the implementation of simulation models, and data interpretation.

Truck safety evaluation on Wyoming mountain passes.

The Manual on Uniform Traffic Control Devices (MUTCD) for Streets and Highways recommends hill signs be placed in advance of downgrade descent of mountain passes. Mountain passes increase the risk of a runaway, or out of control trucks and so the advance warning signs inform the driver to take special precautions such as reducing speed or using lower gears during the descent. The Wyoming Department of Transportation has installed steep grade advance warning systems on Wyoming mountain passes. However, concerns for out of control trucks on the mountain passes persist. The objective of this study is to evaluate the safety effectiveness of steep grade advance warning signs for trucks on Wyoming mountain passes. The safety evaluation was carried out by implementing a zero-inflated negative binomial modeling technique for predicting truck crashes on mountain passes. The outcome was two models that showed the risk of runaway truck accidents were high at locations where either the grades were steep and long or the grades were long with multiple vertical curves. The analysis showed the current advance warning systems were not significantly impacting truck crash risks at the high risk locations. The study, therefore, recommends some improvements to the current advanced warning signs or implementing an improved Federal Highway Administration Grade Severity Rating System based warning system that will significantly improve truck safety at the hazardous locations. The study informs policy makers on the safety issues on Wyoming Mountain passes with regards to runaway trucks and makes recommendations for reducing the risk of runaway truck crashes on mountain passes.

Healthcare Signage Design: A Review on Recommendations for Effective Signing Systems.

This article provides a set of recommendations, selected from the systematic literature review carried out, regarding signage systems for healthcare institutions that can be used for designing or redesigning more competent signage systems. The signage systems in healthcare settings are usually poorly designed due to the expansion of the original facilities, a lack of awareness of existing guidelines by the developers, and a lack of agreement between the existing recommendations. There are several guidelines and recommendations available in the literature; however, each work was developed for specific cultural contexts, so there is a lack of uniformity among them. Hence, there is a need to uniformize the guidelines for signage design in healthcare, in order to provide supportive information for developers to build and implement effective and efficient signage systems. This study examined the available literature on the subject and established a set of guidelines organized in categories to help the design process. A literature review was conducted, and 34 selected publications were analyzed from which recommendations were created. A best practices manual was also studied and used as the analytical framework to establish the design categories of the developed recommendations. This review resulted in guidelines divided into nine design categories that should be considered in the design and implementation process of signage systems in healthcare facilities.

Optimizing location of variable message signs using GPS probe vehicle data.

A multi-objective optimization model is proposed to allocate the location of VMSs by maximizing the average traffic guidance utility of VMSs and the number of benefited links, while minimizing information redundancy. The traffic guidance utility is defined to quantitatively measure the value of an installed VMS, which is calculated from passively collected GPS data and the physical topology of road network. The number of benefited links is to measure how many links are covered by upstream VMS to disseminate information. Information redundancy is introduced to quantify the mutual impairing between any two VMSs. A heuristic search algorithm is developed to solve the optimization model, which can calculate the saturated number of VMS for a road network and optimize the project schedule of VMS installation process based on the proposed objectives. A real-world case study is conducted in Beijing to illustrate the validity of the proposed approach, where taxis are used as probe vehicles to provide GPS data. The results show the effectiveness of the proposed multi-objective optimization model and it is promising to use the emerging GPS data to help agencies to allocate the locations of VMSs on both urban roads and highway networks, instead of relying on the subjective judgment from practitioners.

How Universal Are Universal Symbols? An Estimation of Cross-Cultural Adoption of Universal Healthcare Symbols.

OBJECTIVE: To evaluate the effectiveness of universal health symbol usage and to analyze the factors influencing the adoption of those symbols in Taiwan. BACKGROUND: Universal symbols are an important innovative tool for health facility wayfinding systems. Hablamos Juntos, a universal healthcare symbol system developed in the United States, is a thoughtful, well-designed, and thoroughly tested symbol system that facilitates communication across languages and cultures. METHODS: We designed a questionnaire to test how well the selected graphic symbols were understood by Taiwanese participants and determined factors related to successful symbol decoding, including participant-related factors, stimulation factors, and the interaction between stimulation and participants. Additionally, we further established a design principle for future development of localized healthcare symbols. RESULTS: (1) Eleven symbols were identified as highly comprehensible and effective symbols that can be directly adopted in Taiwanese healthcare settings. Sixteen symbols were deemed incomprehensible or confusing and thus had to be redesigned. Finally, 14 were identified as relatively incomprehensible and could thus be redesigned and then have their effectiveness evaluated again. (2) Three factors were found to influence the participants' differing levels of comprehension of the Hablamos Juntos symbols. CONCLUSIONS: In order to prevent the three aforementioned factors from causing difficulty in interpreting symbols, we suggest that the local symbol designers should (1) use more iconic images, (2) carefully evaluate the indexical and symbolic meaning of graphic symbols, and (3) collect the consensus of Taiwanese people with different educational backgrounds.

