Communicating and reading emotion with masked faces in the Covid era: A short review of the literature

Touch Helps Hearing: Evidence From Continuous Audio-Tactile Stimulation

OBJECTIVES

Identifying target sounds in challenging environments is crucial for daily experiences. It is important to note that it can be enhanced by nonauditory stimuli, for example, through lip-reading in an ongoing conversation. However, how tactile stimuli affect auditory processing is still relatively unclear. Recent studies have shown that brief tactile stimuli can reliably facilitate auditory perception, while studies using longer-lasting audio-tactile stimulation yielded conflicting results. This study aimed to investigate the impact of ongoing pulsating tactile stimulation on basic auditory processing.

DESIGN

In experiment 1, the electroencephalogram (EEG) was recorded while 24 participants performed a loudness-discrimination task on a 4-Hz modulated tone-in-noise and received either in-phase, anti-phase, or no 4-Hz electrotactile stimulation above the median nerve. In experiment 2, another 24 participants were presented with the same tactile stimulation as before, but performed a tone-in-noise detection task while their selective auditory attention was manipulated.

RESULTS

We found that in-phase tactile stimulation enhanced EEG responses to the tone, whereas anti-phase tactile stimulation suppressed these responses. No corresponding tactile effects on loudness-discrimination performance were observed in experiment 1. Using a yes/no paradigm in experiment 2, we found that in-phase tactile stimulation, but not anti-phase tactile stimulation, improved detection thresholds. Selective attention also improved thresholds but did not modulate the observed benefit from in-phase tactile stimulation.

CONCLUSIONS

Our study highlights that ongoing in-phase tactile input can enhance basic auditory processing as reflected in scalp EEG and detection thresholds. This might have implications for the development of hearing enhancement technologies and interventions.

Behind the mask: Stuttering, anxiety, and communication dynamics in the era of COVID-19

BACKGROUND

While wearing masks during the pandemic poses communication and social challenges for people in everyday life, those with social anxiety might find them plausible, aligning with contemporary cognitive theories. Social anxiety involves fearing negative assessments and holding a negative self-image. Concealing anxiety symptoms during mask use may contribute to a more positive self-perception.

AIMS

Given that up to 60% of adults seeking stuttering treatment also meet criteria for social anxiety disorder, this study aims to investigate the complex relationship between communication freedom, self-perceived stuttering and anxiety in adults who stutter (AWS). The unique context of mandatory mask-wearing during the pandemic provides an opportunity to explore these dynamics and understand the conflicting relationships between stuttering, anxiety-related safety behaviours and the need for open communication in AWS.

METHODS AND PROCEDURES

Twenty AWS participated in interviews, responding to open-ended questions to elucidate their affective, cognitive and behavioural experiences while wearing masks during the COVID-19 pandemic. Thematic analysis was used to identify the emerging themes and subthemes based on information-rich quotes, employing a six-phase recursive process. Various speech and anxiety-related measures were used to describe the characteristics of the study participants.

OUTCOMES AND RESULTS

Three main themes and sub-themes emerged. The first theme highlights communication challenges for AWS wearing masks, impacting verbal and nonverbal interactions. The second theme reveals AWS wearing masks to conceal stuttering cues, experiencing reduced stress. The third theme indicates that, despite the comfort in concealment, most AWS prefer speaking freely without a face mask.

CONCLUSIONS AND IMPLICATIONS

The conflict between the desire for authentic, fluent communication and the ease of hiding stuttering symptoms poses a major dilemma for AWS. According to the results of this study, most adults who stutter prioritize open communication. However, there were some individual differences. A major factor influencing their decision was their fear of negative evaluation.

WHAT THIS PAPER ADDS

What is already known on the subject The prevalence of social anxiety is higher among adults who stutter (AWS), possibly stemming from their prior negative experiences with stuttering. In response, AWS may adopt adaptive or maladaptive coping behaviours to manage stuttering and mitigate fears of negative evaluation. Maladaptive strategies, like avoiding certain communication situations, can diminish their satisfaction with everyday speaking situations. What this study adds This study leveraged the mask-wearing mandate during the pandemic to explore the intricate relationship between anxiety-related symptoms and communication. While some participants saw masks as a plausible means to conceal stuttering and anxiety, most preferred open communication without the challenges posed by masks. Our findings offer additional support for the varied emotional, cognitive and behavioural responses that AWS may display in response to changes in daily life, emphasizing the individual differences within this population and highlighting that stuttering goes beyond observable speech dysfluencies. What are the clinical implications of this work? Our study underscores the need for comprehensive therapeutic interventions addressing both the physical and cognitive-emotional aspects of stuttering in AWS. Recognizing the role of safety behaviours and self-focused attention emphasizes the importance of an integrated approach, enhancing communication efficacy and social well-being for AWS. Addressing speech fluency alone, without considering pertinent cognitive-emotional factors, falls short in providing adequate stuttering treatment.

