Dynamics of following and leading: association of movement synchrony and depression severity.

Objective: Depression negatively affects interpersonal functioning and influences nonverbal behavior. Interpersonal theories of depression suggest that depressed individuals engage in behaviors that initially provoke others' support and reassurance, but eventually lead to rejection that may also be expressed nonverbally. Methods: This study investigated movement synchrony as a nonverbal indicator of support and rejection and its association with depression severity in a sample of depressed and healthy individuals. Semi-standardized diagnostic interview segments with N = 114 dyads were video recorded. Body movement was analyzed using Motion Energy Analysis, synchrony intervals were identified by computing windowed cross-lagged correlation and a peak-picking-algorithm. Depression severity was assessed via both self-rating (BDI-II) and clinician rating (HAMD). Results: Both self-rated and clinician-rated depression severity were negatively correlated with patient-led, but not clinician-led movement synchrony measures. The more depressed patients were, the less they initiated movement synchrony with their clinicians. These correlations remained significant after controlling for gender, age, gross body movement, and psychopharmacological medication. Conclusion: Findings suggest that depression may negatively affect patients' active initiative in interaction situations. Automatized methods as used in this study can add valuable information in the diagnosis of depression and the assessment of associated social impairments.

Child, family and professional views on valued communication outcomes for non-verbal children with neurodisability: A qualitative meta-synthesis.

BACKGROUND: There are many children with neurodisability who are unable to rely on speech to communicate and so use a range of augmentative and alternative communication (AAC) methods and strategies to get their message across. Current instruments designed to measure the outcomes of speech and language therapy interventions lack specific attention to communication outcomes that are valued by non-verbal children with neurodisability, their families and support networks. This qualitative meta-synthesis was conducted to identify valued communication outcomes to inform the next stage of developing a novel outcome measure. AIMS: To systematically identify and synthesise the qualitative evidence about which communication outcomes non-verbal children with neurodisability, their family members, healthcare professionals and educators think are important to achieve, specifically which communication outcomes are most valued by: (1) non-verbal children with neurodisability; (2) parents or other family members of non-verbal children with neurodisability; and (3) professionals who work with non-verbal children with neurodisability. METHODS & PROCEDURES: A systematic search of bibliographic databases and the grey literature was undertaken to identify qualitative studies that included evidence of views expressed by children, family members, healthcare professionals and educators on outcomes in relation to the communication of non-verbal children with neurodisability. All papers meeting the inclusion criteria were quality appraised using the Critical Appraisal Skills Programme Qualitative checklist, although none were excluded on this basis. The data synthesis involved organising coded data into descriptive themes which were then synthesised into analytical themes. MAIN CONTRIBUTION: We found 47 papers containing qualitative data meeting the inclusion criteria from research situated in 14 countries. The views of 35 children, 183 parents, six other family members, 42 healthcare professionals and 18 educators are represented in the review. The included studies contained very few data reported by children themselves; most data were provided by adults, especially parents. Three main analytical themes were identified: Experiences of communication and expectations; adapting to and acceptance of AAC; and becoming an autonomous communicator. CONCLUSIONS & IMPLICATIONS: This meta-synthesis brings together the limited qualitative research findings about what parents, professionals and children consider are important communication outcomes for non-verbal children with neurodisability. The synthesis identifies key gaps in our knowledge about the perspectives of children and their siblings. This synthesis will inform primary research to understand valued communication outcomes in this group, and ultimately the development of a patient-reported outcome measure (PROM) that can be used to demonstrate the effect of interventions, at both clinical and service levels. WHAT THIS PAPER ADDS: What is already known on the subject Studies of children with cerebral palsy and autism spectrum disorder indicate that at least 25% of children with these conditions are non-verbal. Studies on the health outcomes of children with neurodisability have identified that communication is rated as important by parents and health professionals. There is an evidence gap about which communication outcomes are important to non-verbal children, their families and the people who work with them. What this paper adds to the existing knowledge This is the first synthesis of data that relates to communication outcomes for non-verbal children with neurodisability. This qualitative meta-synthesis identifies from previous research studies the communication outcomes valued by children who are non-verbal, their parents or other family members, and the professionals who work with them. The findings will be used to shape further primary research and the development of a novel patient-reported communication outcome measure for non-verbal children with neurodisability. It is anticipated that this will be used by clinicians to measure the effect of their interventions. What are the practical and clinical implications of this work? Clinicians should reflect on parents' experiences of communication with their child before discussing potential outcomes with them. Gaining insight into the lived experience of communication for non-verbal children and their families will help healthcare professionals to understand which goals are important to them and why. Few studies have specifically asked which communication outcomes are important for non-verbal children with neurodisability. Further exploration is needed to determine which communication outcomes non-verbal children and their families would like to see included in outcome measures used by clinicians.

