We are all ordinary: the shared visual narratives of daily life promote the patients' positive attitudes toward doctors.

BACKGROUND: Current research on the doctor-patient relationship primarily focuses on the responsibilities of doctors, with relatively less emphasis on examining the contributions patients can make. As a result, there is an urgent demand for exploring innovative approaches that highlight the active role patients play in cultivating a robust doctor-patient relationship. The purpose of this study was to devise an intervention strategy centered around patients to enhance the doctor-patient relationship. Comics were developed to depict shared narratives encompassing challenging daily life experiences between doctors and ordinary individuals. The study aimed to assess the efficacy of this approach in cultivating positive attitudes toward doctors. METHOD: A 3-group design trial was conducted in Shanghai, China. A total of 152 participants were randomly assigned to one of three conditions: the parallel presenting group (n = 51), where narratives about a doctor and an ordinary employee were presented side by side in comics; the single presenting group (n = 50), where only narratives about a doctor were presented; and the control group (n = 51). The outcomes assessed in this study encompassed changes in identification with the doctor portrayed in the comics, perceived intimacy between doctors and patients in reality, and appraisal of the doctor in a prepared doctor-patient interaction situation. RESULTS: The parallel presenting group exhibited significantly larger increases in identification with the doctor portrayed in the comics, perceived intimacy between doctors and patients in reality, and appraisal of the doctor in a prepared doctor-patient interaction scenario compared to the single presenting group. The observed enhancements in the appraisal of the doctor in a prepared doctor-patient interaction scenario can be attributed to the changes in identification with the doctor portrayed in the comics experienced by the participants. CONCLUSION: Our study responds to the doctor-centric focus in existing research by exploring patients' contributions to the doctor-patient relationship. Using comics to depict shared narratives, the parallel presenting group demonstrated significantly increased identification with the depicted doctor, perceived intimacy, and positive appraisal in prepared scenarios compared to the single presenting group. This underscores the effectiveness of patient-centered interventions in shaping positive attitudes toward doctors, highlighting the pivotal role patients play in fostering a resilient doctor-patient relationship. TRIAL REGISTRATION: Chinese Clinical Trail Registry: ChiCTR2400080999 (registered 20 February 2024; retrospectively registered).

Visual narratives in medicine - Bridging the gap in graphic medicine with an illustrated narrative of osteoarthritis.

Objective: Visual narratives have been used in medicine to share information in the form of stories with the potential to improve understanding of conditions and change behaviours. One genre of visual narratives is "graphic medicine", which integrates comics into medical education and the delivery of healthcare. Graphic medicine can maximise the impact of research findings by presenting them in a more accessible format, which may be particularly useful in certain populations, such as those with low levels of health literacy. Those with lower health literacy levels and osteoarthritis (OA) are less likely to manage their condition with guideline recommended management strategies, experience a higher burden of disease, and have lower access to care. Our objectives were to review the current visual narratives in the field of and create a graphic medicine visual narrative based on existing research. Design: This paper summarises the current visual narratives in OA and presents a graphic medicine visual narrative to illustrate the experience of living with OA. Considerations for the dissemination of visual narratives to target audiences are also discussed. Results: The most common visual narratives in are infographics, videos, and graphic medicine. A graphic medicine visual narrative, based on previous qualitative work and informed by a framework, was created to illustrate two distinct narratives - impairment and participatory. Conclusion: Visual narratives remain an emerging field in OA but may serve as a useful resource for patients or clinicians to discuss various aspects of OA management. Future research should evaluate and validate the use of visual narratives in OA.

Individual differences in the neural dynamics of visual narrative comprehension: The effects of proficiency and age of acquisition.

