Precise Fabrication and Manipulation of Individual Polymer Nanofibers.

Polymer nanofibers hold promise in a wide range of applications owing to their diverse properties, flexibility, and cost effectiveness. In this study, we introduce a polymer nanofiber drawing process in a scanning electron microscope and focused ion beam (SEM/FIB) instrument with in situ observation. We employed a nanometer-sharp tungsten needle and prepolymer microcapsules to enable nanofiber drawing in a vacuum environment. This method produces individual polymer nanofibers with diameters as small as ∼500 nm and lengths extending to millimeters, yielding nanofibers with an aspect ratio of 2000:1. The attachment to the tungsten manipulator ensures accurate transfer of the polymer nanofiber to diverse substrate types as well as fabrication of assembled structures. Our findings provide valuable insights into ultrafine polymer fiber drawing, paving the way for high-precision manipulation and assembly of polymer nanofibers.

Twinning and 9R Phase Transition Mediated Extraordinary Cold-drawn Deformability in NiCoCrFeMo High-Entropy Alloy.

The production and application of materials are evolving towards the low-dimensional micro-nano scale. Nevertheless, the fabrication of micron-scale alloy fibers remains a challenge. Herein, a novel Ni-Co-Cr-Fe-Mo high-entropy alloy (HEA) fiber with a cold-drawn reduction rate of 99.9995% and a strain (ɛ) of 12.19 is presented without requiring intermediate annealing. The exceptional deformation strain of 11.62 within the fiber leads to extraordinary tensile strengths of 2.8 GPa at room temperature and 3.6 GPa at 123 K. The in-depth investigation of the microstructure of fibers has revealed the cold drawing deformation mechanisms mediated by the synergistic effects of plane defects. Specifically, various geometrically necessary dislocation interfaces, such as dislocation walls and microbands, along with deformation twins and long-period 9R structures, form in response to external stress when ɛ≤2.7. As the strain increases, the saturated layered structure emerges and progressively evolves into a 3D equiaxed crystal. Moreover, the formation and evolution of the 9R structure (i.e., the migration of incoherent twin boundaries), coupled with the interaction of partial dislocations and the role of deformation twins, are crucial factors determining the fiber's plastic response. This work provides a novel approach to discovering new high-strength metallic fibers with excellent deformability through plane defects engineering.

Diagnostic accuracy of the Clock Drawing Test in screening for early post-stroke neurocognitive disorder: the Nor-COAST study.

BACKGROUND: Post-stroke neurocognitive disorder, though common, is often overlooked by clinicians. Moreover, although the Montreal Cognitive Assessment (MoCA) has proven to be a valid screening test for neurocognitive disorder, even more time saving tests would be preferred. In our study, we aimed to determine the diagnostic accuracy of the Clock Drawing Test (CDT) for post-stroke neurocognitive disorder and the association between the CDT and MoCA. METHODS: This study is part of the Norwegian Cognitive Impairment After Stroke study, a multicentre prospective cohort study following patients admitted with acute stroke. At the three-month follow-up, patients were classified with normal cognition, mild neurocognitive disorder, or major neurocognitive disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. Any neurocognitive disorder compromised both mild- and major neurocognitive disorder. The CDT at the three-month assessment was given scores ranging from 0 to 5. Patients able to complete the CDT and whose cognitive status could be classified were included in analyses. The CDT diagnostic accuracy for post-stroke neurocognitive disorder was identified using receiver operating characteristic curves, sensitivity, specificity, positive predictive value, and negative predictive value. The association between the MoCA and CDT was analysed with Spearman's rho. RESULTS: Of 554 participants, 238 (43.0%) were women. Mean (SD) age was 71.5 (11.8) years, while mean (SD) National Institutes of Health Stroke Scale score was 2.6 (3.7). The area under the receiver operating characteristic curve of the CDT for major neurocognitive disorder and any neurocognitive disorder was 0.73 (95% CI, 0.68-0.79) and 0.68 (95% CI, 0.63-0.72), respectively. A CDT cutoff of < 5 yielded 68% sensitivity and 60% specificity for any neurocognitive disorder and 78% sensitivity and 53% specificity for major neurocognitive disorder. Spearman's correlation coefficient between scores on the MoCA and CDT was 0.50 (95% CI, 0.44-0.57, p < .001). CONCLUSIONS: The CDT is not accurate enough to diagnose post-stroke neurocognitive disorder but shows acceptable accuracy in identifying major neurocognitive disorder. Performance on the CDT was associated with performance on MoCA; however, the CDT is inferior to MoCA in identifying post-stroke neurocognitive disorder. TRIAL REGISTRATION: ClinicalTrials.gov (NCT02650531). Retrospectively registered January 8, 2016.