Video Training and Telepractice for Parents of Nonverbal Children with Autism Spectrum Disorder: a Randomized Control Trial.

Background: Many children with autism spectrum disorder (ASD) are unable to benefit from timely interventions. This research aimed to indirectly enhance play and communication skills in ASD children by providing a video educational package and distance education for their parents. Methods: In this clinical trial study, 32 parents and their children with ASD were randomly assigned to either the intervention or waitlist control groups. The intervention group received an educational video package along with 24 one-hour online sessions. The frequency of communication, engagement in functional games, and the use of conventional and unconventional gestures were assessed before, immediately after, and 3 months following the completion of the intervention in the participating children. The variables were analyzed within and between the two groups using a mixed between-within-subjects analysis of variance (ANOVA). Results: The intervention group achieved significantly higher scores than the control group in the frequency of communication (P = 0.003), functional play (P < 0.001), and conventional gestures (P < 0.001). Conversely, the intervention group had significantly lower scores than the control group in unconventional gestures (P < 0.001). Conclusion: The observed improvements in both parents and children within the intervention group provide compelling support for the effectiveness of telepractice in speech therapy. This suggests that incorporating remote training methods into speech therapy sessions could enhance access for children with ASD to these interventions.

The Psychological Nature of Female Gait Attractiveness.

Walking, a basic physical movement of the human body, is a resource for observers in forming interpersonal impressions. We have previously investigated the expression and perception of the attractiveness of female gaits. In this paper, drawing on our previous research, additional analysis, and reviewing previous studies, we seek to deepen our understanding of the function of gait attractiveness. First, we review previous research on gait as nonverbal information. Then, we show that fashion models' gaits reflect sociocultural genderlessness, while nonmodels express reproductive-related biological attractiveness. Next, we discuss the functions of gait attractiveness based on statistical models that link gait parameters and attractiveness scores. Finally, we focus on observers' perception of attractiveness, constructing a model of the visual information processing with respect to gait attractiveness. Overall, our results suggest that there are not only biological but also sociocultural criteria for gait attractiveness, and men and women place greater importance on the former and latter criteria, respectively, when assessing female gait attractiveness. This paper forms a major step forward in neuroaesthetics to understand the beauty of the human body and the generation of biological motions.

A Louder Call for the Integration of Multiple Nonverbal Channels in the Study of Affect.

Affective science has increasingly sought to represent emotional experiences multimodally, measuring affect through a combination of self-report ratings, linguistic output, physiological measures, and/or nonverbal expressions. However, despite widespread recognition that non-facial nonverbal cues are an important facet of expressive behavior, measures of nonverbal expressions commonly focus solely on facial movements. This Commentary represents a call for affective scientists to integrate a larger range of nonverbal cues-including gestures, postures, and vocal cues-alongside facial cues in efforts to represent the experience of emotion and its communication. Using the measurement and analysis of vocal cues as an illustrative case, the Commentary considers challenges, potential solutions, and the theoretical and translational significance of working to integrate multiple nonverbal channels in the study of affect.

Chinese Version of the Nonverbal Pain Assessment Tool: Critical Patient Reliability and Validity.

