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A new procedure for evaluating symbol comprehension, the phrase generation procedure, was assessed with 52 younger and 52 older adults. Participants generated as many phrases as came to mind when viewing 40 different safety symbols (hazard alerting, mandatory action, prohibition, and information symbols). Symbol familiarity was also assessed. Comprehension rates for both groups were lower than the 85% level recommended by the American National Standards Institute. Moreover, older participants' comprehension was significantly worse than younger participants', and the older adults also generated significantly fewer phrases. Generally, prohibition symbols were comprehended best and hazard alerting symbols worst. In addition, symbol familiarity was positively correlated with symbol comprehension. These findings indicate that important safety information depicted on signs and household products may be misunderstood if presented in symbolic form. Furthermore, certain types of symbols may be better understood (e.g., prohibition symbols) than other types (e.g., hazard alerting symbols) by both younger and older individuals. These findings signify the utility of the phrase generation procedure as a method for evaluating symbol comprehension, particularly when it is not possible or desirable to provide contextual information. Actual or potential applications of this research include using the phrase generation approach to identify poorly comprehended symbols, including identification of critical confusions that may arise when processing symbolic information

AbstractObjectivesTo evaluate the clinical effectiveness of long acting progestogens compared with the combined oral contraceptive pill in preventing recurrence of endometriosis related pain.DesignThe PRE-EMPT (preventing recurrence of endometriosis) pragmatic, parallel group, open label, randomised controlled trial.Setting34 UK hospitals.Participants405 women of reproductive age undergoing conservative surgery for endometriosis.InterventionsParticipants were randomised in a 1:1 ratio using a secure internet facility to a long acting progestogen (depot medroxyprogesterone acetate or levonorgestrel releasing intrauterine system) or the combined oral contraceptive pill.Main outcome measuresThe primary outcome was pain measured three years after randomisation using the pain domain of the Endometriosis Health Profile 30 (EHP-30) questionnaire. Secondary outcomes (evaluated at six months, one, two, and three years) included the four core and six modular domains of the EHP-30, and treatment failure (further therapeutic surgery or second line medical treatment).Results405 women were randomised to receive a long acting progestogen (n=205) or combined oral contraceptive pill (n=200). At three years, there was no difference in pain scores between the groups (adjusted mean difference −0.8, 95% confidence interval −5.7 to 4.2, P=0.76), which had improved by around 40% in both groups compared with preoperative values (an average of 24 and 23 points for long acting progestogen and combined oral contraceptive pill groups, respectively). Most of the other domains of the EHP-30 also showed improvement at all time points compared with preoperative scores, without evidence of any differences between groups. Women randomised to a long acting progestogen underwent fewer surgical procedures or second line treatments compared with those randomised to the combined oral contraceptive pill group (73 v 97; hazard ratio 0.67, 95% confidence interval 0.44 to 1.00).ConclusionsPostoperative prescription of a long acting progestogen or the combined oral contraceptive pill results in similar levels of improvement in endometriosis related pain at three years, with both groups showing around a 40% improvement compared with preoperative levels. While women can be reassured that both options are effective, the reduced risk of repeat surgery for endometriosis and hysterectomy might make long acting reversible progestogens preferable for some.Trial registrationISRCTN registry ISRCTN97865475.

Two experiments were conducted to determine if age affects comprehension for explicit and implied warning information and, if so, to reveal the nature of such effects. Experiment 1 measured younger (18-23 years) and older (65-75 years) adults' comprehension for real-world warnings via a verification test presented immediately after reading the warnings or after a delay. In Experiment 2, younger (18-22 years) and older (64-76 years) participants also read fabricated warnings that were inconsistent with real-world knowledge. In both experiments, older adults frequently failed to infer the correct hazard and safety information. The older adults also had trouble understanding warning information even when it was explicitly stated (when no inferences were required), especially when memory demands were high and product-specific knowledge could not be used. That many of the older adults did not understand commonly used product warnings indicates that the wording on many household products is not conducive to being understood by everyone who uses them. Actual or potential applications of this research include the recommendation that designers of product labels, warnings, and instructions should consider minimizing memory load and maximizing opportunities for knowledge application when designing consumer warnings.

Beliefs about warnings and habits associated with reading them were assessed for 863 individuals of various ages. Information gathered for various common household products included (a) how frequently people attend to warning information, (b) the degree of risk they believe is involved during product usage, and (c) how important they believe warnings are for different product types. Also assessed were perceived helpfulness and comprehension for symbols commonly found on product labels or on signs in the environment. Respondents 55 years and older reported reading product warnings more frequently than did younger adults, although they generally perceived warnings as less important. However, no overall age-related differences were found for perceived level of risk involved in using different product types. Although older adults generally perceived symbols to be very helpful when using a particular product, their comprehension levels were poorer than those of younger adults for half of the symbols. Overall, these data suggest that adults of all ages do read warnings on a variety of product types and that they believe warning information is important. This research illustrates the importance of including older adults in usability studies during the development of warning systems, given age-related effects may be associated with some aspects of the warning processing but not others.

Successful comprehension of warning text necessitates an ability to understand both explicitly stated safety information, as well as information about hazards and safe product usage that may be implied. Comprehension level for this type of text may vary across age groups as a function of normal age-related changes that may be experienced in memory and text comprehension in general. To date, there has been no comprehensive investigation of how well younger and older adults understand explicit and implicit information associated with actual product warnings. In the current study, 43 older and 42 younger adults read text from consumer product warnings and then rated the truth/falsity of statements containing information that was either explicitly stated or implied by the warnings. The results suggest both older and younger adults are able to recognize information that is explicitly associated with an actual product warning. However, they are less able to recognize information that can be inferred from warnings. These data also suggest that older adults perceive themselves to understand consumer warnings fairly well.

Background: Increasing nursing time in patient care is beneficial in improving patient outcomes, but this is proving increasingly difficult with the nursing shortage, budgetary constraints, and higher patient acuity. Objective: Nursing workflow was evaluated after the implementation of a continuous vigilance monitoring system to determine if the system enhanced patient-centric nursing care. Methods: Work sampling observations were conducted at 3 hospitals for 6 categories of nursing activities (direct and indirect nursing, documentation, administrative, housekeeping, and miscellaneous) at baseline and at 3 and 9 months. Results: Statistically significant increases in direct (3 months) and indirect nursing care (3 and 9 months) were found, with variability between sites. Statistically significant increases at 3 and 9 months for documentation of patient care activities and decreases in administrative activities were the most consistent findings for all sites. Conclusion: Continuous vigilance monitoring enhanced patient-centric care with increases in direct and indirect nursing care and documentation of those activities.