The representations of biochemical processes must balance visual portrayals with descriptive content to be an effective learning tool. To determine what type of representation is the most suitable for education, we designed five different representations of adenosine triphosphate (ATP) synthesis and examined how they are perceived. Our representations consisted of an overview of the process in a detailed and abstract illustrative format, continuous video formats with and without narration, and a combined illustrative overview with dynamic components. The five representations were evaluated by non-experts who were randomly assigned one of them and experts who viewed and compared all five representations. Subsequently, we conducted a focus group on the outcomes of these evaluations, which gave insight into possible explanations of our results, where the non-experts preferred the detailed static representation and found the narrated video least helpful, in contradiction to the experts who favored the narrated video the most. Visual communication of abstract scientific concepts is widely used in education . The uphIn our study, we explore the preferences of different audience groups for the different representations—static overview illustrations, animations, and their hybrid combination—by analyzing their benefits and shortcomings. We aimed to find out what kind of representation is most helpful in understanding the concepts in the complex process happening at the molecular scale. We chose the well-known adenosine triphosphate (ATP) synthesis  as a repoverview of the entire process. They differed in the way individual steps were represented—detailed static illustrations, simplified (abstract) static illustrations, and animated sequences, respectively. On the other hand, the Narrated Video and Video without Commentary presented the process in a single continuous video sequence, differing only in the presence of the auditory content.We designed five different representations of the ATP synthesis process see ; (a) DetThe use and advantages of both illustrations and animations for the education and communication of science have already been studied previously. However, to our knowledge, no previous research combines an overview scheme of the entire process with animated media, such as our Hybrid representation. We hypothesized that this combination of the schematic representations outlining key parts of the process, with animations that communicate motion and mechanics of the process, would be most useful from all the representations. To evaluate the benefits and drawbacks of the Hybrid representation against more standard formats, such as static illustrations and videos, we conducted a series of studies. Our studies also aimed to provide more insight into which commonly used visual aids are useful and effective in learning about abstract biochemical processes and what preferences different audience groups have. Our main focus was to find the best way to represent these processes to high school students, where the findings could be further applied to related areas of education. We also focused on finding the best representations for expert use, whether it be for the dissemination of work in the research or education world. We aimed to answer the following questions:Is it more beneficial for learning to view the biochemical process in a continuous or an overview scheme showing the main phases of the process?Is there a difference between user groups with varying levels of knowledge in preference for static or animated representations?Is there any preference for abstract or detailed representations between the expert and non-expert target audience groups?Our findings can help teachers and creators of educational materials for different audiences choose an appropriate format of visual representations, considering aspects such as layout, content fragmentation, visual complexity, and aesthetics. We believe that our gained insights can contribute to a better design of learning materials for biochemical processes beyond the ATP synthesis and extend the process presentation to other domains, for example, biophysics or medicine.Our paper is structured in the following way. After summarizing the existing works related to our study, we introduce our methodology for designing the different representations and the study itself. Then, we summarize and discuss the results and suggest potential future research directions.To successfully carry out a study that aims to explore the comparison of different techniques showing dynamic processes on a molecular level, we have looked at previous research and theories that address similar goals. The following section shows the research already undertaken into effective depictions of biomedical data and explains why we have chosen the representations we did for this study (Sections 2.1- 2.3). This includes research into illustrations and videos, abstractions of designs, and the benefits of the whole process overview. The second half of the related work states principles that should be applied in all educational representations and that we have considered in our study when creating and choosing our five representations (Sections 2.4–2.5). This includes the importance of storytelling in science and Multimedia Learning Theory . ConceptThe standard means of communicating science used to be through medical illustration. Medical illustration is a widely used technique, for example, in education and patient outreach, where specialist illustrators use various methods to effectively communicate medical occurrences . These rMolecular animations have an advantage over illustrations as they show continuous change. Yet, the need for dynamic depiction depends on the audience and the objective to be communicated . The samOnce the media is chosen and the story decided, one must also consider stylistic choices and aesthetics of the output. Abstracted images have been proven to have the benefit of lending more insight into data . This isOne of the questions we aim to answer with this research is whether a continuous presentation of data, as in the video, is more effective than an overview of the entire process, which allows the viewer to skim-read and then return to the place of interest. One example of using an overview of information is data comic visualization, which was proven to be effective . Comics Storytelling is essential to learning about abstract processes, such as biochemical processes inside cells. Botsis et al.  suggesteTo create an effective educational tool, one must follow rules that balance enough provided information to explain the process and not overwhelm the viewer, which hinders the learning process. Mayer and Moreno  proposedATP synthesis is the process through which living cells convert adenosine diphosphate (ADP) molecules into ATP energy inside the cellular organelle mitochondria, often referred to as the ‘powerhouse of the cell’ for this reason. It is one of the most critical yet complex processes in living cells. The ATP synthesis was purposely chosen as the bio-molecular process to be represented in this study because it is commonly internationally taught at the high school level as part of the biology curriculum .Illustrations and videos are widely used to help explain the complexities in the biomedical field, as mentioned by the recent research above. The efficiency in showing movement, spatial relationships, and model accuracy is the reason we chose continuous representations. We have also decided to test the Video and Narrated Video between each other because of the benefits stated by Mansor et al.  and to toverviews utilizing flow-chart-like storyboard layout, two continuous videos, and one hybrid representation—the visual representation of this categorization can be seen in static representations included Detailed Static . These representations were arranged in the same manner and showed the same order of events with the same textual description. For the static representations key video frames were carefully chosen to be able to convey dynamic movement even in static conditions. They were further enriched by labels, arrows, and descriptions in text using action verbs that describe the movement of the actors in the process. As such, each of the selected frames could also serve as a standalone representation. For the Detailed Static representation, the selected keyframes were recreated as illustrated images that resembled the models from the original animation in complexity . The Abstract Static version was based on detailed illustrations simplified to basic three-dimensional shapes, such as cylinders, spheres, and ellipses. Both of the static representations used the color scheme from the original video.The parts of the video representing the critical moments in the ‘story’ of ATP synthesis were used as the basis for the remaining representations employing storyboard overview storyboard approach—outlining the entire process—with dynamic components of the video representations—communicating the motion.The Hybrid representation was made by creating short animations (4–11 seconds) from the original video provided by the animator showing the dynamics of the critical moments of the ATP synthesis process. This representation was designed to combine the best components from the At the same time, the Hybrid representation used interaction by letting the learners start the short animation at each key step in order to view the next part of the ‘story’. They could also replay the animations as it suited them. This differed from passive observation of a static image or a video. While the video representations could also be paused and re-winded, we expected that these interactions would be less frequent in the fully continuous representations.The representations were made using the video editing program Adobe After Effects (2020) and Procreate (2020) drawing application.Our comparison study aimed to collect data that indicate preferences for different types of representations and their properties, such as level of abstraction and continuity. These data are intended to help choose a proper way of abstract data representations in biomedical sciences for educational purposes. We expected that people with different levels of expertise would prefer different types of