Face masks and fake masks: the effect of real and superimposed masks on face matching with super-recognisers, typical observers, and algorithms.

Mask wearing has been required in various settings since the outbreak of COVID-19, and research has shown that identity judgements are difficult for faces wearing masks. To date, however, the majority of experiments on face identification with masked faces tested humans and computer algorithms using images with superimposed masks rather than images of people wearing real face coverings. In three experiments we test humans (control participants and super-recognisers) and algorithms with images showing different types of face coverings. In all experiments we tested matching concealed or unconcealed faces to an unconcealed reference image, and we found a consistent decrease in face matching accuracy with masked compared to unconcealed faces. In Experiment 1, typical human observers were most accurate at face matching with unconcealed images, and poorer for three different types of superimposed mask conditions. In Experiment 2, we tested both typical observers and super-recognisers with superimposed and real face masks, and found that performance was poorer for real compared to superimposed masks. The same pattern was observed in Experiment 3 with algorithms. Our results highlight the importance of testing both humans and algorithms with real face masks, as using only superimposed masks may underestimate their detrimental effect on face identification.

Motivation communication training programme for healthcare professionals to support adherence in patients with diabetic foot ulcers: Proof of concept study.

Patients with diabetic foot ulcers have poor adherence to treatment recommendations. However, the most effective way to support adherence in this population is unknown. This study aimed to assess the preliminary effectiveness of a motivation communication training programme for healthcare professionals working with these patients, using theory and evidence-based strategies.A proof-of-concept study using a non-randomised, controlled before-and-after design. Six podiatrists took part in the motivation communication training programme. Pre-training, observation was undertaken to examine the communication style currently used by podiatrists in routine consultations. Patients' (n = 25) perceptions of podiatrist autonomy support, self-determination for limiting weight-bearing activity and average daily step count were also assessed. Post training, observations and patient measures were repeated with a different group of patients (n = 24). Observations indicated that podiatrists exhibited a more need-supportive communication style (e.g., taking time to understand patients' perspectives) after undergoing the training programme. Patients in the post-training group reported higher levels of autonomy support, while self-determination to limit weight-bearing activity remained unchanged. Although the post-training group had a lower average daily step count, the difference was not statistically significant. This is the first study to investigate implementation of motivation communication strategies in routine consultations with patients with diabetic foot ulcers. Results suggest that training can enhance healthcare professionals' motivation communication skills with potential for addressing adherence issues, however, a larger cluster randomised controlled trial is necessary to confirm this.

Development of a Motivation Communication Training to Aid Diabetes-Specialist Podiatrists With Adherence Discussions.

Diabetic foot ulcers (DFUs) impact a substantial proportion of patients with diabetes, with high recurrence rates, severe complications, and significant financial burden to health care systems. Adherence to treatment advice (e.g., limiting weight-bearing activity) is low with patients reporting dissatisfaction with the way in which advice is communicated. This study aimed to address this problem via the systematic development of a motivation communication training program. The program was designed to support diabetes-specialist podiatrists in empowering patients to actively engage with treatment. The development process followed an intervention mapping approach. Needs assessment involved observations of 24 patient-practitioner consultations within a diabetes-specialist foot clinic. This informed specification of a theory of change (self-determination theory) and relevant evidence-based communication strategies (drawing from motivational interviewing). The training program was developed iteratively with changes made following feedback from five diabetic foot health care professionals. The resulting training program, consisting of six one-hour face-to-face sessions over an 8-week period, was delivered to a further six diabetes specialist podiatrists, with five participating in postprogram telephone interviews to assess acceptability. Deductive thematic analysis of interview data revealed positive aspects of the training (e.g., valuable and relevant content), ideas for improvement (e.g., online resources and context-specific video examples), the acceptability of motivation strategies, and challenges putting the strategies into practice (such as time constraints and breaking old communication habits). This study contributes to our understanding of integrating motivation principles into routine consultations and holds potential for enhancing adherence to treatment recommendations in patients living with diabetic foot ulcers.

Adherence to limiting weight-bearing activity in patients with diabetic foot ulcers: A qualitative study.

