Mand – to Tact Training Transfer Acquisition Rates in Children Diagnosed with Autism Spectrum Disorder with Limited Verbal Skills

Autism Spectrum Disorder () is defined as “the presence of severe and pervasive impairments in reciprocal social interaction and in verbal and nonverbal communication skills” (Diagnostic & Statistical Manual, 2000). It is estimated that 1 in 68 children across the United States are diagnosed with ASD. One of the most common delays that children diagnosed with ASD experience are language delays. Children with ASD that have a language delay will often develop maladaptive behaviors as a result of poor communication skills (Carr & Durand, 1985). The failure to develop mand acquisition in typical fashion results in behaviors ranging from social withdrawal to self-injurious behaviors (Cooper et. al, 2007). A lack of a strong tact repertoire can further impede and complicate the learning of other necessary components of language due to the inability to successfully label items and events in the physical environment of the child. The purpose of this study is to replicate with a reversal in verbal operant training of the procedures described in Wallace et al. (2006) in which two children with ASD underwent tact training to facilitate the formation of mands; essentially this study aims to accomplish mand training first to establish as tact. It is hypothesized that mand training will result in a greater repertoire of tacts due to strength of the relationship between mands and the control over the social environment (Cooper et al., 2007). The two children in the study will be taught to mand items that will be ranked in order of preference via stimulus preference assessment. This study is of great importance due to the indispensable value of effective social communication skills. Data gathered on improving communication skills is of great value to the ASD community as the implications for functional skills result in better communication with family and greater control of individual functioning.

From labelling to social aid for immigrants in the 21st Century

Migration is as old as humanity, but since the 1990s migration flows in Western Europe have led to societies that are not just multicultural but so-called «super-diverse». As a result, Western towns now have very complex social structures, with amongst others large amounts of small immigrant communities that are in constant change. In this paper we argue that for social workers to be able to offer adequate professional help to non-native residents in town, they will need balanced view of ‘culture’ and of the role culture plays in social aid. Culture is never static, but is continually changing. By teaching social workers about how to look at cultural backgrounds of immigrant groups and about the limitations of then role that culture plays in communication, they will be better equipped to provide adequate aid and will contribute to making various groups grow towards each other and to avoid people thinking in terms of ‘out-group-homogeneity’. Nowadays, inclusion is a priority in social work that almost every social worker supports. Social workers should have an open attitude to allow them to approach every individual as a unique person. They will see the other person as the person they are, and not as a part of a specific cultural group. Knowledge about the others makes them see the cultural heterogeneity in every group. The social sector, though, must be aware not to fall into the trap of the ‘inclusion mania’! This will cause the social deprivation of a particular group to be forgotten. An inclusive policy requires an inclusive society. Otherwise, this could result in even more deprivation of other groups, already discriminated against. Emancipation of deprived people demands a certain target-group policymaking. Categorized aid will raise efficiency of working with immigrants and of acknowledging the cultural identity of the non-natives group. It will also create the possibility to work on fighting social deprivation, in which most immigrants can be found.

Skolad blick på blommor : Formandet av yrkeskunnande i floristutbildning

This article-based thesis focuses on the formation of vocational knowing within adult and upper secondary floristry education in Sweden. Three articles explore classroom interaction and assessment actions; a fourth considers changes in vocational subject matter during the period 1990–2015. While the first three articles draw on empirical data in the form of video and audio recordings in combination with participant observation, the fourth is based primarily on material-based interview data. All four articles share a sociocultural perspective on educational practice (Wertsch, 1998; Säljö, 2011, 2013) and a relational view of knowing (e.g., Carlgren, 2015; Molander, 1996), in combination with the use of conversation analysis (Goodwin & Heritage, 1990; Sahlström & Melander, 2010) as a tool to illuminate the formation of vocational knowing. The interaction between teacher, student, and floral arrangement is foregrounded to facilitate analysis of the formation of vocational knowing. The results contribute to our understanding of the schooling of the gaze (Goodwin, 1994; Grasseni, 2009, 2011) as appropriated by participants in the interaction. Floristry vocational knowing is shown to evolve in the temporal dimension, encompassing (a) financial and aesthetic values, (b) verbal and non–verbal communication, (c) botanical material and tools, and (d) making. The respective roles and interrelations of these four components of vocational knowing in floristry are discussed. The contribution of the thesis is twofold. First, these articles contribute to the understanding of vocational education through close appraisal of the formation of vocational knowing. Second, in exploring the previously under-researched field of Swedish floristry vocational education, the thesis bridges a gap in existing knowledge of the evolution of Swedish vocational education. As floristry education is little researched internationally, the thesis also contributes to the wider body of international research. 