information visualization as some contain more information than others .Our study collected quantitative and qualitative data through two iterations and a focus group. In the first part, we conducted two independent online surveys with different target groups, one with non-expert participants (n = 60) and one with experts with backgrounds in biology and data visualization (n = 9). These surveys aimed to assess and compare the educational potential of the representations and collect feedback and preferences from different target groups. Subsequently, we conducted a focus group on the survey results with experts (n = 5) with specific expertise in biology, visualization, design, and education. The qualitative data from open questions from both iterations were later analyzed for themes and ideas with Qualitative Content Analysis .The research presented in this paper was conducted at Masaryk University, Czech Republic in accordance with the Czech law. We have conducted two anonymous online surveys with participants over 18 years of age. No sensitive personal data were collected in these surveys. To further evaluate our results we have also conducted a focus group. The participants of the focus group were over 18 years of age and provided written consent by signing an informed consent form regarding the procedure and further processing of the collected data. The results presented within this paper were fully anonymized and do not contain any personal or sensitive information about the participants. According to Czech law, ethical approval is required only for research in the field of biomedicine/research involving biomedical techniques , or research involving underage participants. With regards to this law, we were not required to obtain an ethical approval.The different surveys and a focus group allowed us to collect qualitative and quantitative data from users with different knowledge levels and experience with biochemical visualizations.The experts were needed to suggest improvements and point to valuable components of the representations since they have experience working with abstract processes.The non-experts’ input allowed us to see how good already existing representations are and find out first-hand what other components would facilitate more accessible learning.The experts from various backgrounds provided insight into the explanation of previous results and future research from different perspectives and also added validation to previous findings.The non-expert participants were reached through convenience sampling . They included predominantly university students from study programs related to the focus of the study, such as biochemistry-related fields and visualizations, and students of unrelated fields, such as law, aircraft design, and urban studies. The variety of students with related and unrelated backgrounds was done purposely to avoid bias in learning about the biochemical process and to gain feedback from students learning biological subjects that would benefit from these representations. The distribution of participants’ capabilities and interest in biochemistry is similar to the distribution of these factors in students in class. They consisted of an international sample from 12 countries; Austria, Czechia, France, Lebanon, Netherlands, Norway, Palestine, Portugal, Serbia, Slovakia, United Kingdom, and the USA. Of these participants, 23 were female, 33 were male, 3 were non-binary, and 1 participant preferred not to say. Their age range was 20 to 43, with an average of 23.84. Two participants with visual impairment  were included in the result analysis as their responses were not statistically different from the rest of the non-experts. Participants were randomly given one of the five representations—each representation was assigned to at least 10 participants; Detailed Static n = 14, Abstract Static n = 12, Hybrid n = 10, Narrated Video n = 13, Video n = 11. A summary of the non-experts’ information can be found in We invited two groups of experts to participate based on their backgrounds: visualization and biochemistry. These areas were chosen as the experts from these fields could give valuable insight into biochemical representations, either as the users or as the creators of visualizations of abstract scientific data. The experts were reached through our professional networks and included participants from six countries; Argentina, Austria, Czechia, Taiwan, Slovakia, and the USA. All participants in this group had normal vision. The summary of the expert description can be found in For the focus group, we invited participants with diverse backgrounds to help evaluate previous results and give insight into future research through semi-structured discussion. Participants included a high school biology and chemistry teacher (four years of experience), biological visualization researcher (ten years of experience), a visualization and human perception researcher (fifteen years of experience), a graphic designer (fifteen years of experience), and biochemistry researcher (twenty years of experience). All participants had teaching experience. The demographics of focus group participants are included in The first iteration of the study consisted of two online surveys, which can be found in We conducted a pilot test for each survey with two participants to estimate the timing and uncover potential issues. Subsequently, the surveys for experts and non-experts ran independently and lasted approximately three months each.The results from both groups were analyzed and presented in the focus group as points for discussion alongside the participants’ own opinions on each of the representation, their use, critique, and future improvements.Each non-expert survey participant received a questionnaire with one randomly selected representation. The questions in the survey were the same for all non-expert participants. We included two categories of representation-related questions—content questions designed to objectively test the participant’s understating of the depicted biochemical process, and questions regarding subjective preferences and impressions about the given representation. The content questions were open-ended, with short unambiguous answers, such as ‘Which two molecules react to make the ATP molecule?’ To evaluate the understanding of the order of events of the biomedical process, participants were given the task of ordering the main events using the drag-and-drop tool. A five-point Likert scale was used to measure the subjectively perceived usefulness of representation in terms of communicating movement and sequence of events. Furthermore, participants were asked to describe the representation by selecting options from a list of positive  and negative  attributes which provided us with the participants’ impression of the visuals . FinallyAll five representations were designed so that the questions about the ATP synthesis in the non-expert group could have been answered from any of the representations. Participants were allowed to return to the representations as often as they liked and were asked in the end to report how many times they looked back. The whole survey was designed to take up to 30 minutes.The expert questionnaire included all five representations and specific questions regarding their usefulness and educational value. Participants were again allowed to return to the representations as often as they wished. In the survey, the experts were asked to select the most and least helpful representations in general and representations that best communicated movement and sequence of events. For each of these questions, they were also asked to provide reasons for their choices, for example: ‘Which representation was most helpful in understanding the movement of molecules and enzyme and why?’ The questionnaire also included closed questions asking participants to choose from a list of positive and negative attributes to describe each of the representations (same as in the non-expert survey) to help us understand their perception of them , and theAfter the responses were collected from both online survey groups, the data were analyzed and compared. A focus group method was chosen as it has the advantage of showing immediate results and time effectiveness and was based on Courage & Baxter  techniquThe focus group took place in a seminar room with a table, chairs, whiteboard, and a TV monitor where the representations were displayed again. Alongside the participants, there were present one moderator, one note-taker, and a camera recording the discussions with the participants’ consent. The session lasted about 120 minutes and consisted of two parts. In the first part, a semi-structured discussion about individual representations was held, with participants offering their opinions, suggested improvements, critiques, real-life use, and possible future research directions. In the second part, participants were presented with the outcomes of the previous surveys and discussed the reasoning for the results and their implications.The combination of qualitative and quantitative results was collected from surveys with students, visualization and biochemistry experts, and a focus group.The results from the non-expert survey were split into three parts: subjective scores, objective scores, and qualitative feedback. We have used one-way ANOVA and between-subject t-tests to calculate statistical significance between the test groups. The subjective scores were computed as averages from the users’ subjective ratings indicated on the five-point Likert scale. To obtain the objective scores, the non-expert results were analyzed by correcting the right and wrong answers in the content and order-of-events questions, which yielded correctness percentages for each person and each group. We then calculated the overall objective score by combining the score averages of the content questions regarding the movement and chemical actors with the average score for the order questions. Two participants (one from the Hybrid representation group and one from the Abstract Static representation group) were eliminated from the quantitative analysis because they indicated that their drag-and-drop tool in the order questions was not working, which was also seen in the raw data results because only these two