Patients with diabetic foot ulcers are advised to limit weight-bearing activity for ulcers to heal. Patients often disregard this advice although the reasons are not yet fully understood. This study explored (1) patients' experiences of receiving the advice and (2) factors influencing adherence to the advice. Semi-structured interviews were conducted with 14 patients with diabetic foot ulcers. Interviews were transcribed and analysed using inductive thematic analysis. Advice regarding limiting weight-bearing activity was described by patients as directive, generic and conflicting with other priorities. Rapport, empathy and rationale supported receptivity to the advice. Barriers and facilitators to limiting weight-bearing activity included demands of daily living, enjoyment of exercise, sick/disabled identity and burden, depression, neuropathy/pain, health benefits, fear of negative consequences, positive feedback, practical support, weather and active/passive role in recovery. It is important that healthcare professionals pay attention to how limiting weight-bearing activity advice is communicated. We propose a more person-centred approach in which advice is tailored to individuals' specific needs with discussion around patient priorities and constraints.

Recognition of facial expressions in autism: Effects of face masks and alexithymia.

It is often assumed that the recognition of facial expressions is impaired in autism. However, recent evidence suggests that reports of expression recognition difficulties in autistic participants may be attributable to co-occurring alexithymia-a trait associated with difficulties interpreting interoceptive and emotional states-not autism per se. Due to problems fixating on the eye-region, autistic individuals may be more reliant on information from the mouth region when judging facial expressions. As such, it may be easier to detect expression recognition deficits attributable to autism, not alexithymia, when participants are forced to base expression judgements on the eye-region alone. To test this possibility, we compared the ability of autistic participants (with and without high levels of alexithymia) and non-autistic controls to categorise facial expressions (a) when the whole face was visible, and (b) when the lower portion of the face was covered with a surgical mask. High-alexithymic autistic participants showed clear evidence of expression recognition difficulties: they correctly categorised fewer expressions than non-autistic controls. In contrast, low-alexithymic autistic participants were unimpaired relative to non-autistic controls. The same pattern of results was seen when judging masked and unmasked expression stimuli. In sum, we find no evidence for an expression recognition deficit attributable to autism, in the absence of high levels of co-occurring alexithymia, either when participants judge whole-face stimuli or just the eye-region. These findings underscore the influence of co-occurring alexithymia on expression recognition in autism.

Are social interactions preferentially attended in real-world scenes? Evidence from change blindness.

In change detection paradigms, changes to social or animate aspects of a scene are detected better and faster compared with non-social or inanimate aspects. While previous studies have focused on how changes to individual faces/bodies are detected, it is possible that individuals presented within a social interaction may be further prioritised, as the accurate interpretation of social interactions may convey a competitive advantage. Over three experiments, we explored change detection to complex real-world scenes, in which changes either occurred by the removal of (a) an individual on their own, (b) an individual who was interacting with others, or (c) an object. In Experiment 1 (N = 50), we measured change detection for non-interacting individuals versus objects. In Experiment 2 (N = 49), we measured change detection for interacting individuals versus objects. Finally, in Experiment 3 (N = 85), we measured change detection for non-interacting versus interacting individuals. We also ran an inverted version of each task to determine whether differences were driven by low-level visual features. In Experiments 1 and 2, we found that changes to non-interacting and interacting individuals were detected better and more quickly than changes to objects. We also found inversion effects for both non-interaction and interaction changes, whereby they were detected more quickly when upright compared with inverted. No such inversion effect was seen for objects. This suggests that the high-level, social content of the images was driving the faster change detection for social versus object targets. Finally, we found that changes to individuals in non-interactions were detected faster than those presented within an interaction. Our results replicate the social advantage often found in change detection paradigms. However, we find that changes to individuals presented within social interaction configurations do not appear to be more quickly and easily detected than those in non-interacting configurations.

New evidence of impaired expression recognition in developmental prosopagnosia.