DTDO: Driving Training Development Optimization enabled deep learning approach for brain tumour classification using MRI.

A brain tumour is an abnormal mass of tissue. Brain tumours vary in size, from tiny to large. Moreover, they display variations in location, shape, and size, which add complexity to their detection. The accurate delineation of tumour regions poses a challenge due to their irregular boundaries. In this research, these issues are overcome by introducing the DTDO-ZFNet for detection of brain tumour. The input Magnetic Resonance Imaging (MRI) image is fed to the pre-processing stage. Tumour areas are segmented by utilizing SegNet in which the factors of SegNet are biased using DTDO. The image augmentation is carried out using eminent techniques, such as geometric transformation and colour space transformation. Here, features such as GIST descriptor, PCA-NGIST, statistical feature and Haralick features, SLBT feature, and CNN features are extricated. Finally, the categorization of the tumour is accomplished based on ZFNet, which is trained by utilizing DTDO. The devised DTDO is a consolidation of DTBO and CDDO. The comparison of proposed DTDO-ZFNet with the existing methods, which results in highest accuracy of 0.944, a positive predictive value (PPV) of 0.936, a true positive rate (TPR) of 0.939, a negative predictive value (NPV) of 0.937, and a minimal false-negative rate (FNR) of 0.061%.

'Talking lines': the stories of diagnosis and support as told by those with lived experience of rare forms of dementia.

BACKGROUND: People living with, or caring for someone with, rare forms of dementia can encounter issues while obtaining a diagnosis and trying to access appropriate support. This can affect their wellbeing, quality of life, social relationships and employment status. This study makes use of an arts-based narrative approach to explore individual accounts of these experiences whilst also exploring how, in telling their stories, those affected by rare forms of dementia might invoke, and situate their stories in relation to, broader cultural narratives around dementia and illness. METHODS: Semi-structured interviews were conducted via video-conferencing software with participants (N = 27), living with, or caring for someone with, a rare forms of dementia. Participants used line drawings to depict their journey from initial symptoms to the present day, followed by prompts to verbally narrate their experiences. All interview transcripts and line drawings were subjected to narrative analysis. Four sets of transcripts and drawings were then subjected to more in-depth analysis. RESULTS: Analysis shed light on the struggles encountered by both care-partners and people with a diagnosis, while navigating a health and social care system that does not always understand their needs. This often led to individuals feeling isolated and unsupported. Accounts also depicted challenges to identity brought on by the process. The moment of diagnosis was also drawn in a complicated light. Individuals found comfort in gaining understanding, but felt fear at recognising upcoming challenges. Participants situated their own accounts against mainstream cultural narratives around what good support for cognitive impairment and dementia might look like, whilst also demonstrating the influential role they took on in pursuing the right care. CONCLUSIONS: The use of line drawing, alongside narrative interviews, allowed participants to tell complicated, sometimes anachronistic, stories about difficult experiences, whilst also reflecting on, and attaching meaning to, them. These stories highlighted pressing gaps in healthcare services and shone a light on the various pieces of collective action individuals were engaged in in order to improve them. Finally, in modelling some elements of the participants' service provision which were working, the narratives pointed to future directions services might move in.

Children's representation of specialized skilled movements: The cases of snowboarding and aikido.

This article investigates children's graphic representation of two complex motor skills, snowboarding and aikido, from the perspective of drawing flexibility research. In particular, the role of working memory capacity in the development of drawing flexibility is examined. A total of 127 children in the age range 5.7-11.9 years were shown short videos of snowboarding and aikido and were required to make drawings of them. In addition, participants were administered Goodenough's Draw-a-man Test (that measures the ability to draw detail and proportion in the human figure) and two working memory tests (the Mr. Cucumber test and the Backward Digit Span). The snowboarding and aikido drawings were scored for 19 or 13 features, respectively, on which they could differ from the participant's standard drawing of a person. The snowboarding and aikido scores were correlated, also controlling for age and Draw-a-man scores, indicating a common variance for drawing flexibility. The drawing flexibility scores increased with age, and were correlated with working memory capacity, also controlling for age and Draw-a-man scores. These results are consistent with a neo-Piagetian model of drawing flexibility development. Detailed analyses are also provided on children's production of stick figures and "transparencies," and on the relation of each single modified feature with age and working memory capacity.

