Is a Picture Worth a Thousand Words? A Scoping Review of the Impact of Visual Aids on Patients Undergoing Surgery.

OBJECTIVE: While graphics are commonly used by clinicians to communicate information to patients, the impact of using visual media on surgical patients is not understood. This review seeks to understand the current landscape of research analyzing impact of using visual aids to communicate with patients undergoing surgery, as well as gaps in the present literature. DESIGN: A comprehensive literature search was performed across 4 databases. Search terms included: visual aids, diagrams, graphics, surgery, patient education, informed consent, and decision making. Inclusion criteria were (i) full-text, peer-reviewed articles in English; (ii) evaluation of a nonelectronic visual aid(s); and (iii) surgical patient population. RESULTS: There were 1402 articles identified; 21 met study criteria. Fifteen were randomized control trials and 6 were prospective cohort studies. Visual media assessed comprised of diagrams as informed consent adjuncts (n = 6), graphics for shared decision-making conversations (n = 3), other preoperative educational graphics (n = 8), and postoperative educational materials (n = 4). There was statistically significant improvement in patient comprehension, with an increase in objective knowledge recall (7.8%-29.6%) using illustrated educational materials (n = 10 of 15). Other studies noted increased satisfaction (n = 4 of 6), improvement in shared decision-making (n = 2 of 4), and reduction in patient anxiety (n = 3 of 6). For behavioral outcomes, visual aids improved postoperative medication compliance (n = 2) and lowered postoperative analgesia requirements (n = 2). CONCLUSIONS: The use of visual aids to enhance the surgical patient experience is promising in improving knowledge retention, satisfaction, and reducing anxiety. Future studies ought to consider visual aid format, and readability, as well as patient language, race, and healthcare literacy.

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.

Free Drawing to assess food consumption information in comparison with the Free Listing: An intracultural study in Brazil with adolescents and dairy products.

This study aimed to evaluate the Free Drawing method to assess food consumption information compared to the Free Listing method. Furthermore, the citation frequencies of dairy products consumed by adolescents were compared in Brazilian regions. Adolescents (14-17 years old, n = 265, n = 53 for each region, North, South, Northeast, Midwest, and Southeast regions) listed or drew the dairy products they consumed using Free Listing or Free Drawing. The contingency tables were constructed, and the cognitive saliency indexes (CSI) were calculated. Multiple Factor Analysis (MFA) was performed, and the RV indices were determined. The adolescents listed/drew 55 dairy products, grouped into 10 categories. The Free Listing method resulted in greater citation frequencies of dairy products. The Free Drawing method resulted in richer and more detailed information, with specifications of the type of product consumed within the category, flavor, type of packaging, and brand. The dairy products with the highest citation frequencies/CSI by adolescents were milk, cheese, and fermented milk. The South and Southeast regions observed greater citation frequencies and diversity of dairy products (prevalence in 6 categories). The CSI did not depend on the method, but it was affected by the region (p < 0.05). The sensory methods showed high similarity considering the categories of dairy products (RV = 0.80) and regions (RV = 0.79). It is concluded that the Free Drawing method proved to be an alternative to Free Listing for evaluating adolescents' consumption information of dairy products in an intracultural study in Brazil.

Research on the Influence of Cold Drawing and Aging Heat Treatment on the Structure and Mechanical Properties of GH3625 Alloy.