Developmental prosopagnosia (DP) is a neurodevelopmental condition characterized by lifelong face recognition difficulties. To date, it remains unclear whether or not individuals with DP experience impaired recognition of facial expressions. It has been proposed that DPs may have sufficient perceptual ability to correctly interpret facial expressions when tasks are relatively easy (e.g., the stimuli are unambiguous and viewing conditions are optimal), but exhibit subtle impairments when tested under more challenging conditions. In the present study, we sought to take advantage of the COVID-19 pandemic to test this view. It is well-established that the surgical-type masks worn during the pandemic hinder the recognition and interpretation of facial emotion in typical participants. Relative to typical participants, we hypothesized that DPs may be disproportionately impaired when asked to interpret the facial emotion of people wearing face masks. We compared the ability of 34 DPs and 60 age-matched typical controls to recognize facial emotions i) when the whole face is visible, and ii) when the lower portion of the face is covered with a surgical mask. When expression stimuli were viewed without a mask, the DPs and typical controls exhibited similar levels of performance. However, when expression stimuli were shown with a mask, the DPs showed signs of subtle expression recognition deficits. The DPs were particularly prone to mislabeling masked expressions of happiness as emotion neutral. These results add to a growing body of evidence that under some conditions, DPs do exhibit subtle deficits of expression recognition.

Impaired grouping of ambient facial images in autism.

Ambient facial images depict individuals from a variety of viewing angles, with a range of poses and expressions, under different lighting conditions. Exposure to ambient images is thought to help observers form robust representations of the individuals depicted. Previous results suggest that autistic people may derive less benefit from exposure to this exemplar variation than non-autistic people. To date, however, it remains unclear why. One possibility is that autistic individuals possess atypical perceptual learning mechanisms. Alternatively, however, the learning mechanisms may be intact, but receive low-quality perceptual input from face encoding processes. To examine this second possibility, we investigated whether autistic people are less able to group ambient images of unfamiliar individuals based on their identity. Participants were asked to identify which of four ambient images depicted an oddball identity. Each trial assessed the grouping of different facial identities, thereby preventing face learning across trials. As such, the task assessed participants' ability to group ambient images of unfamiliar people. In two experiments we found that matched non-autistic controls correctly identified the oddball identities more often than our autistic participants. These results imply that poor face learning from variation by autistic individuals may well be attributable to low-quality perceptual input, not aberrant learning mechanisms.

Sensitivity to orientation is not unique to social attention cueing.

It is well-established that faces and bodies cue observers' visuospatial attention; for example, target items are found faster when their location is cued by the directionality of a task-irrelevant face or body. Previous results suggest that these cueing effects are greatly reduced when the orientation of the task-irrelevant stimulus is inverted. It remains unclear, however, whether sensitivity to orientation is a unique hallmark of "social" attention cueing or a more general phenomenon. In the present study, we sought to determine whether the cueing effects produced by common objects (power drills, desk lamps, desk fans, cameras, bicycles, and cars) are also attenuated by inversion. When cueing stimuli were shown upright, all six object classes produced highly significant cueing effects. When shown upside-down, however, the results were mixed. Some of the cueing effects (e.g., those induced by bicycles and cameras) behaved liked faces and bodies: they were greatly reduced by orientation inversion. However, other cueing effects (e.g., those induced by cars and power drills) were insensitive to orientation: upright and inverted exemplars produced significant cueing effects of comparable strength. We speculate that (i) cueing effects depend on the rapid identification of stimulus directionality, and (ii) some cueing effects are sensitive to orientation because upright exemplars of those categories afford faster processing of directionality, than inverted exemplars. Contrary to the view that attenuation-by-inversion is a unique hallmark of social attention, our findings indicate that some non-social cueing effects also exhibit sensitivity to orientation.

How does the presence of a surgical face mask impair the perceived intensity of facial emotions?

