Illness beliefs relation to physical activity and quality of life in patients with peripheral arterial disease.

Intermittent claudication is the most common symptom of Peripheral Arterial Disease (PAD) and is associated with decreased quality of life (QoL) due to walking impairment. The level of threat attributed to the disease affects QoL and physical activity. This study explores beliefs and illness drawings, and their relationship with quality of life and physical activity in patients undergoing conservative treatment for PAD. A cross-sectional study was carried out including 119 patients with PAD and Intermittent Claudication, in which patients were asked to freely draw their disease and 33 agreed to participate. The profile of beliefs about PAD is characterized by a low level of threat. Belief in the emotional impact of the disease, representations about the consequences and concern about the disease were associated with worse quality of life; the belief of having a high personal control over the disease was associated with more physical activity. The analysis of the disease drawings revealed three categories: extension of the disease (category 1), location and representations of the disease (category 2), and level of detail and complexity of the drawings (category 3). Greater disease extent was associated with more disease symptoms (IPQ 6) (rs = 0.399, p = .021). It is necessary to address beliefs and representations about the disease in consultations with patients with PAD. Patient drawings are a useful, practical, and free tool that does not require a lot of time and can facilitate the approach of health professionals to patient training and education.

Perceptions and Expectations of Youth Regarding the Respect for Their Rights in the Hospital.

Information obtained from children themselves regarding the characteristics of the ideal hospital that ensure well-being during a hospital stay is scarce. Here, we report the opinions, perceptions, and expectations of 700 children and adolescents about their experiences, assessed through a mixed-method research approach with age-appropriate questionnaires, three open-ended questions, and an analysis of optional pictorial and textual narratives. Most children indicated that, while they acknowledged the expertise of hospital staff, they also noted several shortcomings, e.g., insufficiently understandable medical information as well as emotional and cognitive support. The continuity of schooling and the right to suffer as little as possible were also critical issues. Adolescents valued in particular the quality of care and services provided, the hospital's adherence to equality and non-discrimination rights, and protection systems but negatively perceived several aspects related to play and participation. Significant differences in the co-occurrences of the most frequently used text terms with the keywords "hospital" and "child/adolescent" between age groups highlight variations in the way patients perceive and articulate their experiences within the hospital setting depending on the cognitive processes linked to age. In drawings, prevailing attention was placed on the physical context of the hospital room, with figures expressing mostly negative emotions. Specifically, in this regard, the main emotion in children was sadness, and, in adolescents, it was fear. Overall, these insights are pivotal in the context of our research objectives as they shed light on the nuanced preferences, needs, and perspectives of children and adolescents during their hospital stays. Recognizing the identified shortcomings, we propose recommendations emphasizing the improvement of medical communication clarity, enhancement of emotional and cognitive support, and the improvement of programs to avoid instructional gaps during hospital stays. Addressing these specific needs is critical for a more comprehensive approach to pediatric healthcare provision.

Psychological factors are associated with pain extent in patients with carpal tunnel syndrome.

INTRODUCTION: Widespread pain may be related to psychosocial aspects in several musculoskeletal conditions, but the literature on carpal tunnel syndrome (CTS) is scarce. OBJECTIVE: To determine the relationship between pain extent and psychological factors (catastrophizing, kinesiophobia, anxiety symptoms, and depression) in people with CTS. METHODS: A cross-sectional study was conducted. The independent variables were: pain intensity, disability (QuickDASH), duration of symptoms, anxiety and depressive symptoms, catastrophizing, and kinesiophobia. The main outcome was: pain extent (% of total area and categories "pain within the median nerve-innervated territory" versus "extra-median nerve pain"). Correlation analysis was performed using Spearman's correlation coefficient. A linear regression model and binary logistic regression (both with forward selection) were performed to determine the main predictors of pain extent. RESULTS: Forty-eight participants were included. A moderate positive correlation was found between catastrophizing (r = 0.455; p = 0.024) and disability (r = 0.448; p = 0.024) with total pain extent area. Regression models indicated that catastrophizing explained 22% of the variance in the pain extent (ß = 0.003; 95% CI: 0.002-0.005), while kinesiophobia was the variable that best explained the distribution of pain in the extra-median territory (R2 Nagelkerke = 0.182). Null or weak correlations were found for the rest of the associations. CONCLUSION: Catastrophizing and kinesiophobia were the main indicators of pain extent in people with CTS. Clinicians are advised to use specific questionnaires to check for the presence of catastrophizing or kinesiophobia in people with CTS and wider pain extension.