With the development of the petroleum industry, the demand for materials for oilfield equipment is becoming increasingly stringent. The strength increase brought about by time strengthening is limited in meeting the needs of equipment development. The GH3625 alloy with different strength levels can be obtained through cold deformation and heat treatment processes. A study should be carried out to further develop the potential mechanical properties of GH3625. In this study, the GH3625 alloy was cold drawn with different reductions in area (0-30%) and heat treated, and its mechanical properties were tested. The microstructure of the alloy during deformation and heat treatment was characterized by methods such as optical microscopy (OM), scanning electron microscopy (SEM), and transmission electron microscopy (TEM) based on the principles of physical metallurgy. The strength increase caused by dislocation strengthening was calculated from the dislocation density, tested by X-ray diffraction (XRD). The calculated value was compared to the measured value, elucidating the strengthening effect of cold deformation and heat treatment. The results showed that the yield strength and yield ratio of the cold-drawn alloy significantly reduced after aging at 650 °C and 760 °C. Heat treatment can make a cold-deformed material recover, ablate dislocations, and greatly reduce the dislocation density in the microstructure of the GH3625 alloy, which was the main factor in the decrease in yield strength. The work-hardening gradient of the cold-drawn material varied greatly with different reductions in area. When the reduction in area was small (10%), the hardness gradient was obvious. When it increased to 30%, the alloy was uniformly strengthened as the deformation was transmitted to the axis. This study can provide more mechanical performance options for GH3625 alloy structural components in the petrochemical industry.

Scalable Microwires through Thermal Drawing of Co-Extruded Liquid Metal and Thermoplastic Elastomer.

This article demonstrates scalable production of liquid metal (LM)-based microwires through the thermal drawing of extrudates. These extrudates were first co-extruded using a eutectic alloy of gallium and indium (EGaIn) as a core element and a thermoplastic elastomer, styrene-ethylene/butylene-styrene (SEBS), as a shell material. By varying the feed speed of the co-extruded materials and the drawing speed of the extrudate, it was possible to control the dimensions of the microwires, such as core diameter and shell thickness. How the extrusion temperature affects the dimensions of the microwire was also analyzed. The smallest microwire (core diameter: 52 ± 14 µm and shell thickness: 46 ± 10 µm) was produced from a drawing speed of 300.1 mm s-1 (the maximum attainable speed of the apparatus used), SEBS extrusion speed of 1.50 mm3 s-1, and LM injection rate of 5 × 105 µL s-1 at 190 °C extrusion temperature. The same extrusion condition without thermal drawing generated significantly large extrudates with a core diameter of 278 ± 26 µm and shell thickness of 430 ± 51 µm. The electrical properties of the microwires were also characterized under different degrees of stretching and wire kinking deformation which proved that these LM-based microwires change electrical resistance as they are deformed and fully self-heal once the load is removed. Finally, the sewability of these microwires was qualitatively tested by using a manual sewing machine to pattern microwires on a traditional cotton fabric.

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.

'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 perspective of hope in living with leukemia: A qualitative study using drawing.

PURPOSE: This study aimed to explore children's perspective of hope in living with leukemia through the utilization of drawing-based interview technique. DESIGN AND METHODS: This qualitative study was conducted at the Children's Medical Center in Tehran with the participation of children aged 6 to 12 diagnosed with leukemia. The children were asked to prepare a drawing about hope then interviews were conducted face-to-face with each child after completing the drawing. Data analysis was conducted using the qualitative content analysis. RESULTS: In the collection of a total of 20 drawings from school-age children with leukemia, each drawings has different metaphors symbolizing hope. Five themes emerged including positive thinking, embracing the sanctuary of maternal affection and collective caring, the ethereal glow of joy, the melody of resilient soul, and navigating the way back to home. CONCLUSION: Hope from the child's perspective can be achieved in simple, possible and accessible ways, making it easier for the family, community and healthcare system to inspire hope in their lives with Leukemia. PRACTICE IMPLICATION: Health providers in pediatric oncology can integrate hope-based care interventions related to the factors influencing children's perspectives.

Body weight perceptions among youth from six countries and associations with social media use: Findings from the International Food Policy Study.