Design Implications to Increase Utilization of Stairwells.

Stairwell use is a cost-effective opportunity to increase physical activity. Although stairwell use can integrate moderate physical activity in daily work routines, little information is available to guide architects and engineers on how to design facilities that promote stairwell use. This study examined the reasons behind using stairwells versus elevators through a case study at a teaching hospital. A broad range of physical design recommendations were evaluated to understand how the design of stairwells can encourage hospital staff and students to use them. An online survey was used to collect data. Findings indicated travel distance and travel direction as primary reasons for preferring elevators. Design recommendations such as motivational signs and physical movement reinforcements (e.g., cardio indicators) are discussed.

The science behind codes and standards for safe pedestrian walkways: lighting and visual cues.

BACKGROUND: Walkway codes and standards are created through consensus by committees based on a number of factors, including historical precedence, common practice, cost, and, sometimes, empirical data. The authors maintain that codes and standards that can have an impact on human safety and welfare should give consideration in their formulation to the results of pertinent scientific research. PURPOSE: This article extends a companion one in examining many elements of common walkway codes and standards related specifically to lighting, warnings and markings. It indicates which elements are based on or supported by empirical data; and which elements could benefit from additional scientific research. PRACTICAL APPLICATIONS: This article identifies areas in which additional research leading toward scientific based codes and standards may be beneficial in enhancing the safety of pedestrian walkway surfaces.

Variable Message Signs for road tunnel emergency evacuations.

This paper investigates the design of Variable Message Signs (VMS) as a way-finding aid for road tunnel emergency evacuations. The use of the Theory of Affordances is suggested to provide recommendations on the design of VMS. A preliminary evaluation of 11 selected VMS systems was performed and 6 of them were further evaluated using an affordance-based within subject stated-preference questionnaire administered to a sample of 62 participants. Results are used to provide recommendations on the characteristics of the VMS systems, such as (1) size of the sign (large or small); (2) use of flashing lights; (3) colour scheme; (4) message coding (i.e., text, pictograms or a combination of them). The best performing VMS features for road tunnel emergency evacuation included the use of larger signs, flashing lights, the combination of emergency exit pictorial symbol in green in one panel and text in amber in the other panel.

Optimizing the patient-centered environment: results of guided tours with health care providers and employees.

OBJECTIVE: To examine providers' perspectives on the care environment and patient-centered care (PCC) through the eyes of the veteran patient, using guided tours qualitative methodology. BACKGROUND: Environmental factors, such as attractiveness and function, have the potential to improve patients' experiences. Participatory qualitative methods allow researchers to explore the environment and facilitate discussion. METHODS: Guided tours were conducted with 25 health care providers/employees at two Veterans Affairs (VA) health care facilities. In guided tours, participants lead the researcher through an environment, commenting on their surroundings, thoughts, and feelings. The researcher walks along with the participant, asking open-ended questions as needed to foster discussion and gain an understanding of the participant's view. Participants were asked to walk through the facility as though they were a veteran. Tours were audio recorded, with participant permission, and transcribed verbatim by research assistants. Three qualitative researchers were responsible for codebook development and coding transcripts and used data-driven coding approaches. RESULTS: Participants discussed physical appearance of the environment and how that influences perceptions about care. Overall, participants highlighted the need to shed the "institutional" appearance. Differences between VA and non-VA health care facilities were discussed, including availability of private rooms and staff to assist with navigating the facility. They reviewed resources in the facility, such as the information desk to assist patients and families. Finally, they offered suggestions for future improvements, including improvements to waiting areas and quiet areas for patients to relax and "get away" from their rooms. CONCLUSIONS: Participants highlighted many small changes to the care environment that could enhance the patient experience. Additionally, they examined the environment from the patient's perspective, to identify elements that enhance, or detract from, the patient's care experience.

Percepción de la señalización y orientación espacial de los usuarios de tres complejos hospitalarios de Santiago, Chile / A survey about client orientation and wayfinding in Chilean hospitals

Background: Sense of orientation in hospitals can be tricky considering the large extension of buildings and the inadequate signage. Aim: To report some of the findings of a larger research project on wayfinding and patient navigation in Chilean hospitals. Material and Methods: Five hundred nine hospital users waiting for attention in three hospitals were contacted and asked to answer a survey that lasted 10 minutes, about wayfinding and sense of orientation within the hospital. Results: Users declared to have a good opinion of existing signage in the three hospitals analyzed as well as their architectural organization in terms of their capacity to orient people. However, the vast majority of users asked for directions to navigate within the hospital to staff and medical personnel. Conclusions: Patient navigation problems are imposing a great “hidden” cost to hospitals management due to missed appointments.

