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Comprehensibility of the package leaflets of all medicinal products for human use: a questionnaire survey about the use of symbols and pictograms.

Directive 92/27EEC establishes that the package leaflet is a document, which must be included in the package of medicinal products for human use in EU countries. This informative leaflet is directed at the users and it must give full and comprehensible information. The Law suggests the use of symbols but it does not give advice about the subjects to be represented. In order to evaluate the attitude of patients towards package leaflets provided with symbols, we planned a survey interviewing 1004 patients in pharmacies. The data suggest that Italian patients usually read the package leaflet but they neither understand it easily nor find the needed information readily. Most respondents (74.3%) considered the use of symbols helpful in finding the needed information. We proposed five symbols for each heading (therapeutic indications, side effects, paediatric use, contraindications, use in pregnancy) and asked to select which symbol could be used. In the case of 'side effects', 'paediatric use', 'use in pregnancy' and 'dose', most of the respondents chose the same symbol. In the case of 'therapeutic indications' and 'contraindications' there was no uniformity in the answers. The choice depends greatly on education, age and employment of respondents.

Adult↗

Colocalization of human papillomavirus type 11 E1[symbol: see text]E4 and L1 proteins in human foreskin implants grown in athymic mice.

The most abundant viral mRNA species in tissues infected with HPV 11 consists of two exons, joining a short segment of open reading frame (ORF) E1 to ORF E4, potentially encoding an protein of 10 kDa. E4 gene products have previously been identified by immunohistochemistry in human tissues infected with HPV 1 and HPV 16, and in HPV 11-infected raft cultures. The E1[symbol: see text]E4 mRNA is produced in abundance in HPV 11-infected human foreskin implants grown in athymic mice. In contrast, the L1 mRNA is present at low levels and appears late in the course of infection. To characterize the relationship of these proteins, polyclonal rabbit antisera were produced against bacterially expressed HPV 11 trpE/E1[symbol: see text]E4 and trpE/L1 fusion proteins and tested in an immunohistochemical assay of paraffin-embedded sections of HPV 11-infected human foreskin tissue fixed with 10% buffered formalin phosphate or zinc formalin. In sections fixed with either fixative, the anti-L1 serum stained nuclei of cells in the upper spinous and granular layers. In contrast, the anti-E1[symbol: see text]E4 serum stained the cell membrane and, to a lesser degree, the cytoplasm of cells in the upper spinous and granular layers of tissue fixed with zinc formalin, but not 10% buffered formalin phosphate. In sections treated with both the E1[symbol: see text]E4 and L1 antisera, cell membrane staining occurred in the same cells that exhibited nuclear staining. The HPV 11 E1[symbol: see text]E4 protein appears to be a cell membrane-associated protein. Expression of the HPV 11 E1[symbol: see text]E4 and L1 proteins may be influenced by similar factors in differentiating cells.

Animals↗

Joint symbolic dynamic analysis of beat-to-beat interactions of heart rate and systolic blood pressure in normal pregnancy.

Pregnancy induces important changes in the autonomic control. Measures of heart rate (HR) variability and systolic blood pressure (SP) variability are sensitive to those changes. The interactions between HR and SP are complex and strongly non-linear. Therefore they cannot be completely described by linear analysis techniques. A study of joint symbolic dynamics is presented as a new short-term non-linear analysis method to investigate the interactions between HR and SP. Continuous, non-invasive 30 min blood pressure recordings (Portapres) of 25 pregnant and 14 non-pregnant women were analysed. Time series of beat-to-beat HR and SP were extracted. Using the concept of joint symbolic dynamics, HR and SP changes were transformed into a bivariate symbol vector. Subsequently, this symbol vector was transformed into a word series (words consisting of three successive symbols), and the probability of occurrence of each word type was calculated and compared between both groups. Significant differences were found in five word types between pregnant and non-pregnant women: w0,4(0.021+/-0.011 against 0.008+/-0.006; p = 0.022), w4,6(0.020+/-0.010 against 0.007+/-0.003; p = 0.001), w3,2(0.004+/-0.003 against 0.007+/-0.003; p = 0.038), W6,5(0.009+/-0.007 against 0.023+/-0.008; p< 0.001) and w3,6(0.011+/-0.007 against 0.023+/-0.008; p = 0.001). Joint symbolic dynamics provides an efficient non-linear representation of HR and SP interactions that offers simple physiological interpretations.

Adult↗

Legibility of symbols on CRT displays.