Digital mapping of shoulder pain in patients with shoulder disorders: a reliability study.

INTRODUCTION: Digital body mapping can be used to document and quantify the area and location (distribution) of pain and discomfort and support assessment, monitoring, and treatment in clinical populations. This study determines the test-retest reliability of drawings detailing pain and pins and needles using digital body charts and their relationship to pain intensity and patient-reported shoulder function. METHODS: Sixty-two participants with shoulder disorder completed pain and pins and needles drawings with test-retest interval of 30 minutes. Pain intensity in the last week and the patient-reported shoulder function questionnaires were completed. Area and radiating extent were determined using customized software. To assess relative and absolute test-retest reliability, the intraclass correlation coefficient (ICC3,1), standard error of measurement (SEM) and minimal detectable change (MDC95) were calculated. Regression analysis evaluated relation between area and radiating extent of pain and pins and needles with patient-reported function questionnaires. RESULTS: Relative reliability for pain area and radiating extent was excellent (>0.90). Absolute reliability (SEM and MDC95) values for the pain area and radiating extent were 0.20%/34 pixels and 0.57%/94 pixels. Absolute reliability improves for smaller pain areas. Regression analysis revealed the area and radiation extent for both pain and pins and needles are independent constructs to the patient-reported function outcome when adjusted for pain intensity. CONCLUSIONS: Digital body mapping assessing pain area and radiation extent in patients with shoulder disorders are reliable. The magnitude of absolute reliability suggests other sources of variability on repeat testing in this population. Pain area and radiation extent appear to be independent constructs.

Twisted Ways to Find Plane Structures in Simple Drawings of Complete Graphs.

Simple drawings are drawings of graphs in which the edges are Jordan arcs and each pair of edges share at most one point (a proper crossing or a common endpoint). A simple drawing is c-monotone if there is a point O such that each ray emanating from O crosses each edge of the drawing at most once. We introduce a special kind of c-monotone drawings that we call generalized twisted drawings. A c-monotone drawing is generalized twisted if there is a ray emanating from O that crosses all the edges of the drawing. Via this class of drawings, we show that every simple drawing of the complete graph with n vertices contains Ω(n12) pairwise disjoint edges and a plane cycle (and hence path) of length Ω(lognloglogn). Both results improve over best previously published lower bounds. On the way we show several structural results and properties of generalized twisted and c-monotone drawings, some of which we believe to be of independent interest. For example, we show that a drawing D is c-monotone if there exists a point O such that no edge of D is crossed more than once by any ray that emanates from O and passes through a vertex of D.

Aberrant Right and Left Gastric Veins as a Cause of Hepatic Pseudolesions: A Report of Three Cases.

The complex structure of the liver and its elaborate hemodynamics can cause hepatic pseudolesions on contrast-enhanced imaging, making the interpretation of diagnostic liver imaging challenging. Aberrant gastric veins are rare; most of their epidemiology data comes from small single-center studies. While current literature suggests that pseudolesions originating from aberrant gastric veins mainly present as hyperdense defects, some cases can also show up as hypodense, as shown in these cases. Differences in flow rates between the portal and aberrant veins and the timing of the scans could explain this contradiction. Identifying aberrant gastric veins on cross-sectional imaging is crucial because they could be misdiagnosed as liver lesions, granting further unnecessary workups or invasive procedures. Aberrant gastric veins can also act as pathways for the spread of gastric cancer. This manuscript presents one aberrant right gastric vein and two aberrant left gastric veins causing hepatic pseudolesions.