participants had the order of events in the default position. Including these two participants’ content scores without the order score to make an overall average would significantly impact the overall results, hence, their quantitative elimination. However, the qualitative feedback for open questions from these two participants was still used, as their responses on what they liked and disliked about the representation contributed to the evaluation. In the evaluation of open questions, we looked for repeated themes, such as what the participants liked and disliked about each representation in the open comments. The responses for keywords were counted for each representation to get an idea of the general impression of the participants.The expert group’s answers were qualitative and divided into themes about the preference of representation (most and least liked), critique for each respective representation, their comparison, and the potential use of each representation in practice. The discussion from the focus group was recorded, and upon re-examination, themes were established. This involved positives and negatives about each representation, each of the representation’s potential improvement and critique, suggestions for its use, and additional comments.Qualitative Content Analysis  was usedFor the final results, the objective content scores of non-experts were used to determine the order of representations’ helpfulness. This order was compared to the order of helpfulness of experts’ results determined by their answers of which representation is their most and least favorite one.The results were measured by quantitative overall knowledge scores by the participants and their ratings of different attributes of the representations  and some of the qualitative comments in the open-ended questions indicated a preference for Detailed Static representation. The Narrated Video was the least helpful representation based on the objective score . The Hybrid representation was the second most helpful, with 69.90% and SD = 21.22, followed by Abstract Static . The second least helpful representation was Video representation . The One-way ANOVA test has shown a significant difference  between the groups. The quantitative results clearly favor the storyboard overview approach, as the representations with this design were the three with the best results. The t-tests show that the Detailed Static representation was statistically different from the Narrated Video  and Video . There was also a significant difference between the Hybrid and Narrated Video  and no significant difference with Video .The content questions that measured the understanding of the process asked about specific chemical actors and understanding of the movement of molecules and enzyme parts. The one-way ANOVA test showed no statistical difference in the answers to content questions between the groups . The Detailed Static group achieved the highest score on content questions (64.88%) and the lowest score for the Narrated Video (52.56%).According to the one-way ANOVA, the order-related questions showed a significant difference between the groups . The highest scores for order of events were achieved by participants in the Hybrid group (86.11%) and the lowest by the participants with Narrated Video (46.15%).The summary can be seen in In the subjective measurement, non-experts were asked to use a five-point Likert scale (5 being the best and 1 being the worst) to rate how helpful the respective representations were in conveying movement and order of events. For movement, Abstract Static representation was considered the best (3.58), and the least helpful was Video representation (2.91). In the perception of conveying the order of events, Abstract Static (4.08) was perceived as the most helpful, and Video (2.36) was perceived as the least helpful. The summary can be found in Participants were asked to tick keywords associated with their representation in a closed question showing options with checkboxes. Out of the list of a mix of positive and negative keyword attributes, the Detailed Static representation was considered the most detailed (n = 11) and informative (n = 10). Abstract Static representation was considered simplistic (n = 7) and informative (n = 6). Hybrid representation was associated with pretty (n = 6), detailed, and distracting (n = 5 in both). The Video was perceived as confusing (n = 9), distracting, and detailed (n = 5 for both). The Narrated video was seen as distracting (n = 10) and detailed (n = 9).Based on the provided feedback, non-experts appreciated the step-by-step guide, the arrows in the images, and the fact that the Detailed Static representation was not visually cluttered. At the same time, the comments included ‘there was too much detail’ and ‘too much information’. The Narrated Video was described as too fast, dramatic, chaotic, and busy. The positive responses included appreciation for realism, motion, music, aesthetics, and the fact that it had written and narrated content. The summary of results can be seen in Qualitative Content Analysis  was usedParticipants were allowed to return to the representations as often as they liked. Overall, the people who returned 10+ times had the highest overall score (68%), followed by people returning 1–5 times (63.4%). Participants who returned 6–10 times had the second lowest overall score (60%), and the people who did not re-visit the representation at all had the lowest score (55%). Most participants went back 1–5 times (n = 27), followed by 6–10 times (n = 24), some did not go back at all (n = 4), and some went back 10+ times (n = 5).5.2.6.1 Detailed static. People who did not go back at all (n = 2) had the lowest overall score at 30% of correctness. People who went back 10+ times (n = 2) had the highest score in correctness at 80% overall.5.2.6.2 Abstract static. People who went back 6–10 times (n = 7) had the lowest overall score of 57.14%. People who went back 1–5 times (n = 5) had the highest score in overall correctness at 73.33%.5.2.6.3 Hybrid. People who went back 6–10 times (n = 3) had the lowest overall score of 60%. The person who did not go back at all (n = 1) had the highest score of 80%.5.2.6.4 Narrated video. Person who went back 10+ times (n = 1) had the lowest score of 20%. The person who did not go back at all (n = 1) had the highest score of 60%.5.2.6.5 Video. People who went back 6–10 times (n = 6) had the lowest overall score 41.67%. People who went back 1–5 times (n = 5) had the highest score in overall correctness of 40%.The results partially confirm our assumption that the non-experts will reach better scores when revisiting the representations. However, the correlation is not as strong as expected, indicating other factors are worth investigating in the future.continuous video or segmented overview approach to viewing biochemical processes is more beneficial. The results have unanimously shown that the experts’ preference lies in the moving animated representations . The Narrated Video representation was also voted the best (n = 5) in explaining the biochemical process’s movement and order of events. In qualitative feedback, it was reported to be the most descriptive and clear when describing the process without switching between content, showing dynamic changes and dynamic movement. One participant mentioned that it was almost overloading. The least preferred representation among the experts was the Abstract Static representation (n = 1) which was described mainly as too simple to facilitate deep understanding. The experts expressed concern that it was simplified to the point where it could be misleading. On the other hand, the positive remarks regarding this representation included that it could be good for teaching basics. The summary of the expert feedback can be found in In the expert survey, participants selected their most preferred representations in general and for specific tasks such as communication of movement and order of events. Additionally, Qualitative Content Analysis was used to look for themes and ideas about each representation in the open feedback question. These themes helped us identify the experts’ reasons for preferring or disliking each of the representations and whether a The keyword description helped us explain why participants in the different target groups find each representation helpful and unhelpful. The experts saw Detailed Static representation as too detailed and confusing (both n = 5), followed by distracting, informative, and visually unappealing . Abstract Static was perceived as simplistic (n = 7), followed by inaccurate, easy to read, and clear (n = 5). The hybrid was seen as pretty (n = 6), followed by excessive and informative (n = 4). The Narrated Video was marked as pretty (n = 8), followed by informative and detailed (n = 7). The Video was seen as pretty (n = 6) and detailed (n = 5).overview of the process, or a continuous video, more experts preferred the continuous video (5 out of 9). It was noted that videos are better for general understanding and showing dynamics. One participant out of the five mentioned that they would prefer a video they could stop for detailed learning and that it would be highlighted in the timeline. The other experts (n = 4) preferred an overview of the process for understanding. Of the four experts preferring the overview, two noted that they would prefer using their combination by first using the overview and then the continuous video representations.Regarding the type of layout, a storyboard For process understanding, experts deemed that Abstract Static representation (n = 6) is enough to understand the process compared to the Detailed Static (n = 2). One mentioned that this approach is for experts because they already have knowledge of protein shapes. Another noted the abstract is enough unless there is a need to learn about specific binding sites on the proteins for a reaction to occur.For understanding the structures, movement, and spatial understanding, the 3D models used in the videos were considered more beneficial (n = 9). When deciding between seeing the continuous process and then revisiting content (Narrated Video and Video) compared to the overview layout with dynamic components (Hybrid), the experts preferred continuous video (n = 5). At the same