The effects of several parameters - such as letter orientation, slanting versus upright, dot matrix size, etc - of symbol formation on the legibility of CRT displays were studied. Symbols were tested by subjects attempting to identify them when presented briefly on the display screen. Speed and accuracy of identification were used as the measures of legibility. The 7 x 9 dot matrix symbols drawn with circular dots were superior to all others for both reaction time and errors. Slanting had a detrimental effect on dot and stroke symbols and circular dot symbols were superior to elongated dot symbols.

Journal Article↗

An experimental comparison of test and symbols for in-car reconfigurable displays.

As cars become more sophisticated, there is a corresponding increase in the range of information which needs to be presented to drivers. This increased information load is beyond the scope of conventional technology; space requirements on the dashboard limit the number of displays, which can be employed. The study reported in this paper is based on the premise that centralized information presentation could be employed for in-car warming systems. Forty subjects were tested on a computer-based task, in which they had to rate the urgency of displayed information. The information was presented in one of four formats: symbols only, symbols plus title, symbols plus action, or symbol, title and action. Results show that the most effective type of display for urgency rating was symbol plus action, and that symbol, title and action produced the fastest reaction times. These results are considered in terms of previous research, and implications for the design of in-car warnings are discussed.

Journal Article↗

Comprehension and memory for warning symbols: age-related differences and impact of training.

PROBLEM: Prior research indicates that many warning symbols are poorly understood, particularly by the elderly. METHOD: The effectiveness of three different training conditions to improve comprehension and memory for warning symbols was assessed for younger (18-35 years of age) and older (50-67 years of age) participants. All three conditions paired the symbols with associated text during training; however they differed in the extent to which they further elaborated on the meanings of the symbols. RESULTS: Training substantially improved accuracy and speed of responding on a comprehension test; however there was little difference among conditions. Additionally, while the magnitude of the training effect was similar for both age groups, older participants performed much more poorly than younger participants, both before (37% vs. 52% correct) and after training (68% vs. 88% correct on the immediate post-test), and found it more difficult to reject incorrect meanings (55% vs. 68% correct). CONCLUSION: Relatively simple training conditions can dramatically improve accuracy and speed of responding to warning symbols. IMPACT ON INDUSTRY: Training should be used to improve warning symbol comprehension since failures to adequately understand warning information may lead to injury or death. Furthermore, attempts should be made to address individual differences in warning processing such as those related to changes in cognitive processing across the lifespan.

Accidents, Occupational↗

Emergence of symbolic behavior from brain like memory with dynamic attention.

An important feature of human intelligence is the use of symbols. This is seen in our daily use of language and logical thinking. However, the use of symbols is not limited to humans. We observe planned action sequences in primate behavior and prediction-based action in higher mammals. For the representation and operation of symbols by the brain neural circuit, no specific construction principle or computational theory is known so far. In this paper, we regard the brain as a complex of associative memory and dynamic attentional system, and starting from two hypotheses on information representation and operation in the brain, we propose a model of primitive symbolic behavior emergence that is consistent with the conventional symbolic processing model. We also describe a computational theory of the symbolic processing model in associative memory. Through computer simulation studies on a language-like memory search and map learning by a moving robot, we discuss the validity of the model.

Journal Article↗

A comparison of symbol transparency in nonspeaking persons with intellectual disabilities.

This investigation compared the transparency of 11 different types of symbols representing objects with 40 nonspeaking subjects who experienced various degrees of intellectual disability. The subjects included a number of individuals with physical impairments or autism in addition to mild, moderate, or severe mental retardation. The symbol sets included: nonidentical objects, miniature objects, identical colored photographs, nonidentical colored photographs, black-and-white photographs, Picture Communication Symbols (PCS), Picsyms, Rebus, Self-Talk, Blissymbols, and written words. Statistical analyses indicated that real objects were more readily recognized than were any of the symbol sets and that Blissymbols and written words were more difficult than were any of the other sets. In addition, the results suggest the existence of a hierarchy of difficulty at the object (noun) level for the symbol sets assessed. The results are discussed in terms of their implications for selecting an initial symbol set for nonspeaking individuals. In addition, some suggestions for using the assessment protocols in clinical practice are presented, along with future research implications.

Adolescent↗

Symbolic synchronization and the detection of global properties of coupled dynamics from local information.