Understanding visual narrative sequences, as found in comics, is known to recruit similar cognitive mechanisms to verbal language. As measured by event-related potentials (ERPs), these manifest as initial negativities (N400, LAN) and subsequent positivities (P600). While these components are thought to index discrete processing stages, they differentially arise across participants for any given stimulus. In language contexts, proficiency modulates brain responses, with smaller N400 effects and larger P600 effects appearing with increasing proficiency. In visual narratives, recent work has also emphasized the role of proficiency in neural response patterns. We thus explored whether individual differences in proficiency modulate neural responses to visual narrative sequencing in similar ways as in language. We combined ERP data from 12 studies examining semantic and/or grammatical processing of visual narrative sequences. Using linear mixed effects modeling, we demonstrate differential effects of visual language proficiency and "age of acquisition" on N400 and P600 responses. Our results align with those reported in language contexts, providing further evidence for the similarity of linguistic and visual narrative processing, and emphasize the role of both proficiency and age of acquisition in visual narrative comprehension.

Sharing Visual Narratives of Diabetes on Social Media and Its Effects on Mental Health.

Diabetes is a chronic illness affecting over six percent of the global population. Visual social media sites such as Tumblr provide a unique opportunity to understand visual illness narratives of type 1 and type 2 diabetes and its effects on mental health. We qualitatively analyze 259 Tumblr images with a "diabetes" hashtag. The results provide rich insights into the lives of diabetes patients, including personal and social life interactions, visual narratives portraying one's acceptance and maintenance of diabetes, difficulty in social interactions, and how patients' identity and beliefs are shaped by the daily struggles and failures of living with diabetes. We discuss the findings in the context of the chaos, quest, and restitution narratives of illness proposed by Arthur Frank. The results have implications for the visual representation of chronic diseases on social media and for improving patient-provider interactions and treatment of type 1 and type 2 diabetes patients.

Images of Recovery: A PhotoVoice Study on Visual Narratives of Personal Recovery in Persons with Serious Mental Illness.

Personal recovery has become a guiding paradigm in mental health services. Most research on recovery is based on the exploration of personal stories of service users through verbal methods. As not everyone with psychiatric problems is able to verbally formulate a recovery narrative, the current study assesses personal recovery through PhotoVoice, with emphasis on visualisation, small stories and participation. Two ten-week groups were conducted with 18 participants living with severe mental illnesses. They participated in both the collection and analysis of visual narratives. Across the images produced by participants, four main recovery themes were found : People, Places, Activities and Finding Meaning. Compared to other frameworks, the emphasis participants put on the theme Places adds value to the understanding of recovery processes. Furthermore, participants showed that recovery is about dealing with vulnerabilities as well as aspiring a meaningful life. This study demonstrates that exploring visual narratives is powerful within recovery oriented mental health.

Reconstructive nature of temporal memory for movie scenes.

Remembering when events took place is a key component of episodic memory. Using a sensitive behavioral measure, the present study investigates whether spontaneous event segmentation and script-based prior knowledge affect memory for the time of movie scenes. In three experiments, different groups of participants were asked to indicate when short video clips extracted from a previously encoded movie occurred on a horizontal timeline that represented the video duration. When participants encoded the entire movie, they were more precise at judging the temporal occurrence of clips extracted from the beginning and the end of the film compared to its middle part, but also at judging clips that were closer to event boundaries. Removing the final part of the movie from the encoding session resulted in a systematic bias in memory for time. Specifically, participants increasingly underestimated the time of occurrence of the video clips as a function of their proximity to the missing part of the movie. An additional experiment indicated that such an underestimation effect generalizes to different audio-visual material and does not necessarily reflect poor temporal memory. By showing that memories are moved in time to make room for missing information, the present study demonstrates that narrative time can be adapted to fit a standard template regardless of what has been effectively encoded, in line with reconstructive theories of memory.

The Scene Perception & Event Comprehension Theory (SPECT) Applied to Visual Narratives.