AIMS AND OBJECTIVES: To translate and validate the Nonverbal Pain Assessment Tool. BACKGROUND: Timely assessment of the pain degree of nonverbal intensive care unit (ICU) patients can provide humanistic care. However, there is a lack of pain assessment tools that can meet the needs of patients who cannot use language in ICUs in China. DESIGN: A cross-sectional survey. METHODS: We conducted forward-backward translation of the Nonverbal Pain Assessment Tool. A total of 300 critically ill patients in the intensive care unit who could not communicate verbally completed the Chinese version of the Nonverbal Pain Assessment Tool and the Critical Care Pain Observation Tool. Exploratory and confirmatory factor analyses were performed to verify structural validity, and content validity and reliability analyses were also conducted. RESULTS: The Nonverbal Pain Assessment Tool demonstrated high internal consistency (α = 0.901) and interrater reliability (intraclass correlation coefficient = 0.981), with good split-half reliability. Content validity was established through acceptable item-level content validity index and scale-level content validity index scores. Exploratory factor analysis showed a single factor explaining 71.79% of total variance, and confirmatory factor analysis confirmed good model fit. The Spearman rank correlation coefficient was 0.917 between the Nonverbal Pain Assessment Tool and the Critical Care Pain Observation Tool. The Chinese Nonverbal Pain Assessment Tool demonstrated significant differences in scores between different states of consciousness and illness severity, supporting its known-groups validity. CONCLUSION: The Chinese version of the Nonverbal Pain Assessment Tool is a reliable and valid tool for nonverbal pain assessment in ICU patients in China. RELEVANCE TO CLINICAL PRACTICE: The Chinese version of the Nonverbal Pain Assessment Tool can assess the pain of patients who cannot use language in ICU, which provides a new valuable assessment tool for Chinese clinicians and nurses in pain assessment and management. REPORTING METHOD: Our study followed the STROBE Checklists. PATIENT OR PUBLIC CONTRIBUTION: Patients actively cooperated and participated in data collection during the implementation of the study.

Measuring autism with the ADOS-2 using a bifactor model.

The measurement of autism characteristics can be challenging due to variability of social impairments and restricted and repetitive behaviors or interests (RRBs). Psychometrically strong measures such as the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) can improve our capacity for thorough autism assessment. The conceptualization of the ADOS-2 has been shaped by research exploring the structure of its items, which evaluate autism traits associated with social affect and RRBs. Continuously refining our understanding of these items and their relations to other characteristics, such as cognition, is crucial for more accurate autism assessment and diagnosis. This study used data from a sample of 188 school-age children with mostly average cognitive functioning referred for clinical autism evaluations to (1) test the dimensionality of the ADOS-2, Module 3 (appropriate for children with relatively higher verbal ability), across two sets of items (i.e., algorithm only, algorithm with three non-algorithm RRB items) using confirmatory factor analysis (CFA) and (2) examine the relations of cognition to the dimensions tested in the ADOS-2. A bifactor model, featuring a general autism trait and two subfactors (RRB and Social Affect), provided superior fit for algorithm-only and algorithm with three non-algorithm items. Cognitive functioning was not significantly related to the general or specific factors in the model with only algorithm items. While the findings support the validity of the ADOS-2, it may not fully capture RRBs among children referred for autism. This study enhances our understanding of the ADOS-2, highlighting the utility of a bifactor model for characterizing its dimensionality, measuring autism traits with minimal cognitive influence, and identifying its limitations in assessing RRBs.

Digital assessment of nonverbal behaviors forecasts first onset of depression.

BACKGROUND: Adolescence is marked by a sharp increase in the incidence of depression, especially in females. Identification of risk for depressive disorders (DD) in this key developmental stage can help prevention efforts, mitigating the clinical and public burden of DD. While frequently used in diagnosis, nonverbal behaviors are relatively understudied as risk markers for DD. Digital technology, such as facial recognition, may provide objective, fast, efficient, and cost-effective means of measuring nonverbal behavior. METHOD: Here, we analyzed video-recorded clinical interviews of 359 never-depressed adolescents females via commercially available facial emotion recognition software. RESULTS: We found that average head and facial movements forecast future first onset of depression (AUC = 0.70) beyond the effects of other established self-report and physiological markers of DD risk. CONCLUSIONS: Overall, these findings suggest that digital assessment of nonverbal behaviors may provide a promising risk marker for DD, which could aid in early identification and intervention efforts.

Evaluating pain in non-verbal critical care patients: a narrative review of the critical care pain observation tool and Its clinical applications.

