Local signs at insertion site and catheter-related bloodstream infections: an observational post hoc analysis using individual data of four RCTs

Background Little is known on the association between local signs and intravascular catheter infections. This study aimed to evaluate the association between local signs at removal and catheter-related bloodstream infections (CRBSI), and which clinical conditions may predict CRBSIs if inflammation at insertion site is present. Methods We used individual data from four multicenter randomized controlled trials in intensive care units (ICUs) that evaluated various prevention strategies for arterial and central venous catheters. We used multivariate logistic regressions in order to evaluate the association between ≥ 1 local sign, redness, pain, non-purulent discharge and purulent discharge, and CRBSI. Moreover, we assessed the probability for each local sign to observe CRBSI in subgroups of clinically relevant conditions. Results A total of 6976 patients and 14,590 catheters (101,182 catheter-days) and 114 CRBSI from 25 ICUs with described local signs were included. More than one local sign, redness, pain, non-purulent discharge, and purulent discharge at removal were observed in 1938 (13.3%), 1633 (11.2%), 59 (0.4%), 251 (1.7%), and 102 (0.7%) episodes, respectively. After adjusting on confounders, ≥ 1 local sign, redness, non-purulent discharge, and purulent discharge were associated with CRBSI. The presence of ≥ 1 local sign increased the probability to observe CRBSI in the first 7 days of catheter maintenance (OR 6.30 vs. 2.61 [> 7 catheter-days], pheterogeneity = 0.02). Conclusions Local signs were significantly associated with CRBSI in the ICU. In the first 7 days of catheter maintenance, local signs increased the probability to observe CRBSI.

Key Word Signing Has Higher Iconicity Than Sign Language

Purpose Key word signing (KWS) entails using manual signs to support the natural speech of individuals with normal hearing and who have communication difficulties. While manual signs from the local sign language may be used for this purpose, some KWS systems have opted for a distinct KWS lexicon. Distinct KWS lexicon typically aims for higher sign iconicity or recognizability to make the lexicon more accessible for individuals with intellectual disabilities. We sought to determine if, in the Belgian Dutch context, signs from such a distinct KWS lexicon (Spreken Met Ondersteuning van Gebaren [Speaking With Support of Signs; SMOG]) were indeed more iconic than their Flemish Sign Language (FSL) counterparts. Method Participants were 224 adults with typical development who had no signing experience. They rated the resemblance between a FSL sign and its meaning. Raw data on the iconicity of SMOG from a previous study were used. Translucency was statistically and qualitatively compared between the SMOG lexicon and their FSL counterparts. Results SMOG had an overall higher translucency than FSL and contained a higher number of iconic signs. Conclusion This finding may support the value of a separate sign lexicon over using sign language signs. Nevertheless, other aspects, such as wide availability and inclusion, need to be considered.

Minimum Memory-Based Sign Adjustment in Signed Social Networks

In social networks comprised of positive (P) and negative (N) symmetric relations, individuals (nodes) will, under the stress of structural balance, alter their relations (links or edges) with their neighbours, either from positive to negative or vice versa. In the real world, individuals can only observe the influence of their adjustments upon the local balance of the network and take this into account when adjusting their relationships. Sometime, their local adjustments may only respond to their immediate neighbourhoods, or centre upon the most important neighbour. To study whether limited memory affects the convergence of signed social networks, we introduce a signed social network model, propose random and minimum memory-based sign adjustment rules, and analyze and compare the impacts of an initial ratio of positive links, rewire probability, network size, neighbor number, and randomness upon structural balance under these rules. The results show that, with an increase of the rewiring probability of the generated network and neighbour number, it is more likely for the networks to globally balance under the minimum memory-based adjustment. While the Newmann-Watts small world model (NW) network becomes dense, the counter-intuitive phenomena emerges that the network will be driven to a global balance, even under the minimum memory-based local sign adjustment, no matter the network size and initial ratio of positive links. This can help to manage and control huge networks with imited resources.

The Influence of Sign Variations on Drivers’ Comprehension

Road Sign comprehension studies typically focus on differences among signs, demonstrating large variability in comprehension among different signs. Differences in features of sign design can be grouped into their shape, background color, and the symbol/icon in their center. This study demonstrated that specific sign messages can be presented with different sign features without detrimental effects on either comprehension level or response time. In particular, the choice of background color (yellow or white) appears to be inconsequential for comprehension. It seems that some sign characteristics are not critical to comprehension and consequently licensed drivers may even incorrectly identify a non-local sign as the standard sign that they actually encounter on the roads. However, other sign features – especially those relating to the icon/symbol - can be critical to comprehension when they violate the icon-concept compatibility, as it is represented in drivers' long-term memory.

Do Motorists See Business Signs? Maybe. Maybe Not.

This study sought to answer questions about the extent to which on-premise signs (OPS) along US roadways attract the attention of passing motorists, based on a sample of OPS and roadway contexts captured in photo images from along the 3,073 mile length of highway US 50. 3M's Visual Analysis Software (VAS) was used to predict the probability that the selected OPS would be viewed by passing motorists. Results show that for all signs (n=467), the average probability of being viewed was about 57%, with that rising to about 66% for a "primary signs" group (n=100). These results are consistent with early research of motorist detection of on-premise signs in real-world contexts. The findings suggest that a substantial proportion (approximately one-third) of the on-premise signs along roadways in the US are not being viewed by motorists as business intended, and both the businesses and their communities are foregoing the benefits that more effective signage would provide. This study also sought to determine whether the OPS of national and regional businesses are better able to attract the attention of passing motorists compared to the OPS of locally-based businesses. The results show the average probability of being viewed for the national and regional business OPS is significantly higher than for the local businesses, though both business types showed substantial variation in the probability of viewing. These results suggest an opportunity for the OPS of local businesses to be improved. Both findings here raise important implication for understanding how both local sign regulations and industry design and location standards factor into causing and resolving the problem. Finally, VAS was found to provide quick and inexpensive objective analysis of OPS in real-world contexts. Future research is needed to develop advanced protocols for the use of VAS in analyzing OPS in complex environmental contexts.

Do Motorists See Business Signs? Maybe. Maybe Not. A Study of the Probability that Motorists View On-Premise Signs

This study sought to answer questions about the extent to which on-premise signs (OPS) along US roadways attract the attention of passing motorists, based on a sample of OPS and roadway contexts captured in photo images from along the 3,073 mile length of highway US 50. 3M’s Visual Analysis Software (VAS) was used to predict the probability that the selected OPS would be viewed by passing motorists. Results show that for all signs (n=467), the average probability of being viewed was about 57%, with that rising to about 66% for a “primary signs” group (n=100). These results are consistent with early research of motorist detection of on-premise signs in real-world contexts. The findings suggest that a substantial proportion (approximately one-third) of the on-premise signs along roadways in the US are not being viewed by motorists as business intended, and both the businesses and their communities are foregoing the benefits that more effective signage would provide. This study also sought to determine whether the OPS of national and regional businesses are better able to attract the attention of passing motorists compared to the OPS of locally-based businesses. The results show the average probability of being viewed for the national and regional business OPS is significantly higher than for the local businesses, though both business types showed substantial variation in the probability of viewing. These results suggest an opportunity for the OPS of local businesses to be improved. Both findings here raise important implication for understanding how both local sign regulations and industry design and location standards factor into causing and resolving the problem. Finally, VAS was found to provide quick and inexpensive objective analysis of OPS in real-world contexts. Future research is needed to develop advanced protocols for the use of VAS in analyzing OPS in complex environmental contexts.