Lower empathy for face mask wearers is not explained by observer's reduced facial mimicry

Facial occlusion alters social processes that rely on face visibility, including spontaneous mimicry of emotions. Given that facial mimicry of emotions is theorized to play an important role in how we empathize or share emotions with others, here we investigated if empathy was reduced for faces wearing masks because masks may reduce the ability to mimic facial expressions. In two preregistered experiments, participants rated their empathy for faces displaying happy or neutral emotions and wearing masks or no masks. We manipulated mimicry by either blocking mimicry with observers holding a pen in between their teeth (Experiment 1) or by producing a state of constant congruent mimicry by instructing observers to smile (Experiment 2). Results showed reduced empathy ratings for masked faces. Mimicry overall facilitated empathy, with reduced empathy ratings when mimicry was blocked and higher empathy ratings when it was instructed. However, this effect of mimicry did not vary with mask condition. Thus, while observers were impaired in sharing emotions with masked faces, this impairment did not seem to be explained by a reduction in facial mimicry. These results show that mimicry is an important process for sharing emotions, but that occluding faces with masks reduces emotion sharing via a different mechanism.

Therapeutic Relational Communication and Resilience among Nursing Professionals in a Pandemic Situation

Therapeutic relational communication has become a fundamental human resource in the nursing profession. The positive relationship between nurse-patient communication and resilience has been shown in several studies. However, these aspects can be affected in adverse circumstances. The purpose of this study was to identify the relationship between nurse-patient therapeutic relational communication and the resilience of nursing professionals in adverse circumstances. A cross-sectional study with a sample of 201 nursing professionals was conducted. This study found high levels of both therapeutic relational communication between nurses and patients as well as resilience among nurses. The sociodemographic variables of age and years of experience in the profession positively correlated with the data obtained through the measurement instruments. The co-relational analysis revealed a positive correlation between nurse-patient therapeutic relational communication and nurse resilience, and the regression analysis showed that levels of successful therapeutic communication skills were minimally explained by resilience. Nursing professionals who participated in this study demonstrated adequate levels of therapeutic relational communication with their patients as well as adequate levels of resilience required to cope with the challenges of the COVID-19 pandemic in their daily nursing practice. This study was not registered.

Unmasking the Impact: Exploring the Role of Masks in Trauma-Informed Care Communication

INTRODUCTION

The COVID pandemic has necessitated mask-wearing by inpatient providers; however, the impact of masks on the acute care surgeon-patient relationship is unknown. We hypothesized that mask-wearing, while necessary, has a negative impact by acting as a barrier to communication, empathy, and trust between patients and surgeons.

METHODS

A cross-sectional study was performed by administering a written survey in English or Spanish to trauma, emergency general surgery, burn, and surgical critical care inpatients aged ≥18 y at a University Level 1 Trauma Center between January 2023 and June 2023. Patients were asked seven questions about their perception of mask effect on interactions with their surgery providers. Responses were scored on a five-point Likert scale and binarized for multivariable logistic regression.

RESULTS

There were 188 patients who completed the survey. The patients were 68% male, 44% Hispanic, and 17% Spanish speaking, with a median age of 45-54 y. A third of patients agreed that surgeon mask-wearing made it harder to understand the details of their surgical procedure and made them less comfortable in giving consent. Twenty three percent agreed that it was harder to trust their provider; increasing age was associated with lower levels of trust, odds ratio 1.36 (confidence interval 1.10-1.71, P = 0.006). Findings were consistent among patients of different sex, race/ethnicity, language, and pre-COVID hospital experience.

CONCLUSIONS

Mask-wearing, while important, has a negative impact on the patient-surgeon relationship in trauma and acute care surgery. Providers must be conscious of this effect while wearing masks and strive to optimize communication with patients to ensure high-quality trauma-informed care.