Background: Assessing pain in critically ill patients who cannot communicate verbally poses significant challenges. Traditional self-report measures are ineffective for these patients, making the need for reliable observational tools crucial. Objective: To evaluate the effectiveness, reliability, and clinical applicability of the Critical Care Pain Observation Tool (CPOT) in various intensive care unit (ICU) settings and to explore potential innovations for improving its use and integration into clinical practice. Methods: A narrative review evaluated the Critical Care Pain Observation Tool (CPOT) for non-communicative ICU patients, comparing it to the Behavioral Pain Scale (BPS) and the FLACC scale. The review assessed CPOT's effectiveness across different ICU settings, identified limitations and challenges, and explored potential enhancements such as electronic scoring, additional physiological indicators, and improved training protocols. Results: The CPOT has been validated as an effective pain assessment tool for non-verbal ICU patients. It evaluates pain through facial expressions, body movements, muscle tension, and ventilator compliance. The CPOT shows superior sensitivity at 76.5% compared to 62.7% for the BPS and offers a more comprehensive assessment of pain indicators like muscle tension and ventilator compliance than the FLACC scale. Despite its strengths, the CPOT has limitations, including inter-rater variability and challenges in certain patient populations. Barriers to implementation include resource constraints and the need for extensive training. Conclusion: The Critical Care Pain Observation Tool (CPOT) is a highly effective instrument for assessing pain in non-verbal ICU patients, demonstrating superior accuracy and reliability compared to other tools like the Behavioral Pain Scale (BPS) and FLACC scale. Its detailed approach, covering facial expressions, body movements, muscle tension, and ventilator compliance, offers a detailed measure of pain. However, challenges such as inter-rater variability and limitations in specific patient populations highlight the need for ongoing refinement and research.

Artificial intelligence-generated feedback on social signals in patient-provider communication: technical performance, feedback usability, and impact.

Objectives: Implicit bias perpetuates health care inequities and manifests in patient-provider interactions, particularly nonverbal social cues like dominance. We investigated the use of artificial intelligence (AI) for automated communication assessment and feedback during primary care visits to raise clinician awareness of bias in patient interactions. Materials and Methods: (1) Assessed the technical performance of our AI models by building a machine-learning pipeline that automatically detects social signals in patient-provider interactions from 145 primary care visits. (2) Engaged 24 clinicians to design usable AI-generated communication feedback for their workflow. (3) Evaluated the impact of our AI-based approach in a prospective cohort of 108 primary care visits. Results: Findings demonstrate the feasibility of AI models to identify social signals, such as dominance, warmth, engagement, and interactivity, in nonverbal patient-provider communication. Although engaged clinicians preferred feedback delivered in personalized dashboards, they found nonverbal cues difficult to interpret, motivating social signals as an alternative feedback mechanism. Impact evaluation demonstrated fairness in all AI models with better generalizability of provider dominance, provider engagement, and patient warmth. Stronger clinician implicit race bias was associated with less provider dominance and warmth. Although clinicians expressed overall interest in our AI approach, they recommended improvements to enhance acceptability, feasibility, and implementation in telehealth and medical education contexts. Discussion and Conclusion: Findings demonstrate promise for AI-driven communication assessment and feedback systems focused on social signals. Future work should improve the performance of this approach, personalize models, and contextualize feedback, and investigate system implementation in educational workflows. This work exemplifies a systematic, multistage approach for evaluating AI tools designed to raise clinician awareness of implicit bias and promote patient-centered, equitable health care interactions.

Non-verbal effecting - animal research sheds light on human emotion communication.

Cracking the non-verbal "code" of human emotions has been a chief interest of generations of scientists. Yet, despite much effort, a dictionary that clearly maps non-verbal behaviours onto meaning remains elusive. We suggest this is due to an over-reliance on language-related concepts and an under-appreciation of the evolutionary context in which a given non-verbal behaviour emerged. Indeed, work in other species emphasizes non-verbal effects (e.g. affiliation) rather than meaning (e.g. happiness) and differentiates between signals, for which communication benefits both sender and receiver, and cues, for which communication does not benefit senders. Against this backdrop, we develop a "non-verbal effecting" perspective for human research. This perspective extends the typical focus on facial expressions to a broadcasting of multisensory signals and cues that emerge from both social and non-social emotions. Moreover, it emphasizes the consequences or effects that signals and cues have for individuals and their social interactions. We believe that re-directing our attention from verbal emotion labels to non-verbal effects is a necessary step to comprehend scientifically how humans share what they feel.

Pain in non-communicative older adults beyond dementia: a narrative review.