BACKGROUND: Body dissatisfaction is associated with poor psychological and physical health, particularly among young people. However, limited data exist on body size perceptions across countries and factors associated with dissatisfaction. OBJECTIVE: This study examined dissatisfaction prevalence and associations with sociodemographics and social media use among youth in six countries. DESIGN: Repeat cross-sectional national online surveys were conducted as part of the 2019 and 2020 International Food Policy Study Youth Survey. PARTICIPANTS: The sample included 21,277 youth aged 10-17 from Australia, Canada, Chile, Mexico, the United Kingdom, and the United States. Youth were recruited to complete the online survey through parents/guardians enrolled in the Nielsen Consumer Insights Global Panel and their partners' panels. MAIN OUTCOME MEASURES: Figural drawing scales assessed self-perceived and ideal body images, with differences between scales representing body dissatisfaction. STATISTICAL ANALYSES PERFORMED: Multinomial logistic regression models examined differences in body dissatisfaction by country, and associations with sociodemographics and either social media 'screen time' or platforms used, including 2-way interactions with country. RESULTS: Overall, approximately 45% of youth reported the same perceived and ideal body sizes, while 35% were 'larger than ideal' (from 33% in Canada and Australia to 42% in Chile) and 20% were 'thinner than ideal' (from 15% in Chile to 22% in Mexico). Greater social media screen time was associated with a higher likelihood of moderate-severe dissatisfaction for being 'thinner than ideal' and at least mild dissatisfaction for being 'larger than ideal' (p<0.003 for all contrasts), with greater dissatisfaction among users of YouTube and Snapchat than non-users (p≤0.005 for both contrasts). Modest differences in body dissatisfaction between countries were observed for age, ethnicity, body mass index, and weight-based teasing. CONCLUSION: Body dissatisfaction is prevalent among youth across diverse countries. These findings highlight the need to promote healthy body image in youth, particularly among social media users.

A Study on Yield Criteria Influence on Anisotropic Behavior and Fracture Prediction in Deep Drawing SECC Steel Cylindrical Cups.

The deep drawing process, a pivotal technique in sheet metal forming, frequently encounters challenges such as anisotropy-induced defects. This study comprehensively investigates the influence of various yield criteria on the anisotropic behavior and fracture prediction in SECC steel cylindrical cups. It integrates Hill'48R, Hill'48S, and von Mises yield criteria in conjunction with Swift's hardening law to evaluate material behavior under complex stress states. Experimental and numerical simulations assess the anisotropy effects across multiple orientations (0°, 45°, and 90°), revealing intricate relationships between stress criteria and material response. The findings indicate significant discrepancies between isotropic and anisotropic models in predicting fracture heights, emphasizing the importance of selecting appropriate yield criteria. Notably, the von Mises criterion results in lower fracture heights, suggesting higher susceptibility to fractures, while the Hill'48R model aligns closely with experimental data, validated through variations in punch corner radius and blank holder force parameters, with a maximum deviation of 3.23%. Hill'48S displays moderate plastic deformation characteristics.

Thermally Drawn-Based Microtubule Soft Continuum Robot for Cardiovascular Intervention.

Cardiovascular disease is becoming the leading cause of human mortality. In order to address this, flexible continuum robots have emerged as a promising solution for miniaturizing and automating vascular interventional equipment for diagnosing and treating cardiovascular diseases. However, existing continuum robots used for vascular intervention face challenges such as large cross-sectional sizes, inadequate driving force, and lack of navigation control, preventing them from accessing cerebral blood vessels or capillaries for medical procedures. Additionally, the complex manufacturing process and high cost of soft continuum robots hinder their widespread clinical application. In this study, we propose a thermally drawn-based microtubule soft continuum robot that overcomes these limitations. The proposed robot has cross-sectional dimensions several orders of magnitude smaller than the smallest commercially available conduits, and it can be manufactured without any length restrictions. By utilizing a driving strategy based on liquid kinetic energy advancement and external magnetic field for steering, the robot can easily navigate within blood vessels and accurately reach the site of the lesion. This innovation holds the potential to achieve controlled navigation of the robot throughout the entire blood vessel, enabling in situ diagnosis and treatment of cardiovascular diseases.

Voluntary Contraction of the Abdominal Muscles Increases Hip Muscle Activation During Lower-Extremity Exercises: A Critically Appraised Topic.