Understanding how people comprehend visual narratives (including picture stories, comics, and film) requires the combination of traditionally separate theories that span the initial sensory and perceptual processing of complex visual scenes, the perception of events over time, and comprehension of narratives. Existing piecemeal approaches fail to capture the interplay between these levels of processing. Here, we propose the Scene Perception & Event Comprehension Theory (SPECT), as applied to visual narratives, which distinguishes between front-end and back-end cognitive processes. Front-end processes occur during single eye fixations and are comprised of attentional selection and information extraction. Back-end processes occur across multiple fixations and support the construction of event models, which reflect understanding of what is happening now in a narrative (stored in working memory) and over the course of the entire narrative (stored in long-term episodic memory). We describe relationships between front- and back-end processes, and medium-specific differences that likely produce variation in front-end and back-end processes across media (e.g., picture stories vs. film). We describe several novel research questions derived from SPECT that we have explored. By addressing these questions, we provide greater insight into how attention, information extraction, and event model processes are dynamically coordinated to perceive and understand complex naturalistic visual events in narratives and the real world.

Editors' Introduction and Review: Visual Narrative Research: An Emerging Field in Cognitive Science.

Drawn sequences of images are among our oldest records of human intelligence, appearing on cave paintings, wall carvings, and ancient pottery, and they pervade across cultures from instruction manuals to comics. They also appear prevalently as stimuli across Cognitive Science, for studies of temporal cognition, event structure, social cognition, discourse, and basic intelligence. Yet, despite this fundamental place in human expression and research on cognition, the study of visual narratives themselves has only recently gained traction in Cognitive Science. This work has suggested that visual narrative comprehension requires cultural exposure across a developmental trajectory and engages with domain-general processing mechanisms shared by visual perception, attention, event cognition, and language, among others. Here, we review the relevance of such research for the broader Cognitive Science community, and make the case for why researchers should join the scholarship of this ubiquitous but understudied aspect of human expression.

Dismantling the "Visual Ease Assumption:" A Review of Visual Narrative Processing in Clinical Populations.

Visual narratives, such as wordless picture books and picture sequences like comics, have a long history in clinical testing, research, and intervention settings. The widespread "Visual Ease Assumption" rests on the premise that visual narratives, given their non-linguistic nature, may alleviate processing difficulties in populations that struggle with language. In this paper, I review the evidence for and against this Visual Ease Assumption in three clinical populations in which language deficits are common or diagnostic: autism spectrum disorder (ASD), specific language impairment (SLI; now known as Developmental Language Disorder, DLD), and aphasia. I first redefine the Visual Ease Assumption as two testable predictions: (a) that visual narrative processing should be unimpaired for clinical populations compared to neurotypical (NT) populations; and (b) that in clinical populations, visual narrative processing should be less impaired than linguistic narrative processing. Through a review of the limited evidence available to test these predictions in ASD, SLI, and aphasia, I show that the Visual Ease Assumption is largely unsupported in empirical studies. Furthermore, I outline three additional limitations of the Visual Ease Assumption regarding the complexity of narrative processing, visual narrative tasks, and cognitive deficits in different clinical populations. Therefore, visual narratives should not be assumed to be "easier" for clinical populations that struggle with language; instead, a more thorough consideration of the cognitive processes involved in visual narrative processing is needed.

Through the mother's voice: Exposure and intimacy in Lesley McIntyre's photo project The Time of Her Life and Elisabeth Zahnd Legnazzi's Chiara A Journey Into Light.

When it comes to depicting ill or disabled children, the ethics of representation becomes increasingly complex. The perception of photographs as voyeuristic and objectifying is of particular concern here and resonates with widespread fear about the eroticisation, mistreatment and exploitation of children. Although these fears are reasonable, this view does not take into account the voice and agenda of the photographic subject, disregards the possibility of recognition and the participatory nature of photography. In this article, I focus on photography as a collaborative practice. I analyse two photographic projects by photographers/mothers that document their ill and dying daughters - Lesley McIntyre's photographic essay The Time of Her Life (2004) and Elisabeth Zahnd Legnazzi's Chiara A Journey Into Light (2009). Illness in these projects is not experienced in isolation. Instead, the photographs and accompanying texts provide a space to engage in a dialogue which is built on the interdependency of all the participants of the photographic act - the photographer, the subject of the photograph and the viewer. My aim is to question how these projects construct experiences and articulate private expressions of illness and how the photographs enhance and/or challenge the mother-daughter bond. Alan Radley's critical analysis of representations of illness, Emmanuel Lévinas's and Maurice Blanchot's perspectives on ethical philosophy and visual social semiotics approach developed by Kress and Van Leeuwen provide a guiding framework for this study.