Drawing as an efficient encoding tool in younger but not always older adults: The case of associative memory.

Episodic memory strongly declines in healthy aging, at least partly because of reduced abilities to create and remember associations (associative memory) and to use efficient memory strategies. Several studies have shown that drawing the to-be-remembered material is a reliable encoding tool to enhance memory of individual items (item memory) because it simultaneously integrates elaborative, pictorial, and motoric processes. These processes in isolation can enhance associative memory in older adults. Nevertheless, their simultaneous impact on associative memory has never been investigated in drawing as an encoding tool. We aimed to investigate whether drawing as an encoding tool not only enhances item memory, but whether its benefit extends to associative memory in younger and older adults. Therefore, we tested 101 older and 100 younger participants in two online experiments and one in-person experiment. Using a memory task for unrelated word-pairs, we compared relational drawing and repeatedly writing (non-relational) as encoding tools and assessed immediate recognition memory of items and associations. In Experiment 2, we additionally assessed recognition memory after 1 week. The findings were consistent across the three experiments: while younger participants benefited from drawing over writing in item and associative memory, older participants benefited in item but not in associative memory. The observed effects remained after 1 week. Thus, we could extend the benefit of drawing to relational drawing in associative memory in younger adults. The lack of benefit in older adults' associative memory might be explained by age-related difficulties in benefiting from memory strategies, and in creating and retrieving associations.

Watching videos of a drawing hand improves students' understanding of the normal probability distribution.

Understanding normal probability distributions is a crucial objective in mathematics and statistics education. Drawing upon cognitive psychology research, this study explores the use of drawings and visualizations as effective scaffolds to enhance students' comprehension. Although much research has documented the helpfulness of drawing as a research tool to reveal students' knowledge states, its direct utility in advancing higher-order cognitive processes remains understudied. In Study 1, qualitative methods were utilized to identify common misunderstandings among students regarding canonical depictions of the normal probability distribution. Building on these insights, Study 2 experimentally compared three instructional videos (static slides, dynamic drawing, and dynamic drawings done by a visible hand). The hand drawing video led to better learning than the other versions. Study 3 examined whether the benefits from observing a hand drawing could be reproduced by a dynamic cursor moving around otherwise static slides (without the presence of a hand). Results showed no significant learning difference between observing a hand drawing and a moving cursor, both outperforming a control. This research links the cognitive process of drawing with its educational role and provides insights into its potential to enhance memory, cognition, and inform instructional methods.

Visuospatial memory in apraxia: Exploring quantitative drawing metrics to assess the representation of local and global information.

Neuropsychological evidence suggests that visuospatial memory is subserved by two separable processing systems, with dorsal underpinnings for global form and ventral underpinnings for the integration of part elements. Previous drawing studies have explored the effects of Gestalt organisation upon memory for hierarchical stimuli, and we here present an exploratory study of an apraxic dorsal stream patient's (MH) performance. We presented MH with a stimulus set (previously reported by Riddoch et al., Cognitive Neuropsychology, 20(7), 641-671, 2003) and devised a novel quantitative scoring system to obtain a finer grain of insight into performance. Stimuli possessed either good or poor Gestalt qualities and were reproduced in a copy condition and two visual memory conditions (with unlimited viewing before the model was removed, or with 3 s viewing). MH's copying performance was impaired in comparison to younger adult and age-matched older adult controls, with a variety of errors at the local level but relatively few at the global level. However, his performance in the visual memory conditions revealed impairments at the global level. For all participants, drawing errors were modulated by the Gestalt qualities of the stimuli, with accuracy at the global and local levels being lesser for poor global stimuli in all conditions. These data extend previous observations of this patient, and support theories that posit interaction between dorsal and ventral streams in the representation of hierarchical stimuli. We discuss the implications of these findings for our understanding of visuospatial memory in neurological patients, and also evaluate the application of quantitative metrics to the interpretation of drawings.

Detecting the veracity of children's experiences through drawings.