How different face mask types affect interpersonal distance perception and threat feeling in social interaction

Due to the easing of the pandemic, public policies no longer mandated people to wear masks. People can choose to no wear or wear different types of masks based on personal preferences and safety perceptions during daily interaction. Available information about the influence of face mask type on interpersonal distance (IPD) by different aging populations is still lacking. Thus, this study aimed to investigate the face mask type (no wear, cloth, medical and N95 mask) and age group effect of avatars (children, adults and older adults) on IPD perception, threat feeling and physiological skin conductance response under active and passive approaching. One hundred participants with a range from 20 to 35 years old were recruited for this study. Twelve avatars (three age groups*four face mask conditions) were created and applied in a virtual reality environment. The results showed that age group, mask type and approach mode had significant effects on IPD and subjective threat feeling. A non-significant effect was found on skin conductance responses. Participants maintained a significantly longer IPD when facing the older adults, followed by adults and then children. In the passive approach condition, people tended to maintain a significantly greater comfort distance than during the active approach. For the mask type effect, people kept a significantly largest and shortest IPD when facing an avatar with no mask or the N95 mask, respectively. A non-significant IPD difference was found between the N95 and medical mask. Additionally, based on the subjective threat feeling, facing an avatar wearing a medical mask generated the lowest threat feeling compared to the others. The findings of this study indicated that wearing medical masks provided a benefit in bringing people closer for interaction during specific situations. Understanding that mask-wearing, especially medical one, brought to shortest IPD when compared to the unmasked condition can be utilized to enhance safety measures in crowded public spaces and health-care settings. This information could guide the development of physical distancing recommendations, taking into account both the type of mask and the age groups involved, to ensure the maintenance of appropriate distances.

Masks and respirators for prevention of respiratory infections: a state of the science review

SUMMARYThis narrative review and meta-analysis summarizes a broad evidence base on the benefits-and also the practicalities, disbenefits, harms and personal, sociocultural and environmental impacts-of masks and masking. Our synthesis of evidence from over 100 published reviews and selected primary studies, including re-analyzing contested meta-analyses of key clinical trials, produced seven key findings. First, there is strong and consistent evidence for airborne transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other respiratory pathogens. Second, masks are, if correctly and consistently worn, effective in reducing transmission of respiratory diseases and show a dose-response effect. Third, respirators are significantly more effective than medical or cloth masks. Fourth, mask mandates are, overall, effective in reducing community transmission of respiratory pathogens. Fifth, masks are important sociocultural symbols; non-adherence to masking is sometimes linked to political and ideological beliefs and to widely circulated mis- or disinformation. Sixth, while there is much evidence that masks are not generally harmful to the general population, masking may be relatively contraindicated in individuals with certain medical conditions, who may require exemption. Furthermore, certain groups (notably D/deaf people) are disadvantaged when others are masked. Finally, there are risks to the environment from single-use masks and respirators. We propose an agenda for future research, including improved characterization of the situations in which masking should be recommended or mandated; attention to comfort and acceptability; generalized and disability-focused communication support in settings where masks are worn; and development and testing of novel materials and designs for improved filtration, breathability, and environmental impact.

Listening to your partner: serotonin increases male responsiveness to female vocal signals in mice

The context surrounding vocal communication can have a strong influence on how vocal signals are perceived. The serotonergic system is well-positioned for modulating the perception of communication signals according to context, because serotonergic neurons are responsive to social context, influence social behavior, and innervate auditory regions. Animals like lab mice can be excellent models for exploring how serotonin affects the primary neural systems involved in vocal perception, including within central auditory regions like the inferior colliculus (IC). Within the IC, serotonergic activity reflects not only the presence of a conspecific, but also the valence of a given social interaction. To assess whether serotonin can influence the perception of vocal signals in male mice, we manipulated serotonin systemically with an injection of its precursor 5-HTP, and locally in the IC with an infusion of fenfluramine, a serotonin reuptake blocker. Mice then participated in a behavioral assay in which males suppress their ultrasonic vocalizations (USVs) in response to the playback of female broadband vocalizations (BBVs), used in defensive aggression by females when interacting with males. Both 5-HTP and fenfluramine increased the suppression of USVs during BBV playback relative to controls. 5-HTP additionally decreased the baseline production of a specific type of USV and male investigation, but neither drug treatment strongly affected male digging or grooming. These findings show that serotonin modifies behavioral responses to vocal signals in mice, in part by acting in auditory brain regions, and suggest that mouse vocal behavior can serve as a useful model for exploring the mechanisms of context in human communication.

Evaluation of health worker acceptance and tolerance of respirators in clinical practice-An Australian perspective

BACKGROUND

One of the main infection prevention and control measures introduced during the COVID-19 pandemic was the focused application of respiratory protection to ensure health worker safety and the effective use of personal protective equipment. However, user acceptance of these strategies is paramount in sustainable compliance. This study explores various aspects of respirator use and provides recommendations to improve and maximize health worker safety. The aim of this study was to understand the relationship between respirator (P2/N95) comfort and user experience toward respiratory protection. The aim of this study was to understand the relationship between respirator (P2/N95) comfort and user experience toward respiratory protection.