The use of surgical-type face masks has become increasingly common during the COVID-19 pandemic. Recent findings suggest that it is harder to categorise the facial expressions of masked faces, than of unmasked faces. To date, studies of the effects of mask-wearing on emotion recognition have used categorisation paradigms: authors have presented facial expression stimuli and examined participants' ability to attach the correct label (e.g., happiness, disgust). While the ability to categorise particular expressions is important, this approach overlooks the fact that expression intensity is also informative during social interaction. For example, when predicting an interactant's future behaviour, it is useful to know whether they are slightly fearful or terrified, contented or very happy, slightly annoyed or angry. Moreover, because categorisation paradigms force observers to pick a single label to describe their percept, any additional dimensionality within observers' interpretation is lost. In the present study, we adopted a complementary emotion-intensity rating paradigm to study the effects of mask-wearing on expression interpretation. In an online experiment with 120 participants (82 female), we investigated how the presence of face masks affects the perceived emotional profile of prototypical expressions of happiness, sadness, anger, fear, disgust, and surprise. For each of these facial expressions, we measured the perceived intensity of all six emotions. We found that the perceived intensity of intended emotions (i.e., the emotion that the actor intended to convey) was reduced by the presence of a mask for all expressions except for anger. Additionally, when viewing all expressions except surprise, masks increased the perceived intensity of non-intended emotions (i.e., emotions that the actor did not intend to convey). Intensity ratings were unaffected by presentation duration (500ms vs 3000ms), or attitudes towards mask wearing. These findings shed light on the ambiguity that arises when interpreting the facial expressions of masked faces.

Objects that direct visuospatial attention produce the search advantage for facing dyads.

When hidden among pairs of individuals facing in the same direction, pairs of individuals arranged front-to-front are found faster in visual search tasks than pairs of individuals arranged back-to-back. Two rival explanations have been advanced to explain this search advantage for facing dyads. According to one account, the search advantage reflects the fact that front-to-front targets engage domain-specific social interaction processing that helps stimuli compete more effectively for limited attentional resources. Another view is that the effect is a by-product of the ability of individual heads and bodies to direct observers' visuospatial attention. Here, we describe a two-part investigation that sought to test these accounts. First, we found that it is possible to replicate the search advantage with nonsocial objects. Next, we employed a cuing paradigm to investigate whether it is the ability of individual items to direct observers' visuospatial attention that determines if an object category produces the search advantage for facing dyads. We found that the strength of the cuing effect produced by an object category correlated closely with the strength of the search advantage produced by that object category. Taken together, these results provide strong support for the directional cuing account. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The effect of face masks and sunglasses on identity and expression recognition with super-recognizers and typical observers.

Face masks present a new challenge to face identification (here matching) and emotion recognition in Western cultures. Here, we present the results of three experiments that test the effect of masks, and also the effect of sunglasses (an occlusion that individuals tend to have more experienced with) on (i) familiar face matching, (ii) unfamiliar face matching and (iii) emotion categorization. Occlusion reduced accuracy in all three tasks, with most errors in the mask condition; however, there was little difference in performance for faces in masks compared with faces in sunglasses. Super-recognizers, people who are highly skilled at matching unconcealed faces, were impaired by occlusion, but at the group level, performed with higher accuracy than controls on all tasks. Results inform psychology theory with implications for everyday interactions, security and policing in a mask-wearing society.

Searching for people: Non-facing distractor pairs hinder the visual search of social scenes more than facing distractor pairs.

There is growing interest in the visual and attentional processes recruited when human observers view social scenes containing multiple people. Findings from visual search paradigms have helped shape this emerging literature. Previous research has established that, when hidden amongst pairs of individuals facing in the same direction (leftwards or rightwards), pairs of individuals arranged front-to-front are found faster than pairs of individuals arranged back-to-back. Here, we describe a second, closely-related effect with important theoretical implications. When searching for a pair of individuals facing in the same direction (leftwards or rightwards), target dyads are found faster when hidden amongst distractor pairs arranged front-to-front, than when hidden amongst distractor pairs arranged back-to-back. This distractor arrangement effect was also obtained with target and distractor pairs constructed from arrows and types of common objects that cue visuospatial attention. These findings argue against the view that pairs of people arranged front-to-front capture exogenous attention due to a domain-specific orienting mechanism. Rather, it appears that salient direction cues (e.g., gaze direction, body orientation, arrows) hamper systematic search and impede efficient interpretation, when distractor pairs are arranged back-to-back.