Research is lacking regarding adults' ability to determine whether children's drawings are based on an experience or not. Drawings are useful in professional settings to alleviate linguistic demands, facilitate memory, and have been used as evidence. Determining the accuracy of veracity assessments of children's drawings would inform professionals regarding their use as evidence of experiences. Twenty-eight children (14 younger, Mage = 7.53 years, SDage = 1.19; 14 older, Mage = 11.67 years, SD = 1.27) produced drawings of two events: one staged experienced, and one narrative-based not experienced event. Fifty (Study 1, Mage = 23.72 years, SDage = 9.70) and 63 (Study 2, Mage = 25.92, SDage = 12.79) adults indicated whether each drawing was based on experience and their confidence in each assessment. In Study 2, additional drawing quality assessments were collected. Results indicated that adults were more accurate at distinguishing experienced than not experienced drawings for older artists. An inverse relationship was observed between confidence and accuracy-participants were more confident when they were inaccurate, especially for younger artists. Drawing quality improved with age and for drawings of experienced events. Adults tended to rate drawings of higher quality as resulting from experience leading to the highest accuracy for drawings from older artists that were based on experience. Overall, results suggest that there may be some features of drawings that allow for above chance levels of accuracy (up to 75%). However, rates are not high enough across assessments (M = 53.93%, range: 39%-75%) to reliably use them as indicators of experience.

Brain regions supporting retrieval of words drawn at encoding: fMRI evidence for multimodal reactivation.

Memory for words that are drawn or sketched by the participant, rather than written, during encoding is typically superior. While this drawing benefit has been reliably demonstrated in recent years, there has yet to be an investigation of its neural basis. Here, we asked participants to either create drawings, repeatedly write, or list physical characteristics depicting each target word during encoding. Participants then completed a recognition memory test for target words while undergoing functional magnetic resonance imaging (fMRI). Behavioural results showed memory was significantly higher for words drawn than written, replicating the typical drawing effect. Memory for words whose physical characteristics were listed at encoding was also higher than for those written repeatedly, but lower than for those drawn. Voxel-wise analyses of fMRI data revealed two distributed sets of brain regions more active for items drawn relative to written, the left angular gyrus (BA 39) and bilateral frontal (BA 10) regions, suggesting integration and self-referential processing during retrieval of drawn words. Brain-behaviour correlation analyses showed that the size of one's memory benefit for words drawn relative to written at encoding was positively correlated with activation in brain regions linked to visual representation and imagery (BA 17 and cuneus) and motor planning (premotor and supplementary motor areas; BA 6). This study suggests that drawing benefits memory by coactivating multiple sensory traces. Target words drawn during encoding are subsequently remembered by re-engaging visual, motoric, and semantic representations.

Using drawings and deep neural networks to characterize the building blocks of human visual similarity.

Early in life and without special training, human beings discern resemblance between abstract visual stimuli, such as drawings, and the real-world objects they represent. We used this capacity for visual abstraction as a tool for evaluating deep neural networks (DNNs) as models of human visual perception. Contrasting five contemporary DNNs, we evaluated how well each explains human similarity judgments among line drawings of recognizable and novel objects. For object sketches, human judgments were dominated by semantic category information; DNN representations contributed little additional information. In contrast, such features explained significant unique variance perceived similarity of abstract drawings. In both cases, a vision transformer trained to blend representations of images and their natural language descriptions showed the greatest ability to explain human perceptual similarity-an observation consistent with contemporary views of semantic representation and processing in the human mind and brain. Together, the results suggest that the building blocks of visual similarity may arise within systems that learn to use visual information, not for specific classification, but in service of generating semantic representations of objects.

Uncovering the interplay between drawings, mental representations, and arithmetic problem-solving strategies in children and adults.

There is an ongoing debate in the scientific community regarding the nature and role of the mental representations involved in solving arithmetic word problems. In this study, we took a closer look at the interplay between mental representations, drawing production, and strategy choice. We used dual-strategy isomorphic word problems sharing the same mathematical structure, but differing in the entities they mentioned in their problem statement. Due to the non-mathematical knowledge attached to these entities, some problems were believed to lead to a specific (cardinal) encoding compatible with one solving strategy, whereas other problems were thought to foster a different (ordinal) encoding compatible with the other solving strategy. We asked 59 children and 52 adults to solve 12 of those arithmetic word problems and to make a diagram of each problem. We hypothesized that the diagrams of both groups would display prototypical features indicating either a cardinal representation or an ordinal representation, depending on the entities mentioned in the problem statement. Joint analysis of the drawing task and the problem-solving task showed that the cardinal and ordinal features of the diagrams are linked with the hypothesized semantic properties of the problems and, crucially, with the choice of one solving strategy over another. We showed that regardless of their experience, participants' strategy use depends on their problem representation, which is influenced by the non-mathematical information in the problem statement, as revealed in their diagrams. We discuss the relevance of drawing tasks for investigating mental representations and fostering mathematical development in school.