time, one noted that the video ought to have segmenting elements that signal key steps. The overview using dynamic steps (Hybrid) was preferred by three experts.overview approach showing all the steps of the process  versus a continuous communication of the process (Video and Narrated Video).The focus group provided insight into each of the different representations. Overall, the experts did not have a straightforward answer about which representation they find the most and least useful for teaching high school students about the biochemical processes. They discussed attributes of each representation, such as their ability to convey movement, sequence, and visual appearance. During the discussion, the experts seemed to naturally divide general comments between the representations with an The presented five representations were considered very good and were cherry-picked as the best from many more available. So the difference between them may be so small that it does not even matter in the grand scheme of effective learning. In this section, we discuss comments on the visual appearance, layout, motion and function communication, and other remarks.The Abstract Static representation gave metaphors for function, specifically, a metaphor for mechanical car engines, which can be used to explain the energy-making process in the cellular mitochondria. This has the potential as an effective storytelling technique. It was noted that the smaller actors in the representations, such as the small hydrogen molecules, were lost because the enzymes were considered the main components and took the attention. In terms of their visual appeal, they were also described as having ‘too many edges’ and considered unappealing. The expert with a main background in design explained that humans observing biological processes want to look inside a living cell; hence the depictions should show an organic-looking environment. Another expert preferred realistic-looking depictions rather than ‘cartoon-like’ illustrations of molecules. From these two opposing comments, it is evident that the apparent preference of presented data varies between people and their domains. The level of detail was challenged as unnecessary when a lot of movement was shown in the continuous video representations. However, the level of detail and its organic aesthetics were also considered good for inspiring students to want to learn about biochemical processes. All the experts concluded that the videos were very appealing but contained too much information and visual noise, which would not be compartmentalized immediately. No meaningful learning would concur, despite catching attention. Another interesting point about visuals related to Abstract Static representations was an observation that school curricula do not encourage abstract thinking. For example, the more realistically the pieces are rendered in art, the more ‘correct’ they are considered. This could be one of the explanations for not favoring the Abstract Static representation.The Detailed Static representation was seen as suitable for understanding general movement due to the use of arrows and numbers indicating individual steps of the process. For sequence, the experts commented that it is clearly understandable in the overview sequential representations, such as the Static and Hybrid representations. This was a result of the numbering of the steps. The numbering also suggests the order of events, however, it was mentioned that this could be misleading because all these steps are happening simultaneously. Also, the viewer may assume that when part of the process is shown earlier than another, it means that it is more important, which may not always be the case. The video representations were considered suitable to be showing sequence and all the processes going on simultaneously. However, it was noted that students need to exert more cognitive effort to identify the important steps in the biomolecular process in the continuous presentation.The benefits of the videos were also repetitive movements of the ongoing processes, which would help with understanding certain parts of the processes, despite looking abstract. The video representations were labeled as showing very fine-grained detail of movement. In this case, the question was raised whether that level of detail is needed. Unsurprisingly, all the videos used were considered beneficial in showing dynamic processes.Different representations were suggested for different uses to be the most effective learning aid for specific target groups and media. The Detailed Static representation was labeled as a useful tool for revising for an exam. It was also mentioned that because of its size, the presentation of this medium, on posters or in textbooks, should be larger than the Abstract Static representation with fewer details. The Abstract Static representation could occupy a smaller space and be accompanied by more text. The illustrations were also called pretty at one point, and they would look nice on t-shirts, which could be incorporated into public engagement. The Hybrid representation could be used for teaching at school if it was divided into physical stations. Each station would represent a stage in the molecular process and be explained in detail with the use of, for example, tablets. The physical division and movement between stations would make the process more memorable. It was also suggested that there could be a combination of static media and Hybrid representation by creating an interactive poster with Augmented Reality. However, experts in the educational domain stated that students do not always find novelty media, such as virtual or augmented reality, more attractive. It is more suitable for children with more energy to interact with that kind of media. The Video without Commentary was considered a good option for lectures and conferences, where the speaker could narrate the video live. A statement opposed to this is that it makes the Video similar to Narrated Video. However, live interaction differs from passively watching Narrated Video. The Video and Narrated Video were considered helpful in public engagement, such as museum presentations. The Narrated Video was also considered very useful for teaching.In addition to some previously mentioned alterations to the existing representations and critiques, the experts suggested new versions of the ATP synthesis process. This included a comic strip and illustrations with an isometric view to show the depth of field. Comics have been proven to be useful in data science before , 38. TheThe second suggestion was 3D printed physical models that could be taken apart . The use of tangible models would also be useful as previous studies into physicalizations of medical data were appropriate for educational visualizations , 51.It was also suggested to make a cartoon video in the style of the two static representations. This approach has the potential to simplify the visual clutter that some participants mentioned and simplify the chemical actors.Dynamic representation could be made with 3D models showing the same process but from several different points of view and could incorporate arrows and texts. As mentioned before, the 3D models would help understand molecular interactions , dynamicTwo opposing ideas were presented: one by the educational expert who suggested that children could be presented with a representation that shows all the steps in the process and has no dynamic components to understand the process and then be presented with a Narrated Video to fill in the gaps. On the other hand, an expert in bio-visualization suggested a reversed approach where the whole process is shown, and then the viewer goes into a detailed study of each step. The combination of static and dynamic aspects would have the same advantages that we meant for the Hybrid one, but starting with a simpler representation might be better for grasping the basic concept and only then adding the more complex details, such as in animation.Another idea was to create a video with labeled timestamps marking each critical step, such as educational videos on the YouTube platform. Another suggestion was to show slower videos in the native language of the viewers. Slowing down was probably suggested because the video was thought to be quite fast-paced and complex to grasp all the details (a similar reason why the combination was suggested).A hybrid version could also be presented on a scrolling website with an overview of the entire process in the corner of the screen.Another great suggestion was to let the students hand-draw the process after watching a video to create their own learning material by creating a concept from detailed visuals and abstracting it in a suitable way.It was also said that technology makes teaching a lot easier nowadays because many of these options were not available a few years ago; in the next ten years, new technology will be available to be utilized in education. Overall, the representations that are easier to retrieve are considered to be more effective as teaching tools.The discussion about the results from the previous groups allowed us to find possible explanations for why the participants from the two target groups found the representations helpful or unhelpful. The opposing preferences and dislikes of experts and non-experts were unexpected. One of the possible explanations was the fast speed of the video as discussed previously. It was also suggested that the new biology-specific terms not available in written form might have negatively affected the understanding of the Narrated Video by non-experts since it would be more challenging to search and understand those terms in the video. This was also indicated in their open feedback comments. Another possible explanation for this was the language barrier since many of the participants were not native English speakers. Therefore, we carried out post-hoc tests. We have determined that the language barrier was not a reason for participants’ lower scores in the non-expert group because participants with different levels of English language knowledge (including native speakers) had similar results. The Narrated Video with the lowest score and the Detailed Static group with the highest score both had participants from English-speaking