The Inferential Language Comprehension (iLC) Framework: Supporting Children's Comprehension of Visual Narratives.

We present an integrated theoretical framework guiding the use of visual narratives in educational settings. We focus specifically on the use of static and dynamic visual narratives to teach and assess inference skills in young children and discuss evidence to support the efficacy of this approach. In doing so, first we review the basis of the integrated framework, which builds on major findings of cognitive, developmental, and language research highlighting that (a) inference skills can be developed in non-reading contexts using different media, (b) inference skills can transfer across different media, and (c) inference skills can be improved using questioning that includes scaffolding and specific feedback. Second, we review instructional and assessment approaches that align with the proposed framework; these approaches are designed to teach or assess inference making skills using visual narratives and interactive questioning. In this context, we discuss how these approaches leverage the unique affordances of static and dynamic visual narratives with respect to unit of meaning (by increasing opportunities to generate inferences), multimodality (by providing opportunities to generate inferences of higher complexity than text), and vocabulary/knowledge demands (by providing vocabulary/knowledge support), while also reviewing evidence for their usability, feasibility, and efficacy to improve educational outcomes. We conclude with important theoretical and practical questions about future work in this area.

Shortcuts for faster image creation in PyMOL.

PyMOL is often used to generate images of biomolecular structures. Hundreds of parameters in PyMOL provide precise control over the appearance of structures. We developed 241 Python functions-called "shortcuts"-that extend and ease the use of PyMOL. A user runs a shortcut by entering its name at the PyMOL prompt. We clustered the shortcuts by functionality into 25 groups for faster look-up. One set of shortcuts generates new styles of molecular representation. Another group saves files with time stamps in the file names; the unique filenames avoid overwriting files that have already been developed. A third group submits search terms in the user's web browser. The help function prints the function's documentation to the command history window. This documentation includes the PyMOL commands that the user can reuse by copying and pasting onto the command line or into a script file. The shortcuts should save the average PyMOL user many hours per year searching for code fragments in their computer or on-line. STATEMENT FOR LAY PUBLIC: Computer-generated images of protein structures are vital to the interpretation of and communication about the molecular structure of proteins. PyMOL is a popular computer program for generating such images. We made a large collection of macros or shortcuts that save time by executing complex operations with a few keystrokes.

The role of character goals and changes in body position in the processing of events in visual narratives.

BACKGROUND: A growing body of research is beginning to understand how people comprehend sequential visual narratives. However, previous work has used materials that primarily rely on visual information (i.e., they contain minimal language information). The current work seeks to address how visual and linguistic information streams are coordinated in sequential image comprehension. In experiment 1, participants viewed picture stories and engaged in an event segmentation task. The extent to which critical points in the narrative depicted situational continuity of character goals and continuity in bodily position was manipulated. The likelihood of perceiving an event boundary and viewing latencies at critical locations were measured. Experiment 1 was replicated in the second experiment, without the segmentation task. That is, participants read the picture stories without deciding where the event boundaries occurred. RESULTS: Experiment 1 indicated that changes in character goals were associated with an increased likelihood of segmenting at the critical point, but changes in bodily position were not. A follow-up analysis, however, revealed that over the course of the entire story, changes in body position were a significant predictor of event segmentation. Viewing time, however, was affected by both goal and body position shifts. Experiment 2 corroborated the finding that viewing time was affected by changes in goals and body positions. CONCLUSION: The current study shows that changes in body position influence a viewer's perception of event structure and event processing. This fits into a growing body of research that attempts to understand how consumers of multimodal media coordinate multiple information streams. The current study underscores the need for the systematic study of the visual, perceptual, and comprehension processes that occur during visual narrative understanding.

