Graphical integrity issues in open access publications: Detection and patterns of proportional ink violations.

Academic graphs are essential for communicating complex scientific ideas and results. To ensure that these graphs truthfully reflect underlying data and relationships, visualization researchers have proposed several principles to guide the graph creation process. However, the extent of violations of these principles in academic publications is unknown. In this work, we develop a deep learning-based method to accurately measure violations of the proportional ink principle (AUC = 0.917), which states that the size of shaded areas in graphs should be consistent with their corresponding quantities. We apply our method to analyze a large sample of bar charts contained in 300K figures from open access publications. Our results estimate that 5% of bar charts contain proportional ink violations. Further analysis reveals that these graphical integrity issues are significantly more prevalent in some research fields, such as psychology and computer science, and some regions of the globe. Additionally, we find no temporal and seniority trends in violations. Finally, apart from openly releasing our large annotated dataset and method, we discuss how computational research integrity could be part of peer-review and the publication processes.

A Picture Is Worth a Thousand Views: A Triple Crossover Trial of Visual Abstracts to Examine Their Impact on Research Dissemination.

BACKGROUND: A visual abstract is a graphic summary of a research article's question, methods, and major findings. Although they have a number of uses, visual abstracts are chiefly used to promote research articles on social media. OBJECTIVE: This study aimed to determine if the use of visual abstracts increases the visibility of nephrology research shared on Twitter. METHODS: A prospective case-control crossover study was conducted using 40 research articles published in the American Journal of Nephrology (AJN). Each article was shared by the AJN Twitter account in 3 formats: (1) the article citation, (2) the citation with a key figure from the article, and (3) the citation with a visual abstract. Tweets were spaced 2 weeks apart to allow washout of the previous tweet, and the order of the tweets was randomized. Dissemination was measured via retweets, views, number of link clicks, and Altmetric scores. RESULTS: Tweets that contained a visual abstract had more than twice as many views as citation-only tweets (1351, SD 1053 vs 639, SD 343) and nearly twice as many views as key figure tweets (1351, SD 1053 vs 732, SD 464). Visual abstract tweets had 5 times the engagements of citation-only tweets and more than 3.5 times the engagements of key figure tweets. Visual abstract tweets were also associated with greater increases in Altmetric scores as compared to citation-only tweets (2.20 vs 1.05). CONCLUSIONS: The use of visual abstracts increased visibility of research articles on Twitter, resulting in a greater number of views, engagements, and retweets. Visual abstracts were also associated with increased Altmetric scores as compared to citation-only tweets. These findings support the broader use of visual abstracts in the scientific community. Journals should consider visual abstracts as valuable tools for research dissemination.

Construction and validation of an educational gerontotechnology on frailty in elderly people.

OBJECTIVE: to construct and validate an educational gerontechnology on frailty in elderly people. METHOD: a methodological study developed in three stages: educational video construction, validation by expert judges and elderly people. Validation was carried out by 22 judges and 22 elderly people. Educational Content Validation Instrument was used for judges and questions adapted from the Suitability Assessment of Materials questionnaire for elderly people. For validation, agreement criterion greater than 80% was considered, verified using Content Validation Index and binomial test. RESULTS: the video addresses recommendations for elderly people at risk of frailty and health-promoting habits, using cordel literature. An agreement greater than 80% was verified in all items assessed by judges and the target audience. CONCLUSION: the video proved to be valid in terms of content and appearance by judges and elderly people, with the potential to mediate health-promoting educational practices in healthy aging.

Identificación de patrones instruccionales de mediación relacionados con progresos en comprensión lectora en contextos de desventaja sociocultural / Identifying instructional mediation patterns related with progress in reading comprehension in contexts of sociocultural disadvantage

Identificar factores instruccionales específicos relacionados con progresos en comprensión lectora es esencial para optimizar el aprendizaje y orientar la intervención, especialmente en contextos de desventaja socio-cultural o dificultades de aprendizaje. Este estudio pretende identificar patrones instruccionales de mediación eficaces en la explicación del progreso en comprensión. Se grabaron, transcribieron y analizaron sistemáticamente 82 sesiones-clase, y se registraron pautas de mediación relativas a diferentes procesos lectores. Los patrones de mediación fueron analizados mediante codificación y categorización del contenido con el programa Maxqdea-7. Fueron consideradas 19 categorías, que aglutinaron 178 unidades de información significativas (pautas/conductas de mediación). La muestra estuvo compuesta por 21 docentes y 821 estudiantes de tercero a octavo grado de Educación Básica de escuelas públicas de Chile ubicadas en contextos de-privados socialmente. El progreso lector se midió con la prueba estandarizada CL-PT, aplicada al principio y al final del curso escolar. Los resultados permitieron identificar pautas específicas de mediación significativas en la explicación del progreso, especialmente el patrón M_17 (Mediación del uso de estrategias para la activación e integración de conocimientos previos) explicaba el 26% de la varianza (r = .55, p < .01; R2ajustado = .26, F (1, 19) = 8.19, p = .01). Se discuten las implicaciones educativas de estos resultados