We study coupled dynamics on networks using symbolic dynamics. The symbolic dynamics is defined by dividing the state space into a small number of regions (typically 2), and considering the relative frequencies of the transitions between those regions. It turns out that the global qualitative properties of the coupled dynamics can be classified into three different phases based on the synchronization of the variables and the homogeneity of the symbolic dynamics. Of particular interest is the homogeneous unsynchronized phase, where the coupled dynamics is in a chaotic unsynchronized state, but exhibits qualitative similar symbolic dynamics at all the nodes in the network. We refer to this dynamical behavior as symbolic synchronization. In this phase, the local symbolic dynamics of any arbitrarily selected node reflects global properties of the coupled dynamics, such as qualitative behavior of the largest Lyapunov exponent and phase synchronization. This phase depends mainly on the network architecture, and only to a smaller extent on the local chaotic dynamical function. We present results for two model dynamics, iterations of the one-dimensional logistic map and the two-dimensional Henon map, as local dynamical function.

Algorithms↗

The relevance of error analysis in graphical symbols evaluation.

In an increasing number of modern tools and devices, small graphical symbols appear simultaneously in sets as parts of the human-machine interfaces. The presence of each symbol can influence the other's recognizability and correct association to its intended referents. Thus, aside from correct associations, it is equally important to perform certain error analysis of the wrong answers, misses, confusions, and even lack of answers. This research aimed to show how such error analyses could be valuable in evaluating graphical symbols especially across potentially different user groups. The study tested 3 sets of icons representing 7 videophone functions. The methods involved parameters such as hits, confusions, missing values, and misses. The association tests showed similar hit rates of most symbols across the majority of the participant groups. However, exploring the error patterns helped detect differences in the graphical symbols' performances between participant groups, which otherwise seemed to have similar levels of recognition. These are very valuable not only in determining the symbols to be retained, replaced or re-designed, but also in formulating instructions and other aids in learning to use new products faster and more satisfactorily.

Adolescent↗

The impact of memory on age differences in digit symbol performance.

The roles of memory and unnecessary reliance on the coding key were examined in relation to age differences in performance on the WAIS Digit Symbol test. Old and young adults were trained to a stringent criterion of learning the digit-symbol pairings before carrying out the task. Their performances on the Digit Symbol test were then compared to performances of control subjects who had not learned the digit-symbol pairs. Memory training had no effect on the performances of older adults; it did benefit slightly the performances of younger persons. Unnecessary reliance on the coding key was examined by allowing the use of the Digit Symbol key, even when it was not needed. There were no significant differences between the performances of either old or young adults who had the key as compared to those who did not. It was concluded that neither memory nor unnecessary reliance on the coding key explain the difficulties older adults experience in performing digit-symbol substitutions.

Adult↗

The nursing pin: symbol of 1,000 years of service.

The nursing pin is a 1,000-year old symbol of service to others. The earliest ancestor of the pin dates back to the Maltese Cross, adopted by crusaders and worn on their habits as a symbol of service to Christianity. Over the centuries, variations of the crusader's symbol were gradually modified and became family coats of arms, often symbolizing service to a ruler. By the Renaissance, guilds had adopted coats of arms symbolizing masterful service to the community. The most recent ancestor of the pin is the hospital badge of 100 years ago. It was given by the hospital school of nursing to the students to identify them as nurses who were educated to serve the health needs of society. This symbol of service involves many professional rights and responsibilities.

Emblems and Insignia↗

The core variables of symbolic-experiential therapy: a qualitative study.

Symbolic-experiential therapists have been criticized for not adequately operationalizing symbolic theory and empirically validating their methods. Although pioneering researchers have noted that the task of studying and evaluating humanistic therapies is complex, we agree that all therapists need to be held accountable for their interventions. In this article we identify the core variables underlying symbolic-experiential therapy that emerged from a research study using grounded theory. The inductively derived conceptual framework for symbolic-experiential therapy included: (a) Generating an interpersonal set; (b) creating a suprasystem; (c) stimulating a symbolic context; (d) activating stress within the system; (e) creating symbolic experience; and (f) moving out of the system.

Family Therapy↗

The symbol of modern medicine: why one snake is more than two.

Today, two serpent motifs are commonly used to symbolize the practice and profession of medicine. Internationally, the most popular symbol of medicine is the single serpent-entwined staff of Asklepios (Latin, Aesculapius), the ancient Greco-Roman god of medicine. However, in the United States, the staff of Asklepios (the Asklepian) and a double serpent-entwined staff with surmounting wings (the caduceus) are both popular medical symbols. The latter symbol is often designated as the "medical caduceus" and is equated with the ancient caduceus, the double serpent-entwined staff of the Greco-Roman god Hermes (Latin, Mercury). Many physicians would be surprised to learn that the medical caduceus has a quite modern origin: Its design is derived not from the ancient caduceus of Hermes but from the printer's mark of a popular 19th-century medical publisher. Furthermore, this modern caduceus became a popular medical symbol only after its adoption by the U.S. Army Medical Corps at the beginning of the 20th century. This paper describes the ancient origin of the Asklepian and how a misunderstanding of ancient mythology and iconography seems to have led to the inappropriate popularization of the modern caduceus as a medical symbol.