Aging is associated with an increased risk of developing pain, especially in the presence of concurrent chronic clinical conditions. Similarly, multimorbidity can affect the perception and ability of older adults to appropriately respond to and communicate pain, and there is a clinical heterogeneity in the processing of painful sensations in different neurological conditions. The present narrative review is aimed at assessing the prevalent diseases associated with poor communication and pain in older adults, together with the available diagnostic instruments for the clinical assessment of pain in such a vulnerable population. Dementia was the most described pathology identified in the current literature associated with poor communication in older adults affected by pain, along with Parkinson's disease and stroke. Notably, a common pattern of pain behaviors in these neurological disorders also emerged, indicating potential similarities in the clinical presentation and appropriate diagnostic workout. At the same time, there are many differences in the way patients express their pain according to their main neurological pathology. In addition to this, although a plethora of observation-based tools for pain in patients with dementia have been developed, there is no gold standard, and the clinical utility of such measurements is still largely unaddressed. Meanwhile, there is substantially no standardized observation-based tool for pain in non-communicative patients with Parkinson's disease, and only a few for stroke. Overall, the present narrative review provides an update on the prevalent diseases beyond dementia associated with a communicative disability and a painful condition in older adults.

Profiles of nonverbal skills used by young pre-verbal children with autism on the ADOS-2: Relation to screening disposition and outcomes.

Autistic individuals exhibit differences in their use and understanding of nonverbal communication; however, individual patterns of nonverbal strengths and challenges vary significantly. This heterogeneity can complicate the diagnostic and screening processes and can result in delayed or missed diagnoses. In this study, we characterize various profiles of nonverbal communication skills among 215 pre-verbal children with autism (Mage = 36.27 months, range = 18-70) and explore how these profiles are related to screening outcomes, diagnostic certainty, and developmental and behavioral features. We conducted a latent class analysis of nine items assessing nonverbal communication skills from the Toddler Module and Module 1 of the Autism Diagnostic Observation Schedule, 2nd Edition. Five nonverbal profiles were identified that differentiated children based on the form, function, and frequency of their nonverbal communication skills. Furthermore, screening outcomes and clinician certainty in autism diagnosis varied by nonverbal profile. False negative screening outcomes based on parent report were highest for children who used a range of nonverbal skills but with limited frequency or consistency. Clinicians, on the other hand, tended to have high certainty in an autism diagnosis for children with this profile, and instead rated their lowest certainty in diagnosing children who demonstrated consistent integration of eye contact with their nonverbal communication. The profiles identified in this study could be clinically useful in helping to identify children at highest likelihood of being overlooked during the screening or diagnostic processes, providing an opportunity to improve early identification and intervention for autism.

Quantitative phenotyping of verbal and non-verbal cognitive impairment using diffusion-weighted MRI connectome: Preliminary study of the crowding effect in children with left hemispheric epilepsy.

The "crowding" effect (CE), wherein verbal functions are preserved presumably at the expense of nonverbal functions, which diminish following inter-hemispheric transfer of language functions, is recognized as a specific aspect of functional reorganization, offering an insight about neural plasticity in children with neural insult to the dominant hemisphere. CE is hypothesized as a marker for language preservation or improvement after left-hemispheric injury, yet it remains challenging to fully discern it in preoperative evaluation. We present a novel DWI connectome (DWIC) approach to predict the presence of CE in 24 drug-resistant epilepsy (DRE) patients with a left-hemispheric focus and 29 young healthy controls. Psychometry-driven DWIC analysis was applied to create verbal and non-verbal modular networks. Local efficiency (LE) was assessed at individual regions of the two networks and its Z-score was compared to predict the presence of CE. Compared with a traditional organization (TO) group, wherein verbal functions are adversely affected, while non-verbal functions are preserved, the CE group showed significantly higher Z-scores in verbal network and significantly lower Z-scores in non-verbal network, corresponding to network reorganization in CE. A larger number of antiseizure drugs was significantly associated with more decreased Z-score in the right non-verbal network of the CE group and left verbal network of the TO group. These findings hold great potential to identify DRE patients whose verbal/language skills may over time be preserved due to effective inter-hemispheric reorganization and identify those whose verbal/language impairments may persist due to lack of inter-hemispheric reorganization.

Social-touch and self-touch differ in hemodynamic response in the prefrontal cortex - a fNIRS study conducted during the coronavirus pandemic.