countries.In this section, we discuss the findings from the extensive study, including lessons learned from open feedback from all three groups and recommendations for improvement for each representation.The results indicate that different target groups prefer different representations. We identified causes for these preferences, such as complexity, level of detail, familiarity with the concept, and ease of finding information. The familiarity and past experience with interpreting visual scientific representations can also affect the level of competence in interpreting them. As such, the experts with vast previous experience are better at deciphering and using representations and are more likely to gravitate towards more complex choices.overview scheme showing the main phases of the process, unlike experts who prefer continuous representations. This approach was the second favorite of the expert group, just after the Narrated Video. This contradicted the non-expert group, which deemed the Narrated Video the least helpful and chaotic. We have concluded that different representations have different uses for different groups. The student groups’ qualitative and quantitative results indicate that a static overview is the most beneficial as it allows going back to the desired part of the process. This is a claim that was also supported by some of the experts in the focus group.Overall the collected data indicated that the non-experts prefer to view the biochemical processes to be represented in an overview and segmenting approach [overview scheme rather than with dynamic components. Meanwhile, experts prefer the dynamic Hybrid components in the overview scheme. New biology-specific terms, as indicated by non-expert responses, are also the reason why combinations of different media, including written text, are necessary. Most of the scientific education material will introduce unknown terminology and thus would face the same problem as using just narrated video content.Our assumption was that a combination of static overview with dynamic videos in the form of Hybrid representation would be the most successful and favored by both groups, non-experts, and experts. This was because it provides a large amount of detail and insight into the order of events, movement, quick overview, recollection, and auditory effects combined with the approach . In the Our results agree with the claims that representations must contain information but not be too abstracted or too detailed . On the The keywords that were selected in the non-expert and expert surveys helped us to understand how each group perceives the visualizations. This is important as attractive visualizations that are eye-catching and stimulating prompt learning . ConsideOne aspect that hinders the learning of the ATP process specifically is the lack of explicit connection between chemistry and biology information . We belioverview, they can focus on understanding the continuity of the process through dynamic continuous video with narration. The Abstract Static is also beneficial in education, however, based on the results from all the groups, it would be most helpful in printed media like journals and higher-level textbooks targeted at experts. We recommend abstracted illustrations to be used where readers are looking to add the knowledge they already possess and do not need to be taught basics. Details should be used to focus on the new information. We would also like to point to the comments that were left by non-experts and that some have enjoyed and some disliked the color palettes in the illustrations; we agree that certain rules about color palettes in professional molecular visualizations should be followed to achieve harmony [Overall, with the results from the qualitative and quantitative data collected, we came to a conclusion about each of the representations and listed our recommendations for their use. The high results of Detailed Static representation quantitatively combined with the repeated comments appreciating the step-by-step approach and detail make it a very effective learning tool for high-school students learning for exams. It would be even more beneficial to use it in combination with the Narrated Video, despite the non-experts’ low scores and qualitative critique because once they get the basic idea of the actors and processes from  harmony . This waWe anticipate that the Hybrid representation would be most helpful in the education of high school students, where each of the steps could be made into a detailed and interactive activity at different physical stations representing each step. This type of interactivity would also make it suitable for science museums where people are willing to put effort into interaction for the sake of learning. We suggest that the Narrated Video would be beneficial for both learning in the classroom as well as teaching the public and getting people interested in science. However, an audience-appropriate voice-over would need to be used for each specific target group to not overwhelm the novices or not under-stimulate experts who would like to point out new, detailed findings that require prior knowledge. Based on the feedback, we also think that the attractive graphic would help attract students and novices to science, as well as reinforce the experts’ belief that science is beautiful and interesting. For both groups, we also suggest the narrated videos should have the option to be paused as well as have markers pointing to the critical points in the process for easier navigation. The Video ought to be used in combination with live narration based on the audience’s level of understanding. The live interactivity would allow the viewers to ask questions at the moment. Its interactivity would therefore be channeled through the speaker, who would manipulate the video based on the audience’s reactions.The external validity of this study is high as more biochemical processes and other abstract occurrences with time sequences could be studied similarly. Internal validity is high as we employed two study iterations with different populations of experts and non-experts. The study also employed comparisons between individually answered questionnaires (non-experts), people who compared all five versions with each other, and in the end, a focus group, where participants viewed all the representations and were familiarised with the results of the previous test groups and got to discuss them. Ecological validity is high as we asked participants who use and create visualizations, study, and work with biomedical data to participate in our study. In addition, the representation versions were also based on a professionally done biochemical visualization which is considered accurate from the scientific point of view and the point of view of an educational tool.It would be more accommodating if the student population were between 120 to 140 participants. While we had a representation of different backgrounds in each representation for non-expert iteration, we would benefit from having equal representation of biochemical, computer science, and other backgrounds in each representation group. However, the overall number of participants was large enough to generalize the findings to other populations within STEM subjects and also included people from international backgrounds.We acknowledge that experts might have been subjected to Order Effect  as the rAnother critique of our study design could be the conflation of variables, such as using static versus dynamic, abstract versus detailed, and overview versus continuous approaches mixed within our representations. However, in reality, those aspects are used in combinations and not as isolated concepts. Furthermore, it was shown   are currently using to help their students understand and decipher different representations, such as the examples used in our survey.Another interesting avenue to explore would be the application of different representations on different scales of biochemistry. For example, leaving the micro level with the biochemical processes and traversing across to the larger scale with, for example, blood flow or even the processes on the meso scale with human anatomy of organs. In the future, we would like to test approaches indicated by the focus group, such as 3D printed physical models and a combination of several different representations, such as video and static illustration. It would be interesting to take the concept of data comics  and compIn this paper, we have focused on media of illustration and video animation as they are easily accessible, despite more technology, such as Virtual or Augmented Realities. We have assessed their effectiveness in learning by testing them individually and creating a version that combines them. We have answered the questions posed at the beginning of our research.We suggest the combination of different representations would be the best approach to learning about biochemical processes, such as being presented with a simple overview first and then watching a video, rather than combining those two approaches, as suggested by experts and the focus group.Based on the results from the expert group, we can conclude that representations containing a lot of details and information are suitable for people with background knowledge in the subject. Unsurprisingly, movement and space are best understood with 3D models.Our study has shown unexpected results that we would like to explore in the future using further study into creating new materials for testing the Hybrid visualization and branching out into different levels of abstraction in the static overview representations.S1 FileFile containing a link to the website with representations and screenshots of the individual representations.(PDF)Click here for additional data file.S2 FileFile containing questionnaires for two test groups and an itinerary for the focus group.(ZIP)Click here for additional data file.S3 FileFile containing the non-expert demographics and group division.(PDF)Click here for additional data file.S4 FileFile containing the expert demographics and group division.(PDF)Click here for additional data file.S5 FileFile containing the demographics description of the experts participating in the Focus Group.(PDF)Click here for additional data file.