The Psychosocial Effects of the COVID-19 Pandemic on Primary School Children of Health Professionals.

During the COVID-19 pandemic, health professionals had to spend much of their time working in hospitals, which may have caused psychological distress to their children. This study was in the form of a case study pattern, one of the qualitative research methods aimed to identify the psychosocial effects of the COVID-19 pandemic on the primary school children of health professionals. Its sample consisted of health professionals (n = 60) and their children (n = 60), who were all at primary school. Data were collected from the parents using a questionnaire, and from the children by asking them to create drawings and explain them. Descriptive and content analysis were carried out. The findings were grouped under the headings of "Spatial and Social Effects on the Child's Daily Life," "Effects on the Child's Emotions," and "Effects on the Parent From the Child's Perspective." It is recommended that interventions to maintain the psychosocial well-being of children be planned.

"I couldn't see my friends; the internet was bad, and I hardly went out" - insights into children's and adolescents' experiences of COVID-19 in Germany.

PURPOSE: We explored children's experiences of COVID-19 in terms of proximity and distance to significant others. METHODS: Our qualitative study with children in Germany (6-15 years of age) explored their views and experiences of COVID-19 times via drawings and face-to-face semi-structured interviews (n = 13). We analysed data thematically and used the socio-ecological model as the theoretical underpinning. Case studies contextualized how children dealt with the COVID-19 precautions. RESULTS: Salient motives in children's drawings were school scenarios showing distance-keeping and mask-wearing as an expression of interpersonal distance; in the home-schooling context, loneliness was highlighted. Drawings also illustrated the impact of COVID-19 in terms of separation, illness and death. A dynamic perception of proximity and distance emerged from drawings and interviews. COVID-19 barred children from spending "real" time together with close friends. Bridging physical distance virtually was easier for adolescents than for children. CONCLUSION: To bolster children's mental and social resilience in future epidemics, participants' plea for maintaining social and physical interactions with significant others and for keeping schools open should be heeded by policy-makers. Our study also highlights the benefits of conducting direct research with children and using non-verbal methods of data collection.

Drawing as a tool for investigating the nature of imagery representations of blind people: The case of the canonical size phenomenon.

Several studies have shown that blind people, including those with congenital blindness, can use raised-line drawings, both for "reading" tactile graphics and for drawing unassisted. However, research on drawings produced by blind people has mainly been qualitative. The current experimental study was designed to investigate the under-researched issue of the size of drawings created by people with blindness. Participants (N = 59) varied in their visual status. Adventitiously blind people had previous visual experience and might use visual representations (e.g., when visualising objects in imagery/working memory). Congenitally blind people did not have any visual experience. The participant's task was to draw from memory common objects that vary in size in the real world. The findings revealed that both groups of participants produced larger drawings of objects that have larger actual sizes. This means that the size of familiar objects is a property of blind people's mental representations, regardless of their visual status. Our research also sheds light on the nature of the phenomenon of canonical size. Since we have found the canonical size effect in a group of people who are blind from birth, the assumption of the visual nature of this phenomenon - caused by the ocular-centric biases present in studies on drawing performance - should be revised.

Memorability of line drawings of scenes: the role of contour properties.

Why are some images more likely to be remembered than others? Previous work focused on the influence of global, low-level visual features as well as image content on memorability. To better understand the role of local, shape-based contours, we here investigate the memorability of photographs and line drawings of scenes. We find that the memorability of photographs and line drawings of the same scenes is correlated. We quantitatively measure the role of contour properties and their spatial relationships for scene memorability using a Random Forest analysis. To determine whether this relationship is merely correlational or if manipulating these contour properties causes images to be remembered better or worse, we split each line drawing into two half-images, one with high and the other with low predicted memorability according to the trained Random Forest model. In a new memorability experiment, we find that the half-images predicted to be more memorable were indeed remembered better, confirming a causal role of shape-based contour features, and, in particular, T junctions in scene memorability. We performed a categorization experiment on half-images to test for differential access to scene content. We found that half-images predicted to be more memorable were categorized more accurately. However, categorization accuracy for individual images was not correlated with their memorability. These results demonstrate that we can measure the contributions of individual contour properties to scene memorability and verify their causal involvement with targeted image manipulations, thereby bridging the gap between low-level features and scene semantics in our understanding of memorability.