An approach to emotion recognition in single-channel EEG signals: a mother child interaction

In this work, we perform a first approach to emotion recognition from EEG single channel signals extracted in four (4) mother-child dyads experiment in developmental psychology -- Single channel EEG signals are analyzed and processed using several window sizes by performing a statistical analysis over features in the time and frequency domains -- Finally, a neural network obtained an average accuracy rate of 99% of classification in two emotional states such as happiness and sadness

Verhaltens- und fertigkeitenbasierte Frühinterventionen bei Kindern mit Autismus

Einleitung: Zu den autistischen Syndromen werden der frühkindliche Autismus (Kanner-Syndrom), das Asperger-Syndrom und atypische Autismusformen oder nicht-spezifizierte tiefgreifende Entwicklungsstörungen gezählt. Bei den autistischen Syndromen liegen Beeinträchtigungen (1) der Kommunikation und (2) der sozialen Interaktion vor. Weiterhin weisen (3) die Kinder in unterschiedlichem Maß stereotypes, repetitives Verhalten auf und haben bestimmte Sonderinteressen. Verhaltensbasierte Frühinterventionen bei Kindern mit Autismus basieren auf lerntheoretischen und verhaltenstherapeutischen Konzepten. Sie berücksichtigen die besonderen vorliegenden Beeinträchtigungen in der Wahrnehmung, der emotionalen Reaktionen, der sozialen Interaktionen sowie der Kommunikationsmuster. Die systematische Anwendung und Evaluation solcher Modelle in Deutschland ist aber bisher eher die Ausnahme. Fragestellungen: - Wie sind die gesundheitliche Effektivität und Sicherheit von verhaltens- oder fertigkeitenbasierten Frühinterventionen bei autistischen Syndromen untereinander und verglichen mit einer Standardbehandlung? - Gibt es Hinweise auf besondere Wirkfaktoren für die Effektivität? - Wie ist die Kosten-Effektivität? - Wie hoch sind die Kosten der verschiedenen Interventionen? - Lassen sich aus ethischen und rechtlichen Überlegungen Schlüsse für die Anwendung der betrachteten Interventionen bei Betroffenen mit autistischem Syndrom in der Praxis ziehen? Methoden: Basierend auf einer systematischen Literaturrecherche werden ab 2000 in deutscher oder englischer Sprache veröffentlichte kontrollierte Studien zu verhaltens- oder fertigkeitenbasierten Frühinterventionen bei Kindern mit Autismus im Alter von bis zu zwölf Jahren eingeschlossen und bewertet. Die Mindestzahl an Studienteilnehmern muss zehn pro Interventionsgruppe betragen. Ergebnisse: Insgesamt 15 Veröffentlichungen klinischer Primärstudien, acht systematische Reviews und eine ökonomische Veröffentlichung erfüllen die Einschlusskriterien. Die meisten Studien evaluieren intensive Frühinterventionen, die sich an das Modell von Lovaas (Early intensive behavioural treatment (EIBT), Applied behavioural analysis (ABA)) anlehnen. Einige Studien evaluieren andere Interventionen, die teilweise pragmatisch waren und teilweise einem bestimmten Modell folgen (spezifisches Elterntraining, Responsive education and prelinguistic milieu teaching (RPMT), Joint attention (JA) und symbolisches Spielen (SP), Picture exchange communication system (PECS)). Verhaltensanalytische Interventionen basierend auf dem Lovaas-Modell können weiterhin als die am besten empirisch abgesicherten Frühinterventionen angesehen werden. Vorschulkinder mit Autismus können durch verhaltensbasierte Interventionen mit einer Mindestintensität von 20 Stunden pro Woche Verbesserungen in kognitiven und funktionalen Bereichen (expressive Sprache, Sprachverständnis und Kommunikation) erreichen. Es bleibt jedoch unklar, welche Mindestintensität notwendig ist, und welche Wirkkomponenten für die Ergebnisse verantwortlich sind. Für andere umfassende Frühinterventionen bei Kindern mit Autismus liegt keine hochwertige Evidenz vor. Die für den ökonomischen Teilbereich identifizierte und einbezogene Publikation ist methodisch und thematisch nicht dazu geeignet, die Fragen nach der Kosten-Effektivität oder den Kostenwirkungen von Frühinterventionen beim Autismus auch nur ansatzweise zu beantworten. Publikationen zu rechtlichen, ethischen oder sozialen Aspekten werden nicht identifiziert. Die finanzielle Lage der Betroffenen und der Familien wird durch das Pflege-Weiterentwicklungsgesetz (Pf-WG) verbessert. Weitere rechtliche Belange betreffen die Betreuung und die Deliktfähigkeit der Menschen mit Autismus. Auch die gleichheitliche Betreuung und Versorgung sind insbesondere vor dem Hintergrund der Pflege im häuslichen Umfeld eine wichtige Frage. Diskussion: Es gibt nur wenige methodisch angemessene Studien zur Beurteilung der Wirksamkeit von Frühinterventionen bei Kindern mit Autismus. Die meisten Studien sind vergleichsweise kurz und haben teilsweise kein verblindetes Ergebnis-Rating. Der Mangel an hochwertigen vergleichenden Studien lässt keine solide Antwort auf die Frage zu, welche Frühintervention bei welchen Kindern mit Autismus am wirksamsten ist. Programme nach dem Lovaas-Modell scheinen am wirkungsvollsten zu sein. Dies gilt vor allem, wenn sie klinikbasiert durchgeführt werden. Zu einzelnen Wirkfaktoren von Frühinterventionen nach dem ABA-Modell konnte allerdings keine solide Evidenz gefunden werden. Es zeigte sich, dass ein Elterntraining hinsichtlich der Verbesserung der Kommunikation besser ist als eine Routinebehandlung, in der eine Mischung von Theapieelementen angewendet wird. Sowohl für die klinischen als auch die gesundheitsökonomischen Studien besteht das Problem unzureichender Verallgemeinerbarkeit der Studienergebnisse in den deutschen Versorgungskontext. Die ökonomischen Studien sind methodisch und thematisch nicht dazu geeignet die aufgeworfenen Fragestellungen zu beantworten. Schlussfolgerung: Basierend auf der derzeitigen Studienlage liegt für keine der untersuchten verhaltensbasierten Frühinterventionen bei Kindern mit Autismus ausreichende Evidenz vor. Die in diesem Bericht ausgewerteten Studien und Reviews legen nahe, dass Vorschulkinder mit Autismus durch verhaltensbasierte Interventionen mit einer Mindestintensität von 20 Stunden pro Woche Verbesserungen in kognitiven und funktionalen Bereichen erreichen können. Es gibt bisher keine Hinweise, dass bei einem substantiellen Anteil der Kinder eine vollständige Normalisierung der Entwicklung erreicht werden kann. Die meiste Evidenz liegt für die ABA vor. Ein Minimum an erforderlicher oder sinnvoller Behandlungsintensität kann jedoch nicht angegeben werden. Eine professionelle Umsetzung eines verhaltensbasierten Frühinterventionsprogrammes in engem und ausführlichem Kontakt mit den Kindern und unter Einbeziehung der Eltern erscheint sinnvoll. Zur Kosten-Effektivität von intensiven Frühinterventionen bei Kindern mit Autismus können keine validen Angaben gemacht werden. Effektive Frühinterventionen könnten jedoch die Gesamtkosten des Autismus langfristig reduzieren, indem die anfallenden hohen Aufwendungen durch eine spätere bessere soziale Anpassung überkompensiert werden.