Being touched by others (social-touch) and touching oneself (self-touch) are common nonverbal behaviors in everyday interaction. The commonalities and differences between these two types of touching behavior are of particular interest for conditions when social-touch is substantially restricted such as during the corona pandemic. Neuropsychologically, pleasant social-touch is associated with increased activation in frontal brain regions such as frontopolar, dorsolateral prefrontal (dlPFC), and orbitofrontal cortices (OFC). However, for these regions a deactivation has also been reported. Likewise, for self-touch the findings are controversial. Therefore, the aim of this study is to shed light on the controversial findings and to elucidate the relation between self-touch and social-touch. From 2021 to 2022, in a quasi-naturalistic setting, in forty-six participants brain oxygenation and deoxygenation was examined during social-touch and self-touch in frontal cortices applying functional NearInfraRed Spectroscopy (fNIRS). Social-touch compared to self-touch led to a significantly higher brain deoxygenation in the frontopolar areas and in parts of the dlPFC and OFC. In contrast, brain oxygenation in the PFC was significantly increased during self-touch compared to social-touch. The cerebral activation and deactivation pattern in a quasi-naturalistic setting indicates that self-touch cannot achieve the hedonic effects of social-touch, but it can influence internally self-regulating processes.

Exploring the potential of pantomime games in medical education: Non-verbal exercise.

The primary educational challenge in medical education is the lack of focus on non-verbal communication skills, such as body language, facial expressions, and gestures. This gap is crucial, particularly in multicultural and multilingual contexts where non-verbal cues can bridge language barriers and enhance understanding between healthcare professionals and patients. To address this, our wave explores the potential of integrating art, specifically pantomime games, into medical education as a non-verbal exercise. Inspired by ancient drama and role-play, pantomime games offer an innovative methodology for enhancing non-verbal communication skills. These games help students develop observation, empathy, and ambiguity tolerance-skills essential for effective healthcare delivery. Incorporating art and game-based learning into medical curricula has improved visual perception, personal reflection, and student engagement. The benefits of this integration extend globally, fostering emotional intelligence, creative thinking, and cross-cultural understanding. Educational games create a safe environment for students to experiment, learn from mistakes, and gain practical experience, ultimately reducing training time and instructor load. Moreover, non-verbal communication training can enhance professor-student interactions, improving feedback quality and learning outcomes. To implement these innovations, clear guidelines and effective facilitation are crucial. Educators should provide supportive environments for experimentation and learning, using minimal materials such as open spaces and simple props. High-resource settings can leverage AI technologies for feedback and create mobile applications to modernize the approach. This wave advocates for a student-centered, multimodal communication and learning environment, highlighting the transformative potential of integrating performing arts into medical education to prepare future healthcare providers better.

Exploring What Motivates Parents of Children Living With Medical Complexity to Participate in Research.

BACKGROUND: The study aimed to understand the experience of and identify the motivations for parents participating in health research for their children with medical complexity (CMC). Patient-oriented research strategies are increasingly important in health research to ensure that the voices of patients and parents help shape and direct research programmes. To bring a family-centred and patient-oriented focus to our research and objectives, we asked parents about their experiences when they participated in healthcare research related to their child with CMC. METHODS: A parent partner, who also has a CMC, interviewed 12 parents (11 mothers and 1 father) of children living with medical complexity to understand their motivations to participate in healthcare research for their child. The parent partner conducted and transcribed the interviews and led our data analysis. Interpretive phenomenological analysis (IPA) was used to inform our data coding and analytic process. RESULTS: Parents described numerous reasons for their participation in research about their children. These motivations landed within four main themes: feeling helpless and hopeful, child-centred motivation, being part of something good and forming a relationship with the research team. In addition to these themes, parents highlighted factors that influenced their ability or desire to participate, such as time, capacity and the level of invasiveness for their child. Ultimately, the reflections by parents emphasized their unique lives in caring for their CMC and the need to integrate their lived experiences with the research they engage in. CONCLUSION: This study offers important insights for healthcare teams who want to engage parents of CMC to participate in research. Understanding parents' motivation to participate in research can help researchers create richer engagement and more meaningful experiences for themselves and their participants, thereby bolstering research programmes.

Beyond words: investigating non-verbal indicators of collaborative engagement in a virtual synchronous CSCL environment.