Changing What You Like: Modifying Contour Properties Shifts Aesthetic Valuations of Scenes.

To what extent do aesthetic experiences arise from the human ability to perceive and extract meaning from visual features? Ordinary scenes, such as a beach sunset, can elicit a sense of beauty in most observers. Although it appears that aesthetic responses can be shared among humans, little is known about the cognitive mechanisms that underlie this phenomenon. We developed a contour model of aesthetics that assigns values to visual properties in scenes, allowing us to predict aesthetic responses in adults from around the world. Through a series of experiments, we manipulate contours to increase or decrease aesthetic value while preserving scene semantic identity. Contour manipulations directly shift subjective aesthetic judgments. This provides the first experimental evidence for a causal relationship between contour properties and aesthetic valuation. Our findings support the notion that visual regularities underlie the human capacity to derive pleasure from visual information.

Learning in the forest: environmental perception of Brazilian teenagers.

The idea of separation between person and nature, accentuated by current production and consumption models, has generated unthinkable impacts, causing an unprecedented loss and degradation of the global environment. Occupying 13% of the Brazilian territory, the Atlantic Forest is the second-largest tropical rainforest on the American continent; however, it is one of the most threatened biomes in the world, with only 12% of the original cover. In this study, we consider that enabling young people to experience direct contact with nearby natural environments can positively influence their knowledge and feelings about the biodiversity that occurs there, contributing to its protection and conservation for current and future generations. In this study, we explore how teenagers (n = 17) aged between 13 and 17 years old describe and perceive the nearby natural environment before and after an interpretive trail in Una, Bahia, Brazil. Participants were asked to draw the Atlantic Forest with colored pencils on white paper and, based on the drawing, they answered the following questions: "What is in your drawing? and "What is happening in your drawing?," in addition to other information such as the title of the drawing, difficulty of the activity, and sociodemographic aspects. Content analysis was used to analyze the information collected. From the drawings and responses of the participants, categories related to knowledge, experiences, and types of relationships with the visited place emerged. We count the frequency of drawing elements before and after the visit, together with a qualitative analysis of the descriptions of their feelings and meanings attributed to the visit, highlighting the different elements and their relationships. The results showed that, after the trail, the participants manifested bonds of proximity with the visited environment and the organisms protected there, evidencing expressive changes in their perceptions of the person-nature interaction, in the specific knowledge of the visited ecosystem, and in the different forms of relationship provided by the visitation itinerary.

Perception of risk among children: Exploring the risk of TB-rickettsial disease based on the children's drawing pictures in a Mayan community of Yucatan.

Background: It is important to work on designs of health promotion strategies that involve educational interventions about the risk factors associated to TB-rickettsiosis (Tick-Borne rickettsiosis). Children's drawings provide a window into their thoughts and feelings. The aim was to analyze children's risk perceptions regarding by the presence of ticks in a rural community in southeast Mexico. Methods: The main framework used was a social cognitive perspective under the Health Belief Model. Study was carried out in rural elementary schools and included a drawing contest. A total of 224 children (8-12 years old) participated. Drawings were coded and classified; descriptive trend analysis was performed using counts and percentages. The qualitative data was analyzed by researcher experts in TB- rickettsiosis and using Atlas ti V.8. Results: Results are presented in seven categories that consider environmental elements, actors, and cognitive aspects. The environmental context, 99.1% of the drawings represent sites outside the home (92% include vegetation with the presence of ticks in their immediate external environment). In the actors' category, 69.6% included people carrying out activities (prevention and risk). As for the cognitive aspects, 70% included domestic pets and 13.4% farmyards animals. Conclusion: The children expressed their ideas about risk factors and preventive measures against TB-rickettsiosis with a self-care approach. They acquired knowledge about preventive strategies and clinical symptoms. It is necessary to evaluate what happens after an intervention and how they implement in their lives what they have learned.