Visual and linguistic narrative comprehension in autism spectrum disorders: Neural evidence for modality-independent impairments.

Individuals with autism spectrum disorders (ASD) have notable language difficulties, including with understanding narratives. However, most narrative comprehension studies have used written or spoken narratives, making it unclear whether narrative difficulties stem from language impairments or more global impairments in the kinds of general cognitive processes (such as understanding meaning and structural sequencing) that are involved in narrative comprehension. Using event-related potentials (ERPs), we directly compared semantic comprehension of linguistic narratives (short sentences) and visual narratives (comic panels) in adults with ASD and typically-developing (TD) adults. Compared to the TD group, the ASD group showed reduced N400 effects for both linguistic and visual narratives, suggesting comprehension impairments for both types of narratives and thereby implicating a more domain-general impairment. Based on these results, we propose that individuals with ASD use a more bottom-up style of processing during narrative comprehension.

Impact of audio-visual storytelling in simulation learning experiences of undergraduate nursing students.

BACKGROUND: Use of high fidelity simulation has become increasingly popular in nursing education to the extent that it is now an integral component of most nursing programs. Anecdotal evidence suggests that students have difficulty engaging with simulation manikins due to their unrealistic appearance. Introduction of the manikin as a 'real patient' with the use of an audio-visual narrative may engage students in the simulated learning experience and impact on their learning. A paucity of literature currently exists on the use of audio-visual narratives to enhance simulated learning experiences. OBJECTIVE: This study aimed to determine if viewing an audio-visual narrative during a simulation pre-brief altered undergraduate nursing student perceptions of the learning experience. DESIGN: A quasi-experimental post-test design was utilised. PARTICIPANTS: A convenience sample of final year baccalaureate nursing students at a large metropolitan university. METHODS: Participants completed a modified version of the Student Satisfaction with Simulation Experiences survey. This 12-item questionnaire contained questions relating to the ability to transfer skills learned in simulation to the real clinical world, the realism of the simulation and the overall value of the learning experience. Descriptive statistics were used to summarise demographic information. Two tailed, independent group t-tests were used to determine statistical differences within the categories. RESULTS: Findings indicated that students reported high levels of value, realism and transferability in relation to the viewing of an audio-visual narrative. Statistically significant results (t=2.38, p<0.02) were evident in the subscale of transferability of learning from simulation to clinical practice. The subgroups of age and gender although not significant indicated some interesting results. CONCLUSIONS: High satisfaction with simulation was indicated by all students in relation to value and realism. There was a significant finding in relation to transferability on knowledge and this is vital to quality educational outcomes.

Jóvenes, temporalidades y narrativas visuales en el conflicto armado colombiano / Youth, temporality and visual narratives in the Colombian armed conflict / Jovens, temporalidade e narrativas visuais no conflito armado colombiano

En este artículo expongo los resultados de una investigación sobre la construcción social del tiempo, en el contexto del conflicto armado colombiano, de jóvenes que participan en un festival de cine y video comunitario en Ciudad Bolívar (Bogotá). Partiendo del presupuesto de que el tiempo es un regulador que permite a los individuos y grupos sintetizar, integrar y coordinar el mundo social, este estudio lo apoyé metodológicamente en el análisis cultural de los productos visuales que han circulado en las siete versiones del festival -videos, documentales y películas-, asumiendo que a partir de su puesta en escena se conjugan modos de temporización sociales, éticos y estéticos en los mundos de vida juveniles. En los hallazgos se destacan tres grupos de temporalidades juveniles: las temporalidades carnavalescas y polifónicas en la diversidad; los tiempos del duelo, el miedo y la condena; y la anamnesis y las memorias subalternas.

