Comparing virtual vs real faces expressing emotions in children with autism: An eye-tracking study

AbstractDifficulties in processing emotional facial expressions is considered a central characteristic of children with autism spectrum condition (ASC). In addition, there is a growing interest in the use of virtual avatars capable of expressing emotions as an intervention aimed at improving the social skills of these individuals. One potential use of avatars is that they could enhance facial recognition and guide attention. However, this aspect needs further investigation. The aim of our study is to assess differences in eye gaze processes in children with ASC when they see avatar faces expressing emotions compared to real faces. Eye-tracking methodology was used to compare the performance of children with ASC between avatar and real faces. A repeated-measures general linear model was adopted to understand which characteristics of the stimuli could influence the stimuli's fixation times. Survival analysis was performed to understand differences in exploration behaviour between avatar and real faces. Differences between emotion recognition accuracy and the number of fixations were evaluated through a paired t-test. Our results confirm that children with autism have higher capacities to process and recognize emotions when these are presented by avatar faces. Children with autism are more attracted to the mouth or the eyes depending on the stimulus type (avatar or real) and the emotion expressed by the stimulus. Also, they are more attracted to avatar faces expressing negative emotions (anger and sadness), and to real faces expressing surprise. Differences were not found regarding happiness. Finally, they show a higher degree of exploration of avatar faces. All these elements, such as interest in the avatar and reduced attention to the eyes, can offer important elements in planning an efficient intervention

An Innovative Approach to Development of Social Abilities in Individuals with Autism: A Pilot Study

Recent evidence suggests that individuals with Autism Spectrum Disorders (ASD) show a significant impairment in social abilities. There are no treatments that have demonstrated evidence of being effective at improving social skills and promoting independence. The transition to adulthood, which often involves loss of school support and child and adolescent mental health services, is a challenge in the rehabilitation field. Our pilot study is the first that describes a novel approach to involving young adults with ASD in metacognitive exercise focused on social cognition. In treatment proposed, participants with ASD help each other to create software aimed at improving children with ASD's understanding of emotions. Our results showed an qualitative and quantitative improvement of their cognitive empathic abilities, as witnessed by parents and of the post- treatment assessment. This pilot study highlights the importance to help individuals with ASD to fulfil their potential in areas of strength

Register-based cumulative prevalence of Autism Spectrum Disorders during childhood and adolescence in Central Italy

Background: Studies have evaluated the prevalence of Autism Spectrum Disorders (ASD), focusing on different ages during childhood and adolescence. How cumulative prevalence increases before adulthood remains unclear.  Methods: We used data from the Autism Register of the Regional Reference Centre for Autism in L’Aquila, Central Italy, to retrieve information on individuals born in 2001–2012 with any of the inclusion diagnoses of ASD (DSM criteria) for the period 2001 to 2018. Cumulative prevalence on L’Aquila district population data was calculated as percentages for three-year age strata.  Results: All prevalence data were estimated at December 31st, 2018. The overall crude prevalence was 0.95% (352 cases over 36938 population). Cumulative prevalence was 1.19% among those born in 2001-2003 (15 to 17 years of follow up), 1.15% among those born in 2004-2006 (12 to 14 years of follow up), 1.04% among those born in 2007-2009 (9 to 11 years of follow up), 0.80% among those born in 2010-2012 (6 to 8 years of follow up), and 0.57% among those born in 2013-2015 (3 to 5 years of follow up). The proportion of ASD diagnoses until the age of 5 years, compared to the group diagnosed 6 to 8 years of age, showed a significant increasing trend over calendar time (53.6% for those born in 2001-2003, to 77.0% for those born in 2010-2012).  Conclusions: Cumulative prevalence by time period provides a better understanding of ASD occurrence than a point prevalence. We did not find any difference in frequency of diagnosis comparing age strata and year of birth, suggesting that frequencies of ASD diagnosis remained roughly constant from 2001 to 2015. Results show that cumulative prevalence of autism diagnosis does not substantially change over time; instead, diagnosis of ASD is more likely at earliest ages over time, although new cases of ASD are also detected at later ages.&nbsp

Discrepancies between explicit and implicit evaluation of aesthetic perception ability in individuals with autism: a potential way to improve social functioning