The effectiveness of a new dried human amnion derived membrane in addition to standard care in treating diabetic foot ulcers: A patient and assessor blind, randomised controlled pilot study.

Recent reviews suggest that amniotic membrane products may accelerate healing of diabetic foot ulcers. A new dried human amniotic membrane (dHAM) has been used for ocular ulcers but not for diabetic foot ulcers. This was a multi-centre, prospective, patient and observer blind, randomised controlled pilot trial, to investigate whether 2 weekly addition of the dHAM to standard care versus standard care alone increased the proportion of healed participants' index foot ulcers within 12 weeks. Thirty-one people (mean age 59.8 years, 81% male, 87% type 2 diabetes) were randomised (15 dHAM, 16 usual care). Within 12 weeks, healing occurred in 4 (27%) ulcers in the dHAM group versus 1 (6.3%) usual care group (P = .1). Percentage wound area reduction was higher in the dHAM versus control group. (P = .0057). There was no difference in AEs between the two groups. Six participants allocated to dHAM correctly identified their treatment group, although 5 in usual care incorrectly thought they were in the intervention arm. This pilot trial result is encouraging showing that this dHAM preparation is safe and promising treatment. These results will be used to design a statistically powered, definitive double blind randomised controlled trial.

The perception of interpersonal distance is distorted by the Müller-Lyer illusion.

There is growing interest in how human observers perceive social scenes containing multiple people. Interpersonal distance is a critical feature when appraising these scenes; proxemic cues are used by observers to infer whether two people are interacting, the nature of their relationship, and the valence of their current interaction. Presently, however, remarkably little is known about how interpersonal distance is encoded within the human visual system. Here we show that the perception of interpersonal distance is distorted by the Müller-Lyer illusion. Participants perceived the distance between two target points to be compressed or expanded depending on whether face pairs were positioned inside or outside the to-be-judged interval. This illusory bias was found to be unaffected by manipulations of face direction. These findings aid our understanding of how human observers perceive interpersonal distance and may inform theoretical accounts of the Müller-Lyer illusion.

Visual search for facing and non-facing people: The effect of actor inversion.

In recent years, there has been growing interest in how human observers perceive, attend to, and recall, social interactions viewed from third-person perspectives. One of the interesting findings to emerge from this new literature is the search advantage for facing dyads. When hidden amongst pairs of individuals facing in the same direction, pairs of individuals arranged front-to-front are found faster in visual search tasks than pairs of individuals arranged back-to-back. Interestingly, the search advantage for facing dyads appears to be sensitive to the orientation of the people depicted. While front-to-front target pairs are found faster than back-to-back targets when target and distractor pairings are shown upright, front-to-front and back-to-back targets are found equally quickly when pairings are shown upside-down. In the present study, we sought to better understand why the search advantage for facing dyads is sensitive to the orientation of the people depicted. To begin, we show that the orientation sensitivity of the search advantage is seen with dyads constructed from faces only, and from bodies with the head and face occluded. We replicate these effects using two different visual search paradigms. We go on to show that individual faces and bodies, viewed in profile, produce strong attentional cueing effects when shown upright, but not when presented upside-down. Together with recent evidence that arrows arranged front-to-front also produce the search advantage for facing dyads, these findings support the view that the search advantage is a by-product of the ability of constituent elements to direct observers' visuo-spatial attention.

Holistic processing of facial identity in developmental prosopagnosia.