Identifying specific instructional factors related to progress in reading comprehension is essential to optimize learning and guide intervention, especially in contexts of sociocultural disadvantage or learning difficulties. This study aims to identify effective mediational instructional patterns in the explanation of progress in reading comprehension. Teaching guidelines were systematically recorded in relation to different reading processes. Eighty-two sessions were recorded, transcribed and analyzed by coding and categorizing the content of the sessions through the Maxqdea-7 program. Nineteen categories were considered, which comprised 178 significant units of information (mediation guidelines). The sample consisted of 21 teachers and 821 students from third to the eighth grade of public schools of Chile located in deprived contexts. Reading progress was measured with the standardized CL-PT test, which was applied at the beginning and end of the school year. The results have allowed identifying mediation patterns with a significant relevance in the explanation of reading progress, especially the pattern M_P17 (Mediation of the use of strategies for the activation and integration of previous knowledge) managed to explain 26% of the variance in the progress (r = .55, p < .01; R2adjusted = .26, F(1, 19) = 8.19, p = .01). The educational implications of these results are discussed

The scale of COVID-19 graphs affects understanding, attitudes, and policy preferences.

Mass media routinely present data on coronavirus disease 2019 (COVID-19) diffusion with graphs that use either a log scale or a linear scale. We show that the choice of the scale adopted on these graphs has important consequences on how people understand and react to the information conveyed. In particular, we find that when we show the number of COVID-19 related deaths on a logarithmic scale, people have a less accurate understanding of how the pandemic has developed, make less accurate predictions on its evolution, and have different policy preferences than when they are exposed to a linear scale. Consequently, merely changing the scale the data is presented on can alter public policy preferences and the level of worry about the pandemic, despite the fact that people are routinely exposed to COVID-19 related information. Providing the public with information in ways they understand better can help improving the response to COVID-19, thus, mass media and policymakers communicating to the general public should always describe the evolution of the pandemic using a graph on a linear scale, at least as a default option. Our results suggest that framing matters when communicating to the public.

Visual Elicitation: Methods for Enhancing the Quality and Depth of Interview Data in Applied Qualitative Health Research.

Generating rich data from interviews for a qualitative study can be difficult to operationalize; especially when difficulties establishing rapport, power imbalances, and participant factors threaten the interview process and quality of data. The aim of this methods article is to (a) discuss the value of incorporating visual elicitation tools or tasks within semistructured or in-depth qualitative interviews to enhance the depth of data generated and (b) provide a specific example of how this is planned and executed within the context of an applied qualitative health research study.

The Precision-Bias Distinction for Evaluating Visual Decision Aids for Risk Perception.

Risk communication is critically important, for both patients and providers. However, people struggle to understand risks because there are inherent biases and limitations to reasoning under uncertainty. A common strategy to enhance risk communication is the use of decision aids, such as charts or graphs, that depict the risk visually. A problem with prior research on visual decision aids is that it used a metric of performance that confounds 2 underlying constructs: precision and bias. Precision refers to a person's sensitivity to the information, whereas bias refers to a general tendency to overestimate (or underestimate) the level of risk. A visual aid is effective for communicating risk only if it enhances precision or, once precision is suitably high, reduces bias. This article proposes a methodology for evaluating the effectiveness of visual decision aids. Empirical data further illustrate how the new methodology is a significant advancement over more traditional research designs.

Impact of Audiovisual-Assisted Therapeutic Ambience in Radiation Therapy (AVATAR) on Anesthesia Use, Payer Charges, and Treatment Time in Pediatric Patients.