Drawing improves memory in patients with hippocampal damage.

The hippocampus plays a critical role in the formation of declarative memories, and hippocampal damage leads to significant impairments in new memory formation. Drawing can serve as a form of multi-modal encoding that improves declarative memory performance relative to other multimodal encoding strategies such as writing. We examined whether, and to what extent, patients with hippocampal damage could benefit from the mnemonic strategy of drawing. Three patients with focal hippocampal damage, and one patient with both hippocampal and cortical lesions, in addition to 22 age-, sex-, and education-matched controls, were shown a list of words one at a time during encoding and instructed to either draw a picture or repeatedly write each word for 40 s. Following a brief filled delay, free recall and recognition memory for words from both encoding trial types were assessed. Controls showed enhanced recall and recognition memory for words drawn versus those that were written, an effect that was even more pronounced in patients with focal hippocampal damage. By contrast, the patient with both hippocampal and cortical lesions showed no drawing-mediated boost in either recall or recognition memory. These findings demonstrate that drawing is an effective encoding strategy, likely accruing from the engagement of extra-hippocampal processes including the integration of cortical-based motor, visual, and semantic processing, enabling more elaborative encoding.

The drawing effect: Evidence for costs and benefits using pure and mixed lists.

Drawing a referent of a to-be-remembered word often results in better recognition and recall of this word relative to a control task in which the word is written, a pattern dubbed the drawing effect. Although this effect is not always found in pure lists, we report three experiments in which the drawing effect emerged in both pure- and mixed-lists on recognition and recall tests, though the effect was larger in mixed lists. Our experiments then compared drawing effects on memory between pure- and mixed-list contexts to determine whether the larger mixed-list drawing effect reflected a benefit to draw items, a cost to write items, or a combination. In delayed recognition and free-recall tests, a mixed-list benefit emerged for draw items in which memory for mixed-list draw items was greater than pure-list draw items. This mixed-list drawing benefit was accompanied by a mixed-list writing cost compared to pure-list write items, indicating that the mixed-list drawing effect does not operate cost-free. Our findings of a pure-list drawing effect are consistent with a memory strength account, however, the larger drawing effect in mixed lists suggest that participants may also deploy a distinctiveness heuristic to aid retrieval of drawn items.

Better than Goodenough? Evaluating new computational techniques for finding diagnostic structure in children's drawings.

In her 1926 book Measurement of Intelligence by Drawings, Florence Goodenough pioneered the quantitative analysis of children's human-figure drawings as a tool for evaluating their cognitive development. This influential work launched a broad enterprise in cognitive evaluation that continues to the present day, with most clinicians and researchers deploying variants of the checklist-based scoring methods that Goodenough invented. Yet recent work leveraging computational innovations in cognitive science suggests that human-figure drawings possess much richer structure than checklist-based approaches can capture. The current study uses these contemporary tools to characterize structure in the images from Goodenough's original work, then assesses whether this structure carries information about demographic and cognitive characteristics of the participants in that early study. The results show that contemporary methods can reliably extract information about participant age, gender, and mental faculties from images produced over 100 years ago, with no expert training and with minimal human effort. Moreover, the new analyses suggest a different relationship between drawing and mental ability than that captured by Goodenough's highly influential approach, with important implications for the use of drawings in cognitive evaluation in the present day.

Drawing from name in semantic dementia reveals graded object knowledge representations in anterior temporal lobe.