Background: The capacity to evaluate beauty plays a crucial role in social behaviour and social relationships. It is known that some characteristics of beauty are important social cues that can induce stereotypes or promote different behavioural expectations. Another crucial capacity for success in social interactions is empathy, i.e. the ability to understand and share others\u2019 mental and emotional states. Individuals with Autism Spectrum Disorder (ASD) have an impairment of empathic ability. We showed in a previous study that empathy and aesthetic perception abilities closely related. Indeed, beauty can affect different aspects of empathic behaviour, and empathy can mediate the aesthetic perception in typically developing (TD) individuals. Thus, this study evaluates the ability of aesthetic perception in ASD individuals compared to TD individuals, using the Golden Beauty behavioural task adapted for eye-tracking in order to acquire both explicit and implicit evidences. In both groups, the relationship between empathic and aesthetic perception abilities was also evaluated. Methods: Ten ASD individuals (age \ub1 SD:20.7 \ub1 4.64) and ten TD individuals (age \ub1 SD:20.17 \ub1 0.98) participated in the study. Participants underwent empathy tasks and then the Golden Beauty task. To assess differences in the participants\u2019 performance, we carried out a repeated measures general linear model. Results: At the explicit level, our behavioural results show an impairment in aesthetic perception ability in ASD individuals. This inability could have relevance for their ability to experience pleasure during social interactions. However, at the implicit level (eye-tracking results), ASD individuals conserved a good ability to feel aesthetic pleasure during the Golden Beauty task, thus indicating a discrepancy between the explicit and implicit evaluation of the beauty task. Finally, beauty perception appears to be linked to empathy when neither of these capacities is compromised, as demonstrated in the TD group. In contrast, this link lacks in ASD individuals

Systematic versus on-demand early palliative care: results from a multicentre, randomised clinical trial

Background Early palliative care (EPC) in oncology has been shown to have a positive impact on clinical outcome, quality-of-care outcomes, and costs. However, the optimal way for activating EPC has yet to be defined. Methods This prospective, multicentre, randomised study was conducted on 207 outpatients with metastatic or locally advanced inoperable pancreatic cancer. Patients were randomised to receive ‘standard cancer care plus on-demand EPC’ (n = 100) or ‘standard cancer care plus systematic EPC’ (n = 107). Primary outcome was change in quality of life (QoL) evaluated through the Functional Assessment of Cancer Therapy – Hepatobiliary questionnaire between baseline (T0) and after 12 weeks (T1), in particular the integration of physical, functional, and Hepatic Cancer Subscale (HCS) combined in the Trial Outcome Index (TOI). Patient mood, survival, relatives' satisfaction with care, and indicators of aggressiveness of care were also evaluated. Findings The mean changes in TOI score and HCS score between T0 and T1 were −4.47 and −0.63, with a difference between groups of 3.83 (95% confidence interval [CI] 0.10–7.57) (p = 0.041), and −2.23 and 0.28 (difference between groups of 2.51, 95% CI 0.40–4.61, p = 0.013), in favour of interventional group. QoL scores at T1 of TOI scale and HCS were 84.4 versus 78.1 (p = 0.022) and 52.0 versus 48.2 (p = 0.008), respectively, for interventional and standard arm. Until February 2016, 143 (76.9%) of the 186 evaluable patients had died. There was no difference in overall survival between treatment arms. Interpretations Systematic EPC in advanced pancreatic cancer patients significantly improved QoL with respect to on-demand EPC

Refinement of the diagnostic approach for the identification of children and adolescents affected by familial hypercholesterolemia: Evidence from the LIPIGEN study

Background and aims: We aimed to describe the limitations of familiar hypercholesterolemia (FH) diagnosis in childhood based on the presence of the typical features of FH, such as physical sings of cholesterol accumulation and personal or family history of premature cardiovascular disease or hypercholesterolemia, comparing their prevalence in the adult and paediatric FH population, and to illustrate how additional information can lead to a more effective diagnosis of FH at a younger age.Methods: From the Italian LIPIGEN cohort, we selected 1188 (>= 18 years) and 708 (<18 years) genetically-confirmed heterozygous FH, with no missing personal FH features. The prevalence of personal and familial FH features was compared between the two groups. For a sub-group of the paediatric cohort (N = 374), data about premature coronary heart disease (CHD) in second-degree family members were also included in the evaluation.Results: The lower prevalence of typical FH features in children/adolescents vs adults was confirmed: the prevalence of tendon xanthoma was 2.1% vs 13.1%, and arcus cornealis was present in 1.6% vs 11.2% of the cohorts, respectively. No children presented clinical history of premature CHD or cerebral/peripheral vascular disease compared to 8.8% and 5.6% of adults, respectively. The prevalence of premature CHD in first-degree relatives was significantly higher in adults compared to children/adolescents (38.9% vs 19.7%). In the sub-cohort analysis, a premature CHD event in parents was reported in 63 out of 374 subjects (16.8%), but the percentage increased to 54.0% extending the evaluation also to second-degree relatives.Conclusions: In children, the typical FH features are clearly less informative than in adults. A more thorough data collection, adding information about second-degree relatives, could improve the diagnosis of FH at younger age