First impressions: towards becoming a health-literate health service.

A 'health-literate organisation' recognises that miscommunication is very common and can negatively affect consumer care and outcomes, and makes it easier for people to navigate, understand, and use health information and services. This paper reports on the First Impressions Activities conducted by consumers to assess aspects of the literacy environment of a rural health service. The First Impressions Activities consists of three tools to assist health services to begin to consider some of the characteristics of their organisation that help and hinder a consumer's ability to physically navigate their way to and about the health service. The results show that navigation to and within the rural health service was made more complex due to lack of information, difficulty finding information, inconsistent terminology used in signage, missing signage, signage obscured by foliage, and incorrect signage.

Comprehensibility of universal healthcare symbols for wayfinding in healthcare facilities.

Healthcare facilities are often complex and overwhelming for visitors, and wayfinding in healthcare facilities can be challenging. As there is an increasing number of global citizens who travel to seek medical care in another country, it is critical to make wayfinding easy for visitors who are not familiar with the language in a foreign country. Among many wayfinding aids, symbols are helpful for those visitors who have limited ability to understand written language. This study tested universal healthcare symbols in the United States, South Korea, and Turkey to compare the comprehension of symbols cross-country and identify predictors of the correct comprehension. To explore statistically significant relationships between symbol comprehension and countries, Pearson's Chi-square tests, logistic regression, and ANOVA were conducted. The test results showed that ten symbols among 14 tested have significant relationship with countries. Results of this study demonstrate that symbol comprehension can be varied significantly in different countries.

Interpretation of way-finding healthcare symbols by a multicultural population: navigation signage design for global health.

The interpretation of way-finding symbols for healthcare facilities in a multicultural community was assessed in a cross-sectional study. One hundred participants recruited from Al Ain city in the United Arab Emirates were asked to interpret 28 healthcare symbols developed at Hablamos Juntos (such as vaccinations and laboratory) as well as 18 general-purpose symbols (such as elevators and restrooms). The mean age was 27.6 years (16-55 years) of whom 84 (84%) were females. Healthcare symbols were more difficult to comprehend than general-purpose signs. Symbols referring to abstract concepts were the most misinterpreted including oncology, diabetes education, outpatient clinic, interpretive services, pharmacy, internal medicine, registration, social services, obstetrics and gynecology, pediatrics and infectious diseases. Interpretation rates varied across cultural backgrounds and increased with higher education and younger age. Signage within healthcare facilities should be tested among older persons, those with limited literacy and across a wide range of cultures.

[A survey about client orientation and wayfinding in Chilean hospitals]. / Percepción de la señalización y orientación espacial de los usuarios de tres complejos hospitalarios de Santiago, Chile.

BACKGROUND: Sense of orientation in hospitals can be tricky considering the large extension of buildings and the inadequate signage. AIM: To report some of the findings of a larger research project on wayfinding and patient navigation in Chilean hospitals. MATERIAL AND METHODS: Five hundred nine hospital users waiting for attention in three hospitals were contacted and asked to answer a survey that lasted 10 minutes, about wayfinding and sense of orientation within the hospital. RESULTS: Users declared to have a good opinion of existing signage in the three hospitals analyzed as well as their architectural organization in terms of their capacity to orient people. However, the vast majority of users asked for directions to navigate within the hospital to staff and medical personnel. CONCLUSIONS: Patient navigation problems are imposing a great "hidden" cost to hospitals management due to missed appointments.

Developing family-friendly signage in a South African paediatric healthcare setting.

BACKGROUND: Multiple renovations and changing flow in a tertiary children's hospital in Cape Town resulted in numerous signs being posted in the corridors and units, making wayfinding extremely complex. A request from nursing management prompted the formation of a learning collaborative of nurses from all departments to improve wayfinding signage. OBJECTIVES: The project aimed to contribute to a family-friendly environment by reviewing the current situation and developing signage to improve wayfinding and convey essential information to parents, caregivers and patients. METHODS: A participative action research method followed a four-stage process to facilitate the development of family-friendly signage. Nurse participants reviewed existing signage and collaboratively developed new signage templates and posted signs. The signage was then evaluated using a rapid appraisal questionnaire involving 50 parents and nurse respondents. At each stage of data collection, thematic content analysis was used to analyse data gathered in process meetings and the reflections of participating nurses. RESULTS: A design template and then 44 new signs were developed and used to replace old signage. Respondents reported that the new signs were noticeable, looked attractive and were easily understandable. CONCLUSION: Intentional and active participation of nurses in clinical paediatric settings ensured collaborative data gathering and analysis. An inclusive research design allowed for insights into the words and tone of posted signs that nurse participants had not noticed previously. The participative redesign of signage resulted in a sense of ownership of the signs.The support and involvement of hospital management throughout ensured that the resulting signage received wide acceptance.