In the future of higher education, student learning will become more virtual and group-oriented, and this new reality of academic learning comes with challenges. Positive social interactions in virtual synchronous student learning groups are not self-evident but need extra support. To successfully support positive social interactions, the underlying group processes, such as collaborative group engagement, need to be understood in detail, and the important question arises: How can collaborative group engagement be assessed in virtual group learning settings? A promising methodological approach is the observation of students' non-verbal behavior, for example, in videoconferences. In an exploratory field study, we observed the non-verbal behavior of psychology students in small virtual synchronous learning groups solving a complex problem via videoconferencing. The groups were videorecorded to analyze possible relations between their non-verbal behaviors and to rate the quality of collaborative group engagement (QCGE). A rating scheme consisting of four QCGE dimensions (Behavioral, Social, Cognitive, and Conceptual-to-consequential QCGE) was applied, and non-verbal behaviors during the task were coded based on related research literature. We quantitatively and qualitatively analyzed non-verbal behaviors as indicators of QCGE. The results show that groups use a wide range of non-verbal behaviors. Furthermore, certain non-verbal behaviors are significantly related to specific dimensions of QCGE. These results help to identify relevant indicators of QCGE in virtual synchronous learning settings and thus promote the development of advanced methods for assessing QCGE. Furthermore, the indicators can be discussed as possible anchors for supporting collaborative learning in virtual synchronous groups.

Comfort distance between patients and pharmacists during medication instruction: A prospective observational study at a cancer chemotherapy center.

BACKGROUND: The distance from the patient is a crucial factor in the communication with patients. The distance between patients and pharmacists varies depending on several factors. In this study, we aimed to investigate the relationship between comfort distance and patients' physical condition and mood by measuring this distance at a chemotherapy center. METHODS: A total of 114 patients were surveyed regarding their physical condition and mood. The distance at which the patients were best able to talk to the pharmacists was measured. For comfort distance measurement, the pharmacists were instructed to approach or move away from the patients. RESULTS: The correlation between physical condition, mood, and comfort distance was examined in both male and female patients, and no significant correlation was found; however, there was a strong correlation between physical condition and mood in female patients. We looked at correlations by further dividing patients into those over and under 65 years of age and found a slight correlation with comfort distance in women under 65. They tended to shorten the distance when they felt well and lengthen the distance when they felt not well. CONCLUSIONS: No correlation was found between physical condition or mood and comfort distance in male or female. A slight correlation was observed when age was included; however, the results were not satisfactory. By directly measuring the distance in actual patients, we obtained an actual measurement of the comfort distance that synthesized the patient's condition and various backgrounds during chemotherapy, providing a foothold for future studies.

EXPRESS: Hemispheric Asymmetry for Global-Local Processing: Effects of Stimulus Category and Ageing.

Hemispheric asymmetry has been reported for global-local processing in young and older adults, with global processing specialised in the right hemisphere (RH-global specialisation) and local processing specialised in the left hemisphere (LH-local specialisation). Questions persist regarding the extent to which hemispheric asymmetry is influenced by stimulus category (verbal stimuli processed in the left hemisphere; visuospatial stimuli processed in the right hemisphere). Some evidence suggests stimulus category does not influence hemispheric asymmetry (stimulus-independent account) while other evidence suggests it does (stimulus-dependent account). In older adults, there was evidence of a local-processing advantage, believed to result from slower and less accurate performance in right-hemisphere compared to left-hemisphere functioning-the right-hemisphere ageing hypothesis. We examined hemispheric asymmetry for global-local processing in young and older participants with three hierarchical figures (letters, verbalisable objects, nonverbalisable shapes), in a within-subjects design using a divided-attention paradigm and unilateral presentation. Our findings for letters and verbalisable objects support the stimulus-independent account-young and older participants demonstrated RH-global specialisation and LH-local specialisation regardless of stimulus category. In older participants, we also found a local-processing advantage for all three stimulus categories-an advantage best explained as faster and more accurate performance in local processing regardless of the visual field of stimulus presentation. Overall, we found hemispheric asymmetry for global-local processing in both young and older adults, and differences in global processing between young and older adults. Future investigation is suggested for the hemispheric asymmetry found in global-local processing of nonverbalisable shapes, and the mechanisms underlying age-related changes in global processing.