The nature of the perceptual deficit seen in developmental prosopagnosia remains poorly understood. One possibility is that these individuals experience face recognition difficulties because they fail to process faces holistically; they may be less able to analyze distal regions in parallel and therefore struggle to integrate information from different regions into a unified perceptual whole. Consequently, developmental prosopagnosics may be forced to base perceptual decisions on a slow, effortful piecemeal analysis of local facial features. In the present study, we sought to test this view by comparing the face recognition of developmental prosopagnosics and typical observers under two viewing conditions: when target faces were briefly presented in their entirety, and when they were inspected region-by-region through a dynamic aperture. If developmental prosopagnosics are forced to base perceptual decisions on information accumulated from a serial piecemeal analysis, one would expect little if any decrement in performance when target faces are viewed through apertures. Contrary to this prediction, however, developmental prosopagnosics showed strong aperture effects comparable with typical observers; their perceptual decisions were more accurate in the whole-face condition than when targets were viewed through the aperture. As expected, the developmental prosopagnosics were less accurate than typical controls when judging briefly presented faces shown in their entirety. Strikingly, however, they were also less able to accumulate perceptual evidence from a serial region-by-region analysis, than typical observers. Our results suggest that the perceptual problems seen in this population arise from imprecise descriptions of local regions, not aberrant holistic processing.

Systematic review of techniques to monitor remission of acute Charcot neuroarthropathy in people with diabetes.

AIM: The management of acute Charcot neuroarthropathy relies on off-loading which is costly and time-consuming. Published studies have used monitoring techniques with unknown diagnostic precision to detect remission. We performed a systematic review of techniques for monitoring response to offloading in acute Charcot neuroarthropathy. MATERIALS AND METHODS: We included studies of off-loading which evaluated or described monitoring techniques in acute Charcot neuroarthropathy. PubMed, EMBASE, CINAHL and Cochrane databases were searched (January1993-July 2018). We extracted data from papers including study design, setting, population, monitoring techniques and treatment outcomes. We also extracted information on the cost, clinical applicability, sensitivity and specificity, safety and participant acceptability of the monitoring techniques. RESULTS: We screened 1205 titles, 140 abstracts and 45 full-texts, and included 29 studies. All studies were of low quality and at high risk of bias. In seven studies, the primary aim was to evaluate monitoring techniques: three evaluated magnetic resonance imaging, two thermography monitoring, one three-phase bone scanning and one Doppler spectrum analysis. The remaining 22 observational studies reported treatment outcomes and described the monitoring techniques used to assess the Charcot neuroarthropathy. Heterogeneity prevented the pooling of data. Very few studies included data on cost, clinical applicability, sensitivity and specificity, safety and patient acceptability of the monitoring techniques used. CONCLUSION: Multiple techniques have been used to evaluate remission in acute Charcot neuroathropathy but uncertainty remains about their effectiveness. We recommend further research into the influences of different monitoring techniques on treatment outcomes.

Nonlinear transduction of emotional facial expression.

To create neural representations of external stimuli, the brain performs a number of processing steps that transform its inputs. For fundamental attributes, such as stimulus contrast, this involves one or more nonlinearities that are believed to optimise the neural code to represent features of the natural environment. Here we ask if the same is also true of more complex stimulus dimensions, such as emotional facial expression. We report the results of three experiments combining morphed facial stimuli with electrophysiological and psychophysical methods to measure the function mapping emotional expression intensity to internal response. The results converge on a nonlinearity that accelerates over weak expressions, and then becomes shallower for stronger expressions, similar to the situation for lower level stimulus properties. We further demonstrate that the nonlinearity is not attributable to the morphing procedure used in stimulus generation.

Why are social interactions found quickly in visual search tasks?

When asked to find a target dyad amongst non-interacting individuals, participants respond faster when the individuals in the target dyad are shown face-to-face (suggestive of a social interaction), than when they are presented back-to-back. Face-to-face dyads may be found faster because social interactions recruit specialized processing. However, human faces and bodies are salient directional cues that exert a strong influence on how observers distribute their attention. Here we report that a similar search advantage exists for 'point-to-point' and 'point-to-face' target arrangements constructed using arrows - a non-social directional cue. These findings indicate that the search advantage seen for face-to-face dyads is a product of the directional cues present within arrangements, not the fact that they are processed as social interactions, per se. One possibility is that, when arranged in the face-to-face or point-to-point configuration, pairs of directional cues (faces, bodies, arrows) create an attentional 'hot-spot' - a region of space in between the elements to which attention is directed by multiple cues. Due to the presence of this hot-spot, observers' attention may be drawn to the target location earlier in a serial visual search.