Animals↗

Preschool children's symbolic representation of objects through gestures.

To investigate the symbolic quality of preschoolers' gestural representations in the absence of real objects, 48 children (16 3-, 4-, and 5-year-olds) performed 2 tasks. In the first task, they were asked to pretend to use 8 common objects (e.g., "pretend to brush your teeth with a toothbrush"). There was an age-related progression in the symbolic quality of gestural representations. 3- and 4-year-olds used mostly body part gestures (e.g., using an extended finger as the toothbrush), whereas 5-year-olds used imaginary object gestures (e.g., pretending to hold an imaginary toothbrush). To determine if children's symbolic skill is sufficiently flexible to allow them to use gestures other than those spontaneously produced in the first task, in the second task children were asked to imitate, for each object, a gesture modeled by an experimenter. The modeled gesture was different from the one the child performed on the first task (e.g., if the child used a body part gesture to represent a particular object, the experimenter modeled an imaginary object gesture for that object). Ability to imitate modeled gestures was positively related to age but was also influenced by the symbolic mode of gesture. 3-year-olds could not imitate imaginary object gestures as well as body part gestures, suggesting that young preschoolers have difficulty performing symbolic acts that exceed their symbolic level even when the acts are modeled. Results from both tasks provide strong evidence for a developmental progression from concrete body part to more abstract imaginary object gestural representations during the preschool years.

Age Factors↗

Comments on snake symbolism and mind-body relations.

In summary, the symbolic use of an object in part depends on which of its functional-structural qualities is emphasized in a given moment. For example, the snake may take on different symbolic meanings when emphasis is given to its eyes, tongue, fangs, anatomical form, or movement. Its various aspects constitute a complex system of references to unconscious (and conscious) mental and body self-configurations. These references frequently undergo transformations which make use of structurally related symbols. In the present paper, various aspects of the snake symbol were related to one another and to other symbolic transformations, including the elevator and flying. The structural principles underlying these analyses may be found to organize a wide range of phenomena and were here applied to Tausk's "influencing machine."

Animals↗

Deficits, delays, and distractions: an evaluation of symbolic play and memory in children with autism.

Two experiments were conducted to evaluate symbolic-deficit and memory-deficit hypotheses to account for the cognitive problems seen in children with autism. Experiment 1 tested imitation, in immediate and deferred conditions, of familiar actions with different sets of objects representing the developmental progression from functional to symbolic play. The results showed that the autism group and both their receptive language and nonverbal IQ-matched controls imitated familiar actions with realistic objects (evidence for functional play) and placeholder objects (evidence for symbolic play) after delays ranging from 24 hr to 3 weeks. Experiment 2 tested familiar three-step event sequences in which a placeholder object was substituted for the second step in half the events. The results showed that the autism group remembered as many of the actions with the placeholder objects as their language-matched controls and as many correctly ordered sequences, a finding that supports a symbolic-delay (rather than deficit) hypothesis. These results were obtained in highly structured test situations and sharply contrast with the impairments seen in children with autism who are observed in naturalistic settings. Two interpretations of these findings are offered. First, structured test settings minimize distractions that typically occur in naturalistic settings that may interfere or disrupt symbolic play in children with autism. Second, the results are consistent with an executive function deficit in that the autistic group demonstrated more knowledge in the test settings than they demonstrate spontaneously in naturalistic ones.

Attention↗

Symbolic immortality and the management of the terror of death: the moderating role of attachment style.

Three studies were designed to examine the contribution of R. J. Lifton's (1979) symbolic immortality construct to the management of the terror of death and to investigate whether attachment style may underlie this contribution. Using a sample of 420 Israeli students, Study 1 revealed an inverse correlation between self-reports of symbolic immortality and fear of personal death. This finding was validated in Study 2 (N = 120), which found that high symbolic immortality reduced the effects of a death salience manipulation on the level of punishment given to a social transgressor. Study 3 (N = 270) refined the association between symbolic immortality and fear of death. The inverse correlation found in Study 1 was revealed only among securely attached persons. The discussion emphasizes the interconnectedness between personality, symbolic immortality, and the management of the terror of death.

Adaptation, Psychological↗