Semantic dementia (SD) is characterized by progressive impairment in conceptual knowledge due to anterior temporal lobe (ATL) neurodegeneration. Extended neuropsychological assessments can quantitatively demonstrate the semantic impairment, but this graded loss of knowledge can also be readily observed in the qualitative observation of patients' recall of single concepts. Here, we present the results of a simple task of object drawing-from-name, by patients with SD (N = 19), who have isolated atrophy of the ATL bilaterally. Both cross-sectionally and longitudinally, patient drawings demonstrated a pattern of degradation in which rare and distinctive features (such as the hump on a camel) were lost earliest in disease course, and there was an increase in the intrusion of prototypical features (such as the typical small ears of most mammals on an elephant) with more advanced disease. Crucially, patient drawings showed a continuum of conceptual knowledge loss rather than a binary 'present' or 'absent' state. Overall, we demonstrate that qualitative evaluation of line drawings of animals and objects provides fascinating insights into the transmodal semantic deficit in SD. Our results are consistent with a distributed-plus-hub model of semantic memory. The graded nature of the deficit in semantic performance observed in our subset of longitudinally observed patients suggests that the temporal lobe binds feature-based semantic attributes in its central convergence zone.

Cerebral Microbleeds in Different Brain Regions and Their Associations With the Digital Clock-Drawing Test: Secondary Analysis of the Framingham Heart Study.

BACKGROUND: Cerebral microbleeds (CMB) increase the risk for Alzheimer disease. Current neuroimaging methods that are used to detect CMB are costly and not always accessible. OBJECTIVE: This study aimed to explore whether the digital clock-drawing test (DCT) may provide a behavioral indicator of CMB. METHODS: In this study, we analyzed data from participants in the Framingham Heart Study offspring cohort who underwent both brain magnetic resonance imaging scans (Siemens 1.5T, Siemens Healthcare Private Limited; T2*-GRE weighted sequences) for CMB diagnosis and the DCT as a predictor. Additionally, paper-based clock-drawing tests were also collected during the DCT. Individuals with a history of dementia or stroke were excluded. Robust multivariable linear regression models were used to examine the association between DCT facet scores with CMB prevalence, adjusting for relevant covariates. Receiver operating characteristic (ROC) curve analyses were used to evaluate DCT facet scores as predictors of CMB prevalence. Sensitivity analyses were conducted by further including participants with stroke and dementia. RESULTS: The study sample consisted of 1020 (n=585, 57.35% female) individuals aged 45 years and older (mean 72, SD 7.9 years). Among them, 64 (6.27%) participants exhibited CMB, comprising 46 with lobar-only, 11 with deep-only, and 7 with mixed (lobar+deep) CMB. Individuals with CMB tended to be older and had a higher prevalence of mild cognitive impairment and higher white matter hyperintensities compared to those without CMB (P<.05). While CMB were not associated with the paper-based clock-drawing test, participants with CMB had a lower overall DCT score (CMB: mean 68, SD 23 vs non-CMB: mean 76, SD 20; P=.009) in the univariate comparison. In the robust multiple regression model adjusted for covariates, deep CMB were significantly associated with lower scores on the drawing efficiency (ß=-0.65, 95% CI -1.15 to -0.15; P=.01) and simple motor (ß=-0.86, 95% CI -1.43 to -0.30; P=.003) domains of the command DCT. In the ROC curve analysis, DCT facets discriminated between no CMB and the CMB subtypes. The area under the ROC curve was 0.76 (95% CI 0.69-0.83) for lobar CMB, 0.88 (95% CI 0.78-0.98) for deep CMB, and 0.98 (95% CI 0.96-1.00) for mixed CMB, where the area under the ROC curve value nearing 1 indicated an accurate model. CONCLUSIONS: The study indicates a significant association between CMB, especially deep and mixed types, and reduced performance in drawing efficiency and motor skills as assessed by the DCT. This highlights the potential of the DCT for early detection of CMB and their subtypes, providing a reliable alternative for cognitive assessment and making it a valuable tool for primary care screening before neuroimaging referral.

Draw & Doodle Simulation: A colorful strategy to prepare medical teams for electronic dance music festival emergencies.