Have You Ever Seen a Robot? An Analysis of Children's Drawings Between Technology and Science Fiction.

Technologies have become an essential part of the daily life of our children. Consequently, artifacts that imply the early adoption of abstract thinking affect the imagination of children and young people in relation to the world of technology, now much more than they did in the past. With the emerging importance of robots in many aspects of our everyday lives, the goal of this study is to investigate which mental representations children have about robots. To this end, drawings from 104 children aged between 7 and 12 years old were used as a map of representations, considering the drawings as a proxy capable of evoking learned or emerging mental frameworks. The drawings were analyzed in several steps: they were first labeled using binary descriptors and then classified using clustering methods based on Hamming distances between drawings. Finally, questionnaire items covering children's perceptions about robots were analyzed for each of the resulting cluster separately to identify differences between them. The results show that there are relationships between the way children draw robots and their perception about robots' capabilities as well as their aspirations to pursue a career in science. These findings can provide meaningful insights into how to design educational robots and learning activities for children to learn with and about robots.

What do mathematics lessons look like? Analyses of primary students' drawings.

The use of student drawings to assess their experiences and beliefs about teaching and learning of mathematics has become almost a regular research method - especially when working with young students who may not express themselves well, for example, in self-report questionnaires. These methods, nevertheless, need to be improved regarding their objectivity and validity. By building on the existing research, in this study, we focus on objectivity and validity issues in drawing-based methods. We use a drawing-based instrument: Draw A Mathematics Classroom (DAMC) and present 104 fourth-grade students to draw a picture of their regular mathematics lessons. We especially aim to develop and validate a data coding manual with low-inferent categories; that is, well-operationalizable categories that can be used with high interrater-reliability like the presence of teachers, the arrangement of student desks, and teacher-student interactions. The results reveal that almost half of the participating students perceive their lessons as teacher-centered. The results also confirm the reliability and validity of the methodological approach. For example, in pictures where the teacher is depicted larger than the students, the teacher is also depicted in the center, and students are pictured working alone. Classroom observations support students' perceptions, and all these show that the manual used in this study is useful to getting insights into young students' perceptions of their mathematics classroom.

Use of a short, in-class drawing activity to assess student understanding of core concepts of the cell membrane in an undergraduate physiology course.

Students in an animal physiology course are required to have completed prerequisite cell biology and genetics courses that include discussion of basic properties and functions of the cell membrane. However, while many students remember basic information about membrane structure, they often have difficulty relating that structure to membrane functions, such as vesicular transport, active transport, osmosis, and current flow across the membrane. To better understand what students recall about the cell membrane, students were given an open-ended prompt to draw what they know about the structure and function of the animal cell membrane. This activity was repeated 1-2 weeks after finishing discussion of the cell membrane in class, with an emphasis on the concepts of membrane transport and a related core concept, flow along gradients. Student responses were analyzed using the conceptual framework for the "cell membrane" core concept published by Michael and Modell (Michael J, Modell H. Adv Physiol Educ 43: 373-377, 2019). Before covering this content in class, the majority of submissions included a representation of the cell membrane as a phospholipid bilayer, and a high percentage also included membrane proteins or the fluid mosaic model. Similar percentages of students included these concepts in the postcoverage drawing. However, other components of the conceptual framework were included less frequently or not at all before covering the content in class but improved dramatically afterward. This activity provides information about what students recall from prior coursework and which concepts need to be revisited, and it can provide a complementary assessment of student understanding of the core concept of the cell membrane.NEW & NOTEWORTHY Student-constructed drawings can give insight into student understanding, and misunderstandings, of core concepts about the cell membrane.

Human perception and machine vision reveal rich latent structure in human figure drawings.