The article presents the results of a study that analyzed the social construction of time in the context of the Colombian armed conflict with young people participating in a community film and video festival in Ciudad Bolívar (Bogota). Based on the idea that time is a regulator that allows individuals and groups to synthesize, integrate and coordinate with the social world, the methodology used for the study was to engage in the cultural analysis of visual products circulating in the festival (videos, documentaries and films), based on the assumption that these products highlighted the social, ethical and aesthetic temporalities of young people’s life worlds. The results of the study show that three groups of youth temporalities are highlighted in the analysis: the carnival and polyphonic temporalities in diversity; the temporalities of grief, fear and condemnation; and subaltern history and memories.

Objetivo e âmbito: O artigo apresenta os resultados de um estudo que analisou a construção social do tempo, no contexto do conflito armado colombiano, dos jovens que participaram de um festival de cinema e vídeo comunitário na Ciudad Bolivar (Bogotá). Metodologia: Partindo do pressuposto de que o tempo é um controlador que permite a indivíduos e grupos sintetizarem, integrarem e coordenarem o mundo social, o estudo foi metodologicamente embasado na análise cultural de produtos visuais que tenham circulado nas sete versões do festival (vídeos, documentários e filmes), assumindo que por meio de sua encenação são combinados modos sociais, éticos e estéticos de temporização nos mundos da vida juvenil. Resultados: Três grupos de temporalidades juvenis são destacados nos resultados: o carnaval e temporalidades polifônicas na diversidade; o momento de dor, medo e condenação; e a história subalterna e as memórias.

Physicians' Reflections on Death and Dying on Completion of a Palliative Medicine Fellowship.

CONTEXT: Patient and family dissatisfaction may result when they are not satisfied with the physician/patient interaction, although the physician may feel he/she worked hard to provide information to the patient and family. New approaches to visual analysis can (1) identify significant insights from physicians' personal and clinical experiences in providing compassionate palliative care and end-of-life care and (2) provide an effective and practical vehicle for communicating with patients, their families, and other professional caregivers. OBJECTIVES: To elucidate palliative physicians' core experiences with their patients' dying and death. METHODS: A qualitative visual analysis was conducted on 75 images created by physicians completing a one year palliative medicine fellowship. These images are part of a larger personal reflections narratives database of images, text, and auditory projects prepared by students, interns, and fellows completing training in palliative care at a large hospice provider. Participation in the personal reflections project is a required part of the training program, with the goal of blending clinical competencies with lived experiences of caring for the dying. RESULTS: Two categories of visual metaphors underlying the images were identified, with both expressing the relationship and transitional dynamics of life and death: portraits (n = 30, 40%) and nature (n = 45, 60%). Conventional images representing anxiety, pain, or other dimensions of suffering commonly associated with death and dying were virtually absent (n = 2, 0.03%). CONCLUSION: We propose the communication of positive, hopeful, even peaceful perceptions of death and dying was likely the result of effective personal and professional skills gained through physicians' clinical experiences during the fellowship.

Apuntes metodológicos para el análisis narrativo de datos visuales en psicología / Methodological Notes to Narrative Analysis of Visual Data on Psychology

Este artículo presenta una exploración metodológica sobre el análisis de narrativas visuales en la investigación psicológica. Tiene como base el análisis contextualizado del material audiovisual producido en una intervención psicoeducativa en una escuela de la región metropolitana de Barcelona, donde la producción colaborativa de películas ha sido una herramienta fundamental para la producción de una discusión sobre las identidades de los participantes y sobre su escolaridad. Se pretende discutir algunos aspectos metodológicos acerca de la construcción de un referencial para el análisis del material audiovisual, bajo una perspectiva dialógica con énfasis en el marco teórico de la Psicología Cultural.

This article presents a methodological reflection on the analysis of visual narratives in psychological research. The present study is based on contextual analysis of the audiovisual material produced in a psychoeducational intervention in a school in the metropolitan region of Barcelona, where the collaborative production of films has shown itself as a fundamental tool for the production of a discussion about the identity constructions of the participants as about their schooling too. It is here intended to discuss some methodological aspects of the construction of a benchmark for the analysis of audiovisual material in a dialogical perspective with emphasis on the theoretical framework of Cultural Psychology.