Collaboration in 3D virtual worlds : a protocol for case study research

Three-dimensional virtual worlds have been growing fast in number of users, and are used for the most diverse purposes. In collaboration, they are used with good results due to features such as immersion, interaction capabilities, use of avatar embodiment, and physical space. In the particular cases of avatar embodiment and physical space, these features support nonverbal communication, but its impact on collaboration is not well known. In this work we present a protocol for case study research and its creation process, which aims to assert itself as a tool to collect data on how nonverbal communication influences collaboration in three-dimensional virtual worlds. We define the propositions and units of analysis, and a pilot case to validate them. Then, two cases are analysed under the created protocol. Most of the propositions found chains of evidences supporting them.

Comunicação não verbal e estilo instrucional em treinadores de futebol

Dissertação de Mestrado apresentada ao Instituto Superior de Psicologia Aplicada para obtenção de grau de Mestre na especialidade de Psicologia Social e das Organizações.

Caracterización de los saludos en los encuentros de servicio de alto contacto en Medellín

El ser humano constantemente realiza interacciones sociales, en las cuales a través de su lenguaje verbal y no verbal transfiere gran cantidad de información -- Estas interacciones normalmente inician con el saludo, el cual puede llegar a tener implicaciones importantes en aspectos como la percepción que se tiene de un individuo y la forma en la que se lleva a cabo el resto de un encuentro conversacional -- Una de las interacciones sociales más frecuentes, es aquella en la cual los individuos realizan intercambios de tipo comercial, con el objeto de satisfacer una necesidad, como por ejemplo los denominados encuentros de servicio -- Reconociendo la importancia del saludo en las interacciones, así como la frecuencia con la cual los individuos hacen uso de servicios, o laboran en una organización que ofrece productos de tipo intangible, el presente trabajo de investigación tiene