For over a hundred years, children's drawings have been used to assess children's intellectual, emotional, and physical development, characterizing children on the basis of intuitively derived checklists to identify the presence or absence of features within children's drawings. The current study investigates whether contemporary data science tools, including deep neural network models of vision and crowd-based similarity ratings, can reveal latent structure in human figure drawings beyond that captured by checklists, and whether such structure can aid in understanding aspects of the child's cognitive, perceptual, and motor competencies. We introduce three new metrics derived from innovations in machine vision and crowd-sourcing of human judgments and show that they capture a wealth of information about the participant beyond that expressed by standard measures, including age, gender, motor abilities, personal/social behaviors, and communicative skills. Machine-and human-derived metrics captured somewhat different aspects of structure across drawings, and each were independently useful for predicting some participant characteristics. For example, machine embeddings seemed sensitive to the magnitude of the drawing on the page and stroke density, while human-derived embeddings appeared sensitive to the overall shape and parts of a drawing. Both metrics, however, independently explained variation on some outcome measures. Machine embeddings explained more variation than human embeddings on all subscales of the Ages and Stages Questionnaire (a parent report of developmental milestones) and on measures of grip and pinch strength, while each metric accounted for unique variance in models predicting the participant's gender. This research thus suggests that children's drawings may provide a richer basis for characterizing aspects of cognitive, behavioral, and motor development than previously thought.

Children's drawings as a projective tool to explore and prevent experiences of mistreatment and/or sexual abuse.

Reality shows us that situations of mistreatment and sexual abuse in childhood are still seldom visible, despite their high prevalence around the world. It is essential to detect and address them, especially among children in situations of dire risk or neglect. The purpose of this study is to determine if graphic emotional indicators are expressed in the drawings of the projective Draw-a-Person (D.A.P) test, made by children in situations of dire risk or neglect. The sample is made up of 34 children, between the ages of 5 and 11 (17 girls and 17 boys), attended by Specialised Child and Adolescent Care Services of the Barcelona Town Hall (Spain). The drawings were coded quantitatively. The results indicated that most of the drawings show a frequency of graphic emotional indicators, as well as graphic indicators common to experiences of mistreatment and/or abuse, which confirm the existence of emotional problems. However, no significant differences based on gender and age were found, except for one indicator of sexual abuse (body omitted/distorted), which is significantly more common in the boys. Results also revealed that the drawings of human figure enable the children to express their experiences of traumatic situations which are difficult to verbalize. These findings have important implications for professionals, as the use of this projective technique can help to early identification and design treatment strategies in situations of mistreatment and/or abuse in children and their families.

A diagnostic support system based on pain drawings: binary and k-disease classification of EDS, GBS, FSHD, PROMM, and a control group with Pain2D.

BACKGROUND AND OBJECTIVE: The diagnosis of rare diseases (RDs) is often challenging due to their rarity, variability and the high number of individual RDs, resulting in a delay in diagnosis with adverse effects for patients and healthcare systems. The development of computer assisted diagnostic decision support systems could help to improve these problems by supporting differential diagnosis and by prompting physicians to initiate the right diagnostic tests. Towards this end, we developed, trained and tested a machine learning model implemented as part of the software called Pain2D to classify four rare diseases (EDS, GBS, FSHD and PROMM), as well as a control group of unspecific chronic pain, from pen-and-paper pain drawings filled in by patients. METHODS: Pain drawings (PDs) were collected from patients suffering from one of the four RDs, or from unspecific chronic pain. The latter PDs were used as an outgroup in order to test how Pain2D handles more common pain causes. A total of 262 (59 EDS, 29 GBS, 35 FSHD, 89 PROMM, 50 unspecific chronic pain) PDs were collected and used to generate disease specific pain profiles. PDs were then classified by Pain2D in a leave-one-out-cross-validation approach. RESULTS: Pain2D was able to classify the four rare diseases with an accuracy of 61-77% with its binary classifier. EDS, GBS and FSHD were classified correctly by the Pain2D k-disease classifier with sensitivities between 63 and 86% and specificities between 81 and 89%. For PROMM, the k-disease classifier achieved a sensitivity of 51% and specificity of 90%. CONCLUSIONS: Pain2D is a scalable, open-source tool that could potentially be trained for all diseases presenting with pain.