METHODS

The nonexperimental cross-sectional design study was conducted in New South Wales, Australia between November and December 2022 using an anonymous self-administered online questionnaire in Microsoft Forms.

RESULTS

Of 2,514 respondents, 65% reported to have used a respirator every working day with only a few using a respirator once weekly or less (9%). Almost all respondents had completed at least one quantitative fit test (96%) prior to the survey. Fifty-nine percent reported to have experienced discomfort from wearing a respirator and the most reported adverse effect was difficulty communicating (64%), followed by skin irritation or acne (62%) and headache (56%).

CONCLUSIONS

Despite somewhat less favorable ratings on comfort and communication, health workers are in favor of respiratory protection. However, a focus on tolerance of respirators and strategies to address adverse effects from prolonged respirator use must be considered when implementing policies and procedures. Moreover, resources must be allocated to improve the design, breathability, and sustainability of a respirator along with education and training on how to use respiratory protection safely and effectively.

The Influence of COVID-19 in Endocrine Research: Critical Overview, Methodological Implications and a Guideline for Future Designs

The COVID-19 pandemic has changed many aspects of people's lives, including not only individual social behavior, healthcare procedures, and altered physiological and pathophysiological responses. As a result, some medical studies may be influenced by one or more hidden factors brought about by the COVID-19 pandemic. Using the literature review method, we are briefly discussing the studies that are confounded by COVID-19 and facemask-induced partiality and how these factors can be further complicated with other confounding variables. Facemask wearing has been reported to produce partiality in studies of ophthalmology (particularly dry eye and related ocular diseases), sleep studies, cognitive studies (such as emotion-recognition accuracy research, etc.), and gender-influenced studies, to mention a few. There is a possibility that some other COVID-19 related influences remain unrecognized in medical research. To account for heterogeneity, current and future studies need to consider the severity of the initial illness (such as diabetes, other endocrine disorders), and COVID-19 infection, the timing of analysis, or the presence of a control group. Face mask-induced influences may confound the results of diabetes studies in many ways.

Masked Face Emotion Recognition Based on Facial Landmarks and Deep Learning Approaches for Visually Impaired People

Current artificial intelligence systems for determining a person's emotions rely heavily on lip and mouth movement and other facial features such as eyebrows, eyes, and the forehead. Furthermore, low-light images are typically classified incorrectly because of the dark region around the eyes and eyebrows. In this work, we propose a facial emotion recognition method for masked facial images using low-light image enhancement and feature analysis of the upper features of the face with a convolutional neural network. The proposed approach employs the AffectNet image dataset, which includes eight types of facial expressions and 420,299 images. Initially, the facial input image's lower parts are covered behind a synthetic mask. Boundary and regional representation methods are used to indicate the head and upper features of the face. Secondly, we effectively adopt a facial landmark detection method-based feature extraction strategy using the partially covered masked face's features. Finally, the features, the coordinates of the landmarks that have been identified, and the histograms of the oriented gradients are then incorporated into the classification procedure using a convolutional neural network. An experimental evaluation shows that the proposed method surpasses others by achieving an accuracy of 69.3% on the AffectNet dataset.

Predictors of Healthcare Workers' Compassionate Care Amid the COVID-19 Pandemic: A Cross-Sectional Study from Patients' Perspective in Kelantan, Malaysia

Background: Compassionate care served by healthcare workers (HCWs) has been recognized as one of the most critical aspects of high-quality care. Unfortunately, there is still an unmet need for the assessment of compassionate care from the patient’s perspective. During the COVID-19 pandemic, many new rules were enacted to tackle the raging pandemic, which raised concerns about its effect on compassionate care. Methods: A cross-sectional study involving 315 patients from three public hospitals was conducted during the conditional movement control order (CMCO). A self-administered Malay version of the Relational Aspect of Care Questionnaire (RAC-QM) was used to assess compassionate care. Multiple linear regression was used to determine the predictors. Results: More than 90% of the patients were Malays, Muslims, and fell under the B40 household income category. Companions were present for 51.7% of the patients, but 75.2% had no visitors. All hospitals received scores of more than 90%. Occupation (student, p = 0.032), dependency level (total dependent, p < 0.001), and household income level (M40, p = 0.027) were the statistically significant predictors for compassionate care. Conclusions: The current study revealed that compassionate care to patients was not compromised during the pandemic. Patients with disabilities or financial constraints are more likely to experience less compassionate care, while students are generally more satisfied. This study may provide clues for hospital administrators and policymakers regarding the vulnerable group of patients. It also provides opportunities for future research to study the perspective of HCWs.