Malnutrition is strongly linked to adverse outcomes in patients with Crohn’s disease (CD). In this study, our objective was to validate the Global Leadership Initiative on Malnutrition (GLIM) criteria and develop a fast and accurate diagnostic approach for identifying malnutrition in CD patients.This study assessed 177 CD patients from four general hospitals. The efficacy of the GLIM criteria for the diagnosis of CD malnutrition was compared. By analyzing the independent factors, a nomogram model was derived and internally validated to predict the diagnosis of malnutrition in patients with CD. Model performance was assessed using discrimination and calibration, decision curves, and net benefit analyses.Compared with the SGA criteria, the GLIM criteria was consistent in sensitivity (88.89%) and specificity (78.43%) . The Harvey-Bradshaw index(HBI) score , body mass index , and mid-upper arm circumference  were independent factors associated with malnutrition. The nomogram was developed based on these indicators showing good discrimination in malnutrition diagnosis , with agreement after calibration curve and decision curve analysis.The GLIM criteria are appropriate for diagnosing malnutrition in CD patients. The HBI score may be used to diagnose malnutrition in patients with CD and become a possible selection for the GLIM etiologic criteria of inflammation. The HBM nomogram could be a simple, rapid, and efficient method for diagnosing malnutrition in CD patients. MalnutrIn the past few decades, several tools have been used in the clinical diagnosis of malnutrition in patients with CD. The World Health Organization (WHO) considers the body mass index (BMI) as an essential indicator of malnutrition ; howeverIn 2018, the GLIM criteria were proposed as the global uniform criteria for the diagnosis of malnutrition . The GLIIn addition, In the clinical application of the GLIM criteria, multiple parameters are utilized for diagnosing malnutrition based on the criteria. Due to the complexity and time-consuming nature of using multiple parameters, it would be beneficial to develop a simplified yet accurate clinical approach for diagnosing malnutrition upon admission in patients with CD.Therefore, the objective of this study was to assess the reliability of the GLIM criteria in diagnosing malnutrition in patients with CD. Furthermore, the study sought to investigate the specific etiological criteria incorporated in the GLIM criteria for diagnosing malnutrition in patients with CD. Moreover, the aim was to develop and validate a simplified, efficient, and precise diagnostic approach for identifying malnutrition in CD patients. Ultimately, this will contribute to the early detection of malnutrition in patients with CD and facilitate timely diagnosis and treatment.2.2.1.This study is a multicenter, prospective, observational study (registration number: ChiCTR2000035720). The study enrolled patients diagnosed with Crohn’s disease at four general hospitals, including the Affiliated Jinling Hospital of Nanjing University, The First Hospital of China Medical University, Sir Run Run Shaw Hospital, and The Affiliated Hospital of Qingdao University, during the period from September 2020 to May 2021. All assessments and data collection were carried out within 48 h of admission for each patient.The study’s inclusion criteria were as follows: (1) age ≥ 18 years, (2) diagnosis of Crohn’s disease based on clinical, radiologic, endoscopic, and histologic criteria, and (3) willingness to participate in the study and provide written consent. The exclusion criteria were: (1) emergency surgery for an intestinal fistula or abdominal abscess, (2) unstable vital signs or hemodynamics, (3) pregnant or lactating women, (4) admission due to other critical comorbidities or organ dysfunction, (5) patients with a life expectancy of less than 24 h, (6) immunosuppressive treatment for conditions unrelated to inflammatory bowel disease (such as organ transplantation), (7) contraindications to bioelectrical impedance analysis (BIA), making body composition analysis unsuitable, and (8) patients who had already been selected for participation in other clinical studies see .2.2.Within 48 h of admission, researchers collected baseline characteristics including sex, age, height, weight, and history of smoking and drinking. They also gathered information related to inflammatory bowel disease (IBD), recent changes in non-volitional weight loss, and food intake. The Inflammatory Bowel Disease Questionnaire (IBDQ) was used to assess the quality of life (QoL) of patients with Crohn’s disease. The IBDQ is a validated and reliable measurement tool . Several2.3.Physical function was evaluated using various measures, including body composition, mid-upper arm circumference (MUAC), muscle strength, the five-repetition sit-to-stand test (5STS), and the 6-meter walk test. The patient’s left arm was in a state of natural sagging when the MUAC was measured. The circumference of the left upper arm was measured at the midpoint twice, and the average value was calculated . Other s2.4.The Crohn’s Disease Activity Index (CDAI)  and HBI 2.5.p values < 0.05 were considered as independent predictors. Random forest plots were drawn to demonstrate the precision and importance of the predictors, and incorporated into nomograms for the individualized predictions of malnutrition. To evaluate the performance of the nomogram, the area under the curve (AUC) was calculated to assess discrimination. Additionally, calibration curve analysis was performed with 1,000 bootstrap repetitions to evaluate calibration. Decision curve analysis was conducted to evaluate the clinical utility of the nomogram by calculating the standardized net benefits at different threshold probabilities. Several recommended malnutrition diagnostic tools were set as comparators to the nomogram model, including the WHO-related BMI, ESPEN, and SGA criteria.Multivariate logistic regression analysis was performed using the stepwise selection method based on Akaike’s information criterion to identify independent risk factors for malnutrition in patients with CD. Variables with 2.6.p < 0.05) were included in the logistic multivariate regression analysis model (backward selection) to determine independent risk factors for malnutrition. For all analyses, statistical significance was determined using a significance level of p < 0.05. The statistical software packages SPSS  and MedCalc  were utilized for conducting the statistical analyses.Categorical variables were presented as frequencies or percentages. For continuous variables, normal distribution was assessed, and the results were reported as mean and standard deviation (SD) if normally distributed, or median and interquartile range (IQR) if not normally distributed. Univariate analysis was performed by Pearson Chi-square test or Fisher exact probability method, and factors with statistical difference . Prior to the commencement of the study, all patients provided informed consent by signing a consent form.3.3.1.2, mean age, 36.4 ± 13.5 years) were enrolled in the analysis, as shown in p < 0.05). The IBDQ score of patients with malnutrition was significantly lower than that of well-nourished patients . No statistically significant differences were observed between the two groups in terms of age, sex, and duration of disease .A total of 177 hospitalized patients with CD  with the SGA criteria. When compared to the SGA criteria, the ESPEN criteria were superior to the WHO criteria in all aspects of data on malnutrition diagnosis in patients with CD，while the GLIM criteria were superior to the ESPEN criteria in sensitivity (88.89% vs. 70.64%) and negative predictive value (78.43% vs. 54.88%), and the specificity (78.43% vs. 88.24%) and positive predictive value (91.06% vs. 93.68%) were not far behind those of the ESPEN criteria. According to the ROC curve analysis results . These variables were included in the multivariate logistic regression analysis. After stepwise variable screening, three variables were screened as independent factors related to malnutrition in CD patients , including BMI , MUAC , and HBI score . A random forest plot was constructed to show the precision and importance of these predictors  was conducted as indicated in 4.In the present study, we investigated the validity of the GLIM criteria for the diagnosis of malnutrition in patients with CD and observed higher HBI scores in patients with malnutrition compared with those with normal nutritional status. For the first time, we used the HBI score as an independent diagnostic parameter for identifying malnutrition in patients with CD. Additionally, we integrated BMI and MUAC to develop and validate a simple, efficient, and precise diagnostic method for malnutrition in CD patients.Our study found that the prevalence of malnutrition in CD patients was 69.5%, according to the GLIM criteria, in line with previous findings of studies that employed the GLIM criteria as a standard , 19, 21.Owing to the use of the GLIM criteria, current research has gradually recognized the important role of etiological criteria for the diagnosis of malnutrition; however, they still focus more on the phenotypic criteria, ignoring the specific selection of the etiological criteria for the GLIM criteria, resulting in diversity. In three studies investigating inflammatory bowel disease (IBD), the plasma C-reactive protein (CRP) level was examined as a specific marker for the GLIM etiological criteria of inflammation , 18, 21,However, Huang et al.  showed tDuring the analysis of the inflammatory etiology criteria for the GLIM criteria, our results showed that HBI score was independently associated with GLIM-defined malnutrition . HBI is associated with nutrient deficiencies in malnourished patients, which further supports our results , 29. In To simplify the diagnostic process, we developed the HBM nomogram model. Although there are many nomogram models for the prediction of postoperative complications in CD , 33, no Significantly, compared to other forecasting models , the HBMWe acknowledge some limitations in the study. First, our nomogram model can only diagnose malnutrition in patients with CD and cannot distinguish the severity of malnutrition. Second, there is a lack of external validation cohorts due to the limitation of the sample size; therefore, it is necessary to further expand the sample size and conduct further research to improve the evaluation model. Nevertheless, we are cautiously optimistic that the HBM nomogram may be useful once externally validated.5.In summary, the GLIM criteria are appropriate for diagnosing malnutrition in patients with CD. In addition, we developed and validated a simple, rapid, and efficient nomogram model for malnutrition diagnosis in patients with CD, and external validation in independent cohorts is recommended. This is the first study to use the HBI score as a diagnostic indicator of malnutrition, thus suggesting that the HBI score may be a possible selection for the GLIM etiological criteria of inflammation.The original contributions presented in the study are included in the article/The studies involving human participants were reviewed and approved by The Affiliated Jingling Hospital of Nanjing University . The patients/participants provided their written informed consent to participate in this study.The study was conceived and designed by XW and WZhu. The trial protocol was designed and drafted by XW, YZ, and LZ. The statistical analysis plan was contributed by LH and YS, who also performed the statistical analysis. LH, FN, and YS were involved in drafting and critically revising the manuscript. The research was conducted by YZ, CD, YH, YW, WZho, QC, XJ, and HJ, who were responsible for the data collection and hands-on work. Data curation and quality checking were carried out by LH, YZ, CD, YW, and XJ. All authors critically revised and approved the final version of the manuscript, and share responsibility for its content.This work was funded by the 13th Five-Year Plan Foundation of Jiangsu Province for Medical Key Talents (ZDRCA2016091) and the Science Foundation of Outstanding Youth in Jiangsu Province (BK20170009).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.https://www.frontiersin.org/articles/10.3389/fnut.2023.1236036/full#supplementary-materialThe Supplementary material for this article can be found online at: Click here for additional data file.