PURPOSE: Pediatric radiation therapy (RT) requires optimal immobilization that often necessitates daily anesthesia. To decrease anesthesia use, we implemented a novel audiovisual-assisted therapeutic ambience in RT (AVATAR) system that projects video onto a radiolucent screen within the child's line of vision to provide attentional diversion. We investigated its reduction on anesthesia use, payer charges, and treatment time, in addition to its impact on radiation delivery. METHODS AND MATERIALS: A 6-year retrospective analysis was performed among children undergoing RT (n = 224) 3 years before and 3 years after the introduction of AVATAR. The frequency of anesthesia use before and after AVATAR implementation, in addition to RT treatment times, were compared. The number of spared anesthesia treatments allowed for a charge to payer analysis. To document the lack of surface dose perturbation by AVATAR, a phantom craniospinal treatment course was delivered both with and without AVATAR. Additionally, an ion chamber course was delivered to document changes to the dose at depth. RESULTS: More children were able to avoid anesthesia use entirely in the post-AVATAR cohort compared with the pre-AVATAR cohort (73.2% vs 63.4%; P = .03), and fewer required anesthesia for each treatment (18.8% vs 33%; P = .03). AVATAR introduction reduced anesthesia use for all ages studied. Treatment time per session was reduced by 38% using AVATAR compared with anesthesia. There were 326 fewer anesthesia sessions delivered over 3 years after AVATAR was introduced, with an estimated savings of >$500,000. Optically stimulated luminescent dosimeters revealed a small increase in dose of 0.8% to 9.5% with AVATAR, whereas the use of a thermomolded face mask increased skin dose by as much as 58%. CONCLUSIONS: AVATAR introduction decreased anesthesia use in children undergoing RT. More children avoided anesthesia entirely, and fewer needed anesthesia for every treatment, resulting in a reduction in treatment time and savings of nearly $550,000 in approximately 3 years, with minimal perturbation of RT dose delivery.

Cost Analysis of Audiovisual-Assisted Therapeutic Ambiance in Radiation Therapy (AVATAR)-Aided Omission of Anesthesia in Radiation for Pediatric Malignancies.

PURPOSE: Because children cannot reliably remain immobile during radiation therapy (RT) for cancer anatomy targeting requiring millimeter precision, daily anesthesia plays a large role in each RT session. Unfortunately, anesthesia is a source of financial burden for patients' families and is invasive and traumatic. This study attempts to assess the cost-savings benefit of audiovisual-assisted therapeutic ambiance in radiation therapy (AVATAR)-aided omission of pediatric anesthesia in RT. METHODS AND MATERIALS: The baseline time of anesthesia during RT was derived from documented anesthesia billing time during RT simulation at our institution and from the published literature. Current Procedural Terminology and relative value unit codes encompassing anesthesia-related charges from radiation oncology and anesthesia were analyzed in concert with this value to calculate the total cost of pediatric anesthesia per RT session. RESULTS: The mean number of RT fractions administered per patient with AVATAR-directed anesthesia omission at our institution was 19.0, similar to the 17.6 previously reported. At a mean anesthesia time exceeding 30 minutes (with mean RT duration of 4 weeks), the cost of pediatric anesthesia per RT fraction in non-AVATAR sessions was $1,904.35, yielding a total RT treatment anesthesia cost of $38,087.00 per patient (including simulation). Patients at our institution were not billed for AVATAR-assisted RT. CONCLUSIONS: The ability of AVATAR to obviate the need for daily anesthesia in pediatric RT provides substantial cost-savings. These findings argue for increased utilization of AVATAR and for analyses of RT targeting the accuracy of AVATAR versus conventional anesthesia-guided treatment of pediatric malignancies.

Does Animation Improve Comprehension of Risk Information in Patients with Low Health Literacy? A Randomized Trial.

Introduction. Enhanced visual effects, like animation, have the potential to improve comprehension of probabilistic risk information, particularly for those with lower health literacy. We tested the effect of presentation format on comprehension of colorectal cancer (CRC) screening probabilities to identify optimal risk communication strategies. Methods. Participants from a community foodbank and a cancer prevention center were randomized to 1 of 3 CRC screening risk presentations. The presentations used identical content but varied in format: 1) video with animated pictographs, 2) video with static pictographs, and 3) audiobooklet with static pictographs. Participants completed pre- and postpresentation surveys. The primary outcome was knowledge of probability/risk information regarding CRC screening, calculated as total, verbatim, and gist scores. Results. In total, 187 participants completed the study and were included in this analysis. Median age was 58 years (interquartile range [IQR]: 14 years), most participants were women (63%), and almost half had a high school education or less (46%). Approximately one-quarter had inadequate health literacy (Short Test of Functional Health Literacy in Adults marginal/inadequate: 28%; Brief Health Literacy Screener low: 18%), and about half had low numeracy (Subjective Numeracy Scale low: 54%; Graphical Literacy Measure low: 50%). We found no significant differences in total, verbatim, or gist knowledge across presentation formats (all P > 0.05). Discussion. Use of an animated pictograph to communicate risk does not appear to augment or impede knowledge of risk information. Regardless of health literacy level, difficulty understanding pictographs presenting numerical information persists. There may be a benefit to teaching or priming individuals on how to interpret numerical information presented in pictographs before communicating risk using visual methods. Trial Registry: NCT02151032.