EDUCATIONAL CHALLENGE: Electronic dance music (EDM) festivals - crowded, loud, low-resource environments - pose unique challenges to event medical teams. Simulation can prepare teams to manage clinical presentations in this unconventional context. Without access to simulation infrastructure, a low-technological, low-fidelity simulation modality is warranted. SOLUTION: Draw & Doodle Simulation (D&D SIM) is a low-fidelity simulation where patients are hand-drawn (i.e. on paper, whiteboard, or digitally) instead of utilizing manikins or live actors. Facilitators draw all patient findings, while participants doodle any possible interventions. SOLUTION IMPLEMENTATION: Two D&D SIM cases (serotonin toxicity and refractory anaphylaxis) were piloted in classrooms. Participants included paramedics, medical students, lifeguards, and first aiders. Facilitators conducted simulations using chart paper, with each participant doodling contributions using differently colored markers. LESSONS LEARNED: Participants responded positively, rating the serotonin toxicity case 4.31/5 (n = 13) and refractory anaphylaxis case 4.53/5 (n = 15). Participants appreciated the 'low-stakes', useful 'visual' representation of progress, 'fun and [interactivity]', and appropriate '[realism]' of D&D SIM. However, D&D SIM was perceived as 'less life threatening', would not be appropriate for physical skills (e.g. CPR), required everyone to be 'oriented in the same direction to see the drawing', and the chart paper risked becoming cluttered. NEXT STEPS: Next steps include writing new cases, implementing D&D SIM in other teaching contexts, exploring its use in digital platforms, and studying its effectiveness against higher-fidelity simulation.

Characteristics of drawing deficits in people with aphasia: Differences between symbolic and realistic drawn objects.

BACKGROUND: Pictures drawn by people with aphasia (PWA) are often more challenging to understand than those drawn by healthy people. There are two types of objects: those that tend to be drawn symbolically (symbolically drawn objects-SOs) and those that are likely to be drawn realistically (realistically drawn objects-ROs). AIMS: To compare the identification rate and number of misunderstanding types between SOs and ROs drawn by PWA and healthy controls (HCs). To reveal trends in the misunderstandings of drawings by PWA, and to identify the language or cognitive abilities related to the identification rate of pictures drawn by PWA. METHODS & PROCEDURES: We designed a drawing task involving SOs and ROs. A total of 18 PWA and 30 HCs completed the task, and respondents identified the drawings. The identification rate and number of misunderstandings were analysed with two-way analysis of variance (ANOVA) including group (PWA and HCs) and object type (SOs and ROs). The misunderstandings were divided into four categories varying in semantic and morphological similarity; these ratios were examined with a chi-square test. The relationships of language and cognitive abilities with the identification rate were investigated with multiple regression analyses. OUTCOMES & RESULTS: There was a significant effect of the interaction between group and object type on the identification rate (F(1.1387) = 3.90, Mean Squared Error (MSE) = 4139.67, p = 0.04): the identification rates for ROs were lower in the PWA than in the HCs. For the number of misunderstanding types, an interaction was observed between group and object type (F(1.56) = 8.26, MSE = 26.93, p < 0.01): the number of misunderstanding types for ROs in the PWA was greater than that in the HCs. The misunderstanding patterns differed between ROs and SOs (χ2(3) = 694.30, p < 0.001, V = 0.37). ROs were semantically related, whereas SOs were morphologically related. The identification rates of ROs and SOs were correlated only with Kanji writing scores (ROs: ß = 3.66, p = 0.01; SOs: ß = 6.57, p < 0.01). CONCLUSIONS & IMPLICATIONS: In drawings by the PWA, SOs had a higher identification rate, while ROs had a lower identification rate and a greater variety of misunderstandings. SOs may increase drawing motivation. Interventions to improve the identifiability of SOs and ROs should reflect each character. Identification rates were correlated only with Kanji writing scores. The PWA, whose native language was Japanese and had preserved Kanji writing abilities, and their communication abilities may be increased through drawing. WHAT THIS PAPER ADDS: What is already known on the subject PWA often have impaired drawing abilities and draw pictures that third parties misinterpret. Some objects tend to be drawn symbolically, and some are drawn realistically. However, it is not clear whether there is a difference between these types of drawings depicted by PWA in identifiability and the tendency to be misunderstood by ordinary people. In addition, the relationships between language or cognitive abilities and the identification rate of drawn pictures are not clear. What this paper adds to the existing knowledge The identification rate differed between SOs and ROs. In drawings by PWA, SOs had a higher identification rate, while ROs had a lower identification rate and the greatest variety of misunderstandings. Approximately half of the misunderstandings were related to the target object. SOs tended to be confused with morphologically related objects, while ROs tended to be confused with semantically related objects. Identification rates were correlated only with Kanji writing scores. What are the potential or actual clinical implications of this work? To motivate PWA's drawing, it is suitable to begin with SOs. Examining drawing ability from the perspective of SOs and ROs increases the chance of identifying drawing ability. PWA whose native language is Japanese and have preserved Kanji writing abilities may be able to increase their communication abilities through drawing.