P = .004), likes (P = .000), view ratio (P = .019), and video power index (P = .024). During the COVID-19 pandemic, views (P = .033), view ratio (P = .006), and video power index (P = .043) also increased. Douyin has been a valuable source of health information for patients during COVID-19 pandemic regarding the occurrence of humeral supracondylar fracture in children. Medical professionals and institutions should upload credible, informative videos and clear, high-quality, scientifically reviewed surgical footage of children with humeral supracondylar fracture. And the videos uploaded by medical professionals and filtered by Douyin’s staff appear to be necessary.We aimed to investigate whether Douyin videos on pediatric humeral supracondylar fractures could be a useful source during the COVID-19 pandemic. A search was conducted using the term “humeral supracondylar fracture of children” on Douyin. The top 100 videos were selected based on view count. 74 was the final analysis, after excluding 26 videos for various reasons. First, the videos were classified into medical and the non-medical groups based on authorship. The medical team videos were about explanations or detailed surgical procedures directly related to child’s fracture. There were also non-medical videos, mostly about personal experiences and other things. The videos were then also divided into 2 groups abased on the year of COVID-19 pandemic. The number of views, content type, video duration and number of likes about the video were analyzed. Among the 74 videos included in this study, had a total of 19,647,988 views . Compared to the medical group, the non-medical group had more views ( However, during the COVID-19 pandemic in the Chinese Mainland, patients tried to obtain relevant information from other sources due to difficulties in treatment. As previous reported, networks may provide access to a wide range of visual educational and online medical resources. As the anxiety levels of many guardians of children with pediatric supracondylar humerus fracture are increasing, it is important to use reliable Douyin videos to obtain appropriate information, especially during pandemic periods when medical treatment is inconvenient.Supracondylar humerus fractures Fig.  are the  The internet has already had a major impact on how the world communicates, with social media platforms facilitating mechanisms for instant information sharing. One of them is Douyin (Tik tok), a mobile app created in 2016 that has gained more than 800 million users in a few years and is the largest social online short video platform in China. However, a lack of professional information is often posted due to the lack of expertise of Douyin staff. In addition, there are still disputes about the reliability of the videos due to the lack of peer review. There has been no study on the information of supracondylar fracture of humerus in children from Douyin. Therefore, we analyzed the content of the videos related to pediatric supracondylar humerus fracture that were most played on Douyin and found out the characteristics of the videos related to pediatric supracondylar humerus fracture viewed by the public. In addition, we also evaluated the quality of these videos to determine whether they conveyed accurate and important information during the COVID-19 pandemic in the Chinese mainland.People are spending more time online due to social restrictions caused by COVID-19.The study was authorized by the ethics committee of the Second People’s Hospital of Lianyungang and followed the Declaration of Helsinki.Using the term “supracondylar fracture of humerus,” a Douyin search was conducted on September 26, 2022. The following criteria were applied for inclusion: use of the Chinese language; videos related to supracondylar fracture of humerus; and adequate audiovisual quality. The exclusion criteria: use of languages other than Chinese; objectionable visual or audio; supracondylar fractures in adults; and duplicate videos.The top 100 of the videos were chosen. The final analysis included 74 Douyin videos using the keywords “humeral supracondylar fracture of children” after 26 videos were excluded  , pediatric orthopedic surgeons, patients , commercial establishments, or auxiliary medical cares. Based on the content of the videos, they were categorized into 4 categories: Disease explanations ; surgical procedures ; personal experiences ; and others .The videos were then divided into medical and non-medical groups. The former included videos uploaded by academic and pediatric orthopedic surgeons, and the latter included videos uploaded by patients, commercial establishments, and auxiliary medical cares Table . At the  The overall quality of the video was then assessed based on whether or not it contained important information about the humeral supracondylar fracture in children and how much scientific evidence was available.Based on a previous study, we employed a validated scoring system: the global quality score to evaluate a the overall quality of healthcare videos Table .[10] The,12 This was different from some previous studies, because the number of dislikes was not indicated in Douyin. And thus dislikes were not included in the video evaluation metric in this study.Based on previous studies on YouTube, we used likes to assess the popularity of the videos, like ratio = likes/views*100, view ratio = number of views/days since upload, and video power index (VPI) = like ratio*view ratio/100.P value < .05 was considered statistically significant.The continuous variable video data were shown as median (range) values and compared using an unpaired test-test. The categorical variables were denoted as n (%) and were compared using Fisher’s exact test. The statistical analysis was conducted with Graphpad Prism 8, and the A total of 19,647,988  views were given to 74 videos related to pediatric humeral supracondylar fractures. The median time of the video was 4.60 (range 0.20–12.00) min and the average uploaded time of the videos was 622 range 43–1947) days previously (Table –1947 dayP = .004), likes (P = .000), view ratios (P = .019), and VPI (P = .024), however, there was no significant difference in video length (P = .762), time on Douyin (P = .497), and score (P = .377) , view ratios (P = .006), and VPI (P = .043), however, video length (P = .451), likes (P = .421), and score (P = .555) were not significantly different . For video authorship, it was found that videos uploaded by surgeons were the most (n = 20). And videos sharing the personal experiences and feelings of children with humeral supracondylar fracture were the fewest (n = 10). The medical and nonmedical groups uploaded 39 and 35 videos, respectively. After statistical analysis, it was found that the non-medical group had more views (th P = .72, time o In a study that analyzed YouTube videos of cardiopulmonary resuscitation by Turkey scholars, in their review, they reported a relationship between high VPI scores and low professional perspective. We believe that this may be related to the following reasons: With Douyin’s stricter audit system, low-quality videos may not be uploaded; and During the COVID-19 pandemic, normal ways of seeking medical care were affected, so internet-based medical care has risen in China. Non-medical units also paid great attention to online promotion, and they tend to upload high-quality videos.It was found that the most viewed video on Douyin about a child’s humeral supracondylar fracture was uploaded in 2020 by an account belonging to Dr Yao Jinghui, which provides information on the surgery. The second most viewed video on Douyin was also uploaded by Beijing Children’s Hospital in 2020. However, the highest VPI video was uploaded in 2021 by a parent of a child, which belongs to the non-medical group. Reflecting on the results, we found that the most viewed video does not necessarily have the highest VPI, since the VPI is an aggregate metric. In contrast to the medical group, VPI was found to be significantly higher in the non-medical group. Moreover, the medical group did not have significantly higher video scores than the non-medical group. Since the current research related to short videos and medical information is mainly related to YouTube, we compared out results to previous studies and found that our results are not similar to some previous studies Some scholars reviewed 50 videos on Youtube regarding meniscus and found that the videos uploaded by non-medical groups with information about meniscus tended to have lower video scores and often lower quality and reliability.It was found that the number of views, the view ratio, and VPI, which are indicators of the popularity of videos on Douyin, differ significantly between videos uploaded before 2019 and after 2019. We found that in terms of metrics that reflect the video popularity, the above metrics were significantly higher for video groups uploaded after 2019 than for those uploaded before 2019. Considering that the number of uploaded videos also increased after 2019, this could also be accounted for by the fact that Douyin became more popular during the COVID-19 pandemic and amateurs could easily access and produce content.