The art of consent: visual materials help adult patients make informed choices about surgical care.

Supporting patients in making informed healthcare decisions is a cornerstone of ethical medical practice. Surgeons frequently draw for and show images to patients when consenting them for operations but the value of this practice in informed decision-making is unclear. An audit was conducted in a General Surgery Department. 244 patients completed questionnaires on the value of visual materials when giving consent for surgery. The complexity of the operations was classified into "simple", "moderate" or "complex". 100% of patients felt they had given informed consent to surgery. 62% of patients received at least one form of visual material during the consenting process. All patients who received a drawing, and 99% of those provided with other images, valued these resources. Visual materials were considered more useful to patients when giving consent for moderate or complex operations than simple ones. Approximately one third of patients who did not receive visual materials would have appreciated these when making an informed decision. This research highlights the value of surgeons drawing for, and providing other visual resources to, their patients as part of the consent process. There is a role for further research and training materials in drawing skills for surgeons.

Me dirijo a usted para hacerle llegar un aporte actual junto con algunos comentarios a propósito del artículo «Psicopro-filaxis quirúrgica audiovisual en cirugía general pediátrica: ¿Podemos disminuir la ansiedad del niño y de su familia?»firmado por la Dra. Natalia Álvarez y colaboradores, que ha sido publicado en Cirugía Pediátrica, número 30 de 2017... [carta al director] / No disponible

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Helping Hispanic Family Caregivers of Persons With Dementia "Get the Picture" About Health Status Through Tailored Infographics.

BACKGROUND AND OBJECTIVES: Caregivers need to understand their health status and the disabilities of the care recipient to engage in effective health management. Infographics tailored with personal health data are a promising approach to facilitating comprehension, particularly for individuals with low health literacy/limited English proficiency. Such approaches may be especially important for dementia caregivers given the high care burden. RESEARCH DESIGN AND METHODS: Guided by the Health Belief Model and the Data-Frame Theory of Sensemaking, we conducted iterative participatory design sessions with Hispanic family caregivers (N = 16) of persons with dementia. We created multiple prototype infographic designs to display scores on validated instruments of topics such as caregiving burden, overall health, and psychological distress. We retained and refined designs participants judged to be easily comprehensible. Analysis focused on identifying the graphical elements that contributed to the comprehensibility of designs and on evaluating participants' reactions to the designs. RESULTS: Successful infographics used intuitive scaling consistent with caregivers' perspective of dementia as inevitable decline. Participants reacted to infographics by describing the self-management actions they would take to address the health issue at hand. DISCUSSION AND IMPLICATIONS: Tailored infographics supported caregivers' comprehension of their health status and served as cues to engaging in self-management. As such, they should be presented in the context of informational support that can facilitate selection of appropriate next steps. This can mitigate the potential mental and physical health consequences of caregiving and enable caregivers to continue to care for their relatives with dementia with less damage to their own well-being.

Improving patients' ability to identify their physicians through the use of physician facecards and whiteboards.

Background: Hospitalised patients are often not able to correctly identify members of their physician team. Identifying physicians is a critical component of developing the patient-physician relationship and visual aids have been shown to improve physician identification and overall patient satisfaction. Objectives: The aim of this quality improvement study was to assess the impact of implementation of a physician facecard on the ability of patients to identify their attending physician and other members of the physician team, as well as to evaluate current use of patient whiteboards for physician team identification. Methods: We prospectively studied 149 patients admitted to the medicine teaching service, who were randomised to receive a physician facecard or usual care. Patients were surveyed to determine their ability to identify physician team members. Observational data was also collected regarding use of patient whiteboards. Additionally, all hospitalists were surveyed to assess their perception of these visual aids. Results: Patients who received the facecard were more likely to recall the name of the attending physician as compared with the control group (63% vs 32%, p<0.01). Additionally, 68% of patients with the attending name correctly listed on their whiteboard were able to correctly identify the attending physician (p<0.01). Ninety per cent of patients who both received a facecard and had their whiteboard correctly filled out were able to identify the attending physician. Eighty per cent of hospitalists surveyed agreed that use of the facecard added value and 90% disagreed that routine use of the facecard was burdensome. Conclusion: The use of physician facecards improves the ability of hospitalised patients to identify their attending physicians, and the combined use of facecards and whiteboards may provide additive benefits.

Conflict of interest disclosure slides at the European Society of Cardiology Congress 2016 in Rome: are they displayed long enough to assess their content? A cross-sectional study.