Notulae to the Italian flora of algae, bryophytes, fungi and lichens: 14

In this contribution, new data concerning bryophytes, fungi and lichens of the Italian flora are presented. It includes new records and confirmations for the algal genus Chara, for the bryophyte genera Bryum, Grimmia, Cephaloziella, Hypnum, Nogopterium, Physcomitrium, Polytrichastrum, Rhynchostegiella, Saelania, and Schistostega, the fungal genera Cortinarius, Lentinellus, Omphalina, and Xerophorus, and the lichen genera Acarospora, Agonimia, Candelariella, Cladonia, Graphis, Gyalolechia, Hypogymnia, Lichinella, Megalaria, Nephroma, Ochrolechia, Opegrapha, Peltigera, Placidium, Ramalina, Rhizoplaca, Ropalospora, Strangospora, Toniniopsis, Usnea, and Zahlbrucknerell

Lipoprotein(a) Genotype Influences the Clinical Diagnosis of Familial Hypercholesterolemia

: Background Evidence suggests that LPA risk genotypes are a possible contributor to the clinical diagnosis of familial hypercholesterolemia (FH). This study aimed at determining the prevalence of LPA risk variants in adult individuals with FH enrolled in the Italian LIPIGEN (Lipid Transport Disorders Italian Genetic Network) study, with (FH/M+) or without (FH/M-) a causative genetic variant. Methods and Results An lp(a) [lipoprotein(a)] genetic score was calculated by summing the number risk-increasing alleles inherited at rs3798220 and rs10455872 variants. Overall, in the 4.6% of 1695 patients with clinically diagnosed FH, the phenotype was not explained by a monogenic or polygenic cause but by genotype associated with high lp(a) levels. Among 765 subjects with FH/M- and 930 subjects with FH/M+, 133 (17.4%) and 95 (10.2%) were characterized by 1 copy of either rs10455872 or rs3798220 or 2 copies of either rs10455872 or rs3798220 (lp(a) score ≥1). Subjects with FH/M- also had lower mean levels of pretreatment low-density lipoprotein cholesterol than individuals with FH/M+ (t test for difference in means between FH/M- and FH/M+ groups <0.0001); however, subjects with FH/M- and lp(a) score ≥1 had higher mean (SD) pretreatment low-density lipoprotein cholesterol levels (223.47 [50.40] mg/dL) compared with subjects with FH/M- and lp(a) score=0 (219.38 [54.54] mg/dL for), although not statistically significant. The adjustment of low-density lipoprotein cholesterol levels based on lp(a) concentration reduced from 68% to 42% the proportion of subjects with low-density lipoprotein cholesterol level ≥190 mg/dL (or from 68% to 50%, considering a more conservative formula). Conclusions Our study supports the importance of measuring lp(a) to perform the diagnosis of FH appropriately and to exclude that the observed phenotype is driven by elevated levels of lp(a) before performing the genetic test for FH

Simple mindreading abilities predict complex theory of mind: developmental delay in autism spectrum disorders

Theory of Mind (ToM) is impaired in individuals with Autism Spectrum Disorders (ASD). The aims of this study were to: i) examine the developmental trajectories of ToM abilities in two different mentalizing tasks in children with ASD compared to TD children; and ii) to assess if a ToM simple test known as Eyes-test could predict performance on the more advanced ToM task, i.e. Comic Strip test. Based on a sample of 37 children with ASD and 55 TD children, our results revealed slower development at varying rates in all ToM measures in children with ASD, with delayed onset compared to TD children. These results could stimulate new treatments for social abilities, which would lessen the social deficit in ASD

Beta-Blocker Use in Older Hospitalized Patients Affected by Heart Failure and Chronic Obstructive Pulmonary Disease: An Italian Survey From the REPOSI Register

Beta (β)-blockers (BB) are useful in reducing morbidity and mortality in patients with heart failure (HF) and concomitant chronic obstructive pulmonary disease (COPD). Nevertheless, the use of BBs could induce bronchoconstriction due to β2-blockade. For this reason, both the ESC and GOLD guidelines strongly suggest the use of selective β1-BB in patients with HF and COPD. However, low adherence to guidelines was observed in multiple clinical settings. The aim of the study was to investigate the BBs use in older patients affected by HF and COPD, recorded in the REPOSI register. Of 942 patients affected by HF, 47.1% were treated with BBs. The use of BBs was significantly lower in patients with HF and COPD than in patients affected by HF alone, both at admission and at discharge (admission, 36.9% vs. 51.3%; discharge, 38.0% vs. 51.7%). In addition, no further BB users were found at discharge. The probability to being treated with a BB was significantly lower in patients with HF also affected by COPD (adj. OR, 95% CI: 0.50, 0.37-0.67), while the diagnosis of COPD was not associated with the choice of selective β1-BB (adj. OR, 95% CI: 1.33, 0.76-2.34). Despite clear recommendations by clinical guidelines, a significant underuse of BBs was also observed after hospital discharge. In COPD affected patients, physicians unreasonably reject BBs use, rather than choosing a β1-BB. The expected improvement of the BB prescriptions after hospitalization was not observed. A multidisciplinary approach among hospital physicians, general practitioners, and pharmacologists should be carried out for better drug management and adherence to guideline recommendations