–17 At the same time, similar results were reported in the study of Douyin. In recent years, however, there has been a gradual increase in research on Douyin especially on its benefits.,19 Because Douyin has a more rigorous audit system than YouTube, it is possible to use Douyin in the future to provide high-quality medical information in the field of pediatric humeral supracondylar fracture. Therefore, Douyin must strengthen the monitoring function of the active filtering process; in such a way that more useful medical knowledge can be provided during the COVID-19 pandemic.Several studies on YouTube have pointed out that the short video platform may be somewhat flawed in its function of transmitting medical information, as such information can be widely disseminated without filtering or scientific verification.It was found that the video of Douyin regarding humeral supracondylar fracture in children were provided a lot of useful information in this study. The results showed that videos with humeral supracondylar fracture of children are of high quality of information and Douyin is currently the appropriate source of such information for children with humeral supracondylar fracture. Medical professionals and medical institutions should upload credible and accurate videos and clear, high-quality, scientifically commented surgical clips to rigorously and quickly assess the quality of online video dissemination of pediatric humeral supracondylar fractures. In addition, it seems necessary for Douyin staff to use categories for advanced filtering. If necessary, even some medical related background staff may be employed.There are some limitations to this study as well. We only analyzed 74 Douyin videos identified using the keyword “humeral supracondylar fracture of children.” The classification in this study was based on the number of views and included only Chinese videos, so there could be sampling bias. However, since there was no unified standard for evaluating videos, the scoring system was based on previous studies. Therefore, more validation is need to ensure that this evaluation method is applicable to accurately assess the video quality of pediatric humeral supracondylar fracture. In the future, we will further investigate the role of short videos in medical knowledge acquisition and dissemination, especially during the epidemics.Conceptualization: Zhitao Zhu, Yan Zheng, Dongsheng Zhu.Data curation: Yan Zheng, Dongsheng Zhu.Formal analysis: Yan Zheng, Dongsheng Zhu.Investigation: Dongsheng Zhu.Methodology: Dongsheng Zhu.Project administration: Dongsheng Zhu.Resources: Dongsheng Zhu.Software: Dongsheng Zhu.Supervision: Dongsheng Zhu.Validation: Dongsheng Zhu.Visualization: Zhitao Zhu, Dongsheng Zhu.Writing – original draft: Dongsheng Zhu.Writing – review & editing: Zhitao Zhu, Dongsheng Zhu.


Jena Eyewitness Research Stimuli (JERS). They comprise six video sequences depicting a mock theft committed by two different perpetrators, available in both two-dimensional (2D) and 360° format, combined with the corresponding lineup images presented in 2D or three-dimensional (3D) format. Images of one suspect and eight fillers are available for each lineup. We evaluated lineup fairness by using mock eyewitness paradigm and noted a Tredoux’s E of 4.687 for Perpetrator 1 and 5.406 for Perpetrator 2. Moreover, no bias towards the perpetrators was observed in the lineups. We incorporated 360° videos and 3D lineup images to encourage the adoption of innovative data formats in experimental investigations of eyewitness accuracy. In particular, compatibility with Virtual Reality (VR) makes JERS a promising tool for advancing eyewitness research by enabling researchers to construct controlled environments that offer observers an immersive experience. JERS is freely accessible for the use of academic purposes via the Open Science Framework (OSF).Empirical investigations into eyewitness identification accuracy typically necessitate the creation of novel stimulus materials, which can be a challenging and time-consuming task. To facilitate this process and promote further research in this domain, we introduce the new  Eyewitness identifications of suspected criminals are often crucial evidence in criminal proceedings. However, it is frequently observed that eyewitnesses exhibit suboptimal accuracy in identification tasks –5, and mJena Eyewitness Research Stimuli (JERS). This database offers six video sequences of a mock theft involving two different perpetrators in 2D and 360° format, as well as corresponding lineup images in 2D or 3D format. Decades of research in eyewitness and memory studies provide contrasting results on the effects of acute stress on memory ),The utilization of a VR technology offers new opportunities for experimental psychological research owing to its ability to engender a heightened sense of authenticity and realism in user experiences , 15. To Valence and Arousal scales of the Self-Assessment Manikin [SD = 10.28, min = 18, max = 56; additional descriptive data can be found in S8 Table in TM Rift VR glasses and a desktop computer with an NVIDIA GeForce GTX 1060 6GB graphics card were used to present these stimuli. Valence and Arousal measures were assessed at three different time points: prior to viewing the videos (t1), after watching the “low stress” video (t2), and after watching the “high stress” video (t3). After data collection, the authors did not have access to information that could have identified individual participants. The results displayed in Valence and Arousal were observed between t1 and t2, t2 and t3, and t1 and t3. Detailed results can be found in S9 Table in To validate the manipulation of stress level induced by the two videos, we used the  Manikin . For thiThe research reported in this article has been approved by the Ethics Committee of the Faculty for Social and Behavioral Sciences of Friedrich Schiller University (Reg.-Nr. FSV 20/035). All participants provided written informed consent to their participation; moreover, all participants appearing in the images or videos of the stimulus database provided written informed consent to the non-commercial use of these stimuli in scientific research, and to their inclusion and publication in the context of this database. The individual in this manuscript has given written informed consent (as outlined in PLOS consent form) to publish these case details.st, 2000, as compared with 360 papers published in the years 1975–1999. However, as the creation and validation of appropriate stimuli take substantial time and effort, we hope that by providing JERS to the research community, we will facilitate further eyewitness research and encourage the use of new data formats in eyewitness accuracy studies. Especially the utilization of VR videos and 3D lineup images appears to be inadequately represented despite its potential, which may be attributed to the perceived high levels of expertise, equipment and resources required for generating such stimuli. JERS is freely accessible for the use of academic purposes via the Open Science Framework .There is high and increasing demand for, and use of, lineup stimuli in psychological eyewitness research. For instance, a Web of Science search of scientific articles using the keyword ’lineup’ (conduced on 22 Mai 2023) returned more than 1,200 papers published since January 1The importance of conducting eyewitness research stems from the recognition that eyewitness reports may be vulnerable to inaccuracies, despite their considerable influence in criminal justice proceedings –4. ConseFurthermore, while we appreciate that some researchers who wish to use the JERS stimuli to investigate effects or stress or emotions on eyewitness memory might use their own or customized material Click here for additional data file.S1 File(PDF)Click here for additional data file.