OBJECTIVES: To assess the duration of display of conflict of interest (COI) disclosure slides of presentations at the European Society of Cardiology (ESC) Congress 2016, and to identify factors associated with the duration of display of the disclosure slide. DESIGN: Cross-sectional observational study. OUTCOME MEASURES: Display duration of the COI disclosure slide and display duration per disclosure. RESULTS: Analysis of official video recordings of all oral presentations, viewed on the ESC website. 1673 oral presentations were analysed. In 706 presentations (42.2%), COIs were present on the disclosure slide. The median display duration of the disclosure slide was 2.49 s (minimum value: 0.16 s; IQR 1.47-4.08). In multivariable analysis, time spent on COI disclosures was positively related to the number of COIs (+0.11 s per extra COI), older estimated age of the speaker (+3.92 s for 75-85 years compared with <25 years), verbally commenting on disclosures (up to +8.25 s) and disclosures being of a non-commercial nature (+2.83 s). In addition, speakers from Eastern, Southern and Western Europe, Africa+East Asia and Asia showed their disclosures significantly shorter than the reference group (Northern Europe). CONCLUSION: COI disclosure slides are often displayed too briefly to reasonably assess their content. Several factors appear to influence the duration of display of the COI disclosure slides, but none do so to the degree that the display duration becomes sufficiently long.

Picture This: Presenting Longitudinal Patient-Reported Outcome Research Study Results to Patients.

BACKGROUND: Patient-reported outcome (PRO) results from clinical trials and research studies can inform patient-clinician decision making. However, data presentation issues specific to PROs, such as scaling directionality (higher scores may represent better or worse outcomes) and scoring strategies (normed v. nonnormed scores), can make the interpretation of PRO scores uniquely challenging. OBJECTIVE: To identify the association of PRO score directionality, score norming, and other factors on a) how accurately PRO scores are interpreted and b) how clearly they are rated by patients, clinicians, and PRO researchers. METHODS: We electronically surveyed adult cancer patients/survivors, oncology clinicians, and PRO researchers and conducted one-on-one cognitive interviews with patients/survivors and clinicians. Participants were randomized to 1 of 3 line graph formats showing longitudinal change: higher scores indicating "better," "more" (better for function, worse for symptoms), or "normed" to a population average. Quantitative data evaluated interpretation accuracy and clarity. Online survey comments and cognitive interviews were analyzed qualitatively. RESULTS: The Internet sample included 629 patients, 139 clinicians, and 249 researchers; 10 patients and 5 clinicians completed cognitive interviews. "Normed" line graphs were less accurately interpreted than "more" (odds ratio [OR] = 0.76; P = 0.04). "Better" line graphs were more accurately interpreted than both "more" (OR = 1.43; P = 0.01) and "normed" (OR = 1.88; P = 0.04). "Better" line graphs were more likely to be rated clear than "more" (OR = 1.51; P = 0.05). Qualitative data informed interpretation of these findings. LIMITATIONS: The survey relied on the online platforms used for distribution and consequent snowball sampling. We do not have information regarding participants' numeracy/graph literacy. CONCLUSIONS: For communicating PROs as line graphs in patient educational materials and decision aids, these results support using graphs, with higher scores consistently indicating better outcomes.

Audiovisual interventions for parental preoperative anxiety: A systematic review and meta-analysis.

OBJECTIVE: To systematically review and meta-analyze studies assessing the effectiveness of audiovisual (AV) interventions aimed at reducing anxiety in parents whose children are undergoing elective surgery. METHODS: A comprehensive search of multiple electronic databases was performed. A narrative synthesis of findings and random-effects meta-analyses were used to summarize the results. Our primary outcome was parental anxiety. Secondary outcomes included children's preoperative anxiety and postoperative outcomes; parental satisfaction, knowledge, and need for anesthesia information. Risk of bias was appraised within and across studies. RESULTS: Our search yielded 723 studies and 11 were included. A Standardized Mean Difference (SMD) of -0.53 (95% CI [-0.91, -0.15], p < .01) was found between parental anxiety scores in AV interventions and control groups. In terms of children's preoperative anxiety, there was a SMD of -0.59 (95% CI [-1.11, -0.07], p < .05) between children's anxiety scores in AV intervention and nonintervention participants. Furthermore, AV interventions were shown to shorten the recovery time for children undergoing surgery (SMD = -0.21; 95% CI [-0.39, -0.02], p = .03) but did not lead to improvements on other postoperative outcomes. CONCLUSIONS: These findings suggest that AV interventions have modest, positive effects on both parental and children's preoperative anxiety. Although a statistically significant medium size effect was detected, the clinical significance of this finding requires further exploration. Further research aimed at developing better AV interventions to help guide future practice is warranted. (PsycINFO Database Record