CLINICAL SCENARIO: Existing studies have posited that incorporating abdominal enhancement techniques during lower-extremity exercises might mitigate compensatory pelvic motions and enhance the engagement of specific hip muscles. CLINICAL QUESTION: Does performing lower-extremity exercises with abdominal enhancement techniques increase hip muscle activation levels in healthy individuals? Summary of Key Finding: After the literature review, 4 cross-sectional studies met the inclusion criteria and were included in this critically appraised topic. CLINICAL BOTTOM LINE: There is moderate evidence to support that prone hip extension with abdominal enhancement may increase gluteus maximus and hamstring muscle activity. Gluteus medius activity may not be affected by abdominal enhancement during hip abduction exercises. Strength and Recommendation: The collective findings from the 4 cross-sectional trials indicate that the incorporation of abdominal enhancement techniques during lower-extremity exercises may have the potential to enhance targeted muscle activation levels in healthy individuals. Further research is recommended to establish more robust conclusions.

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.

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.

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.

High-speed spinning of collagen microfibers comprising aligned fibrils for creating artificial tendons.

Bundles of engineered collagen microfibers are promising synthetic tendons as substitutes for autogenous grafts. The purpose of this study was to develop high-speed and continuous spinning of collagen microfibers that involves stretching of collagen stream. Our study revealed the 'critical fibrillogenesis concentration (CFC)' of neutralized collagen solutions, which is defined as the upper limit of the collagen concentration at which neutralized collagen molecules remain stable as long as they are cooled (⩽10 °C). Neutralized collagen solutions at collagen concentrations slightly below the CFC formed cord-like collagen gels comprising longitudinally aligned fibrils when extruded from nozzles into an ethanol bath. Dry collagen microfibers with a controlled diameter ranging from 122 ± 2-31.2 ± 1.7 µm can be spun from the cord-like gels using nozzles of various sizes. The spinning process was improved by including stretching of collagen stream to further reduce diameter and increase linear velocity. We extruded a collagen solution through a 182 µm diameter nozzle while simultaneously stretching it in an ethanol bath during gelation and fiber formation. This process resembles the stretching of a melted thermoplastic resin because it solidifies during melt spinning. The mechanical properties of the stretched collagen microfibers were comparable to the highest literature values obtained using microfluidic wet spinning, as they exhibited longitudinally aligned fibrils both on their surface and in their core. Previous wet spinning methods were unable to generate collagen microfibers with a consistent tendon-like fibrillar arrangement throughout the samples. Although the tangent modulus (137 ± 7 MPa) and stress at break of the swollen bundles of stretched microfibers (13.8 ± 1.9 MPa) were lower than those of human anterior cruciate ligament, they were within the same order of magnitude. We developed a spinning technique that produces narrow collagen microfibers with a tendon-like arrangement that can serve as artificial fiber units for collagen-based synthetic tendons.

Multifunctional and Flexible Neural Probe with Thermally Drawn Fibers for Bidirectional Synaptic Probing in the Brain.

Synapses in the brain utilize two distinct communication mechanisms: chemical and electrical. For a comprehensive investigation of neural circuitry, neural interfaces should be capable of both monitoring and stimulating these types of physiological interactions. However, previously developed interfaces for neurotransmitter monitoring have been limited in interaction modality due to constraints in device size, fabrication techniques, and the usage of flexible materials. To address this obstacle, we propose a multifunctional and flexible fiber probe fabricated through the microwire codrawing thermal drawing process, which enables the high-density integration of functional components with various materials such as polymers, metals, and carbon fibers. The fiber enables real-time monitoring of transient dopamine release in vivo, real-time stimulation of cell-specific neuronal populations via optogenetic stimulation, single-unit electrophysiology of individual neurons localized to the tip of the neural probe, and chemical stimulation via drug delivery. This fiber will improve the accessibility and functionality of bidirectional interrogation of neurochemical mechanisms in implantable neural probes.

CineMol: a programmatically accessible direct-to-SVG 3D small molecule drawer.

Effective visualization of small molecules is paramount in conveying concepts and results in cheminformatics. Scalable vector graphics (SVG) are preferred for creating such visualizations, as SVGs can be easily altered in post-production and exported to other formats. A wide spectrum of software applications already exist that can visualize molecules, and customize these visualizations, in many ways. However, software packages that can output projected 3D models onto a 2D canvas directly as SVG, while being programmatically accessible from Python, are lacking. Here, we introduce CineMol, which can draw vectorized approximations of three-dimensional small molecule models in seconds, without triangulation or ray tracing, resulting in files of around 50-300 kilobytes per molecule model for compounds with up to 45 heavy atoms. The SVGs outputted by CineMol can be readily modified in popular vector graphics editing software applications. CineMol is written in Python and can be incorporated into any existing Python cheminformatics workflow, as it only depends on native Python libraries. CineMol also provides programmatic access to all its internal states, allowing for per-atom and per-bond-based customization. CineMol's capacity to programmatically create molecular visualizations suitable for post-production offers researchers and scientists a powerful tool for enhancing the clarity and visual impact of their scientific presentations and publications in cheminformatics, metabolomics, and related scientific disciplines.Scientific contributionWe introduce CineMol, a Python-based tool that provides a valuable solution for cheminformatics researchers by enabling the direct generation of high-quality approximations of two-dimensional SVG visualizations from three-dimensional small molecule models, all within a programmable Python framework. CineMol offers a unique combination of speed, efficiency, and accessibility, making it an indispensable tool for researchers in cheminformatics, especially when working with SVG visualizations.

Case Report: Nonverbal approaches in the treatment of a patient with fibromyalgia with anger rooted in adverse childhood experiences.

Introduction: In psychotherapy, it is important to establish and deepen a therapeutic trusting relationship, but patients who have experienced extreme adversity in childhood tend to have difficulty in building such a relationship. This paper reports a case of fibromyalgia with adverse childhood experiences (ACEs) in which a nonverbal approach was successful in building a trusting relationship. Case and methods: The patient is a woman in her late 40s. She had strong anger rooted in ACEs, including neglect by her father, a feeling of unfair parenting by her mother compared to her younger brother, overcontrol of her life by her mother, and sexual abuse by her uncle. She was filled with strong interpersonal distrust and anger, and the experience of an unsuccessful surgery compounded her distrust of medical care. The therapist initially had severe difficulty in verbal interaction with the patient. When conducting "drawing" therapy, she ignored the therapist's comments and completely blacked out the drawing paper. However, the patient-therapist relationship gradually changed, and verbal interaction became possible through the use of nonverbal approaches such as framing her drawing paper and "Towel Baby Holding." Results: The therapist was able to understand the patient's emotions through these nonverbal approaches and to communicate with the patient that she understood her feelings. This approach was also successful in the patient's understanding of her own pathology. The patient became able to honestly express her feelings in words, which eventually enabled her to be introduced to mindfulness therapy, leading to a favorable treatment course. Conclusion: For patients with ACEs, a nonverbal approach helps build a therapeutic relationship and plays an important role in understanding the patient.

A picture of hope: From the perspective of adolescents with cancer-A phenomenological-visual qualitative study.

This study aims to investigate the phenomenon of hope in adolescents diagnosed with cancer and examine adolescents' lived experiences of hope. The study was conducted between November 2022 and March 2023. The study used a phenomenological-visual qualitative research design with 20 adolescents in the pediatric oncology ward. The purposive sampling method was used in the study. Data were collected using "Descriptive Characteristic Form," "Semi-structured Interview Form," "Drawing Technique," and "Mutual Storytelling Technique". The adolescents were instructed, "Let us draw our hopes," and asked to draw pictures. Each adolescent was interviewed about the drawings and asked four semi-structured questions. Audio recordings of the interviews were made and transcribed. A hermeneutic phenomenological approach was used in the analysis of the data. Two main themes and four subthemes were identified in the study. Metaphorical and conceptual context was included in the theme of symbolizing and linking hope. Two subthemes, facilitators and barriers, were identified in the main theme of rooting hope. The study sheds light on hope experiences in adolescents receiving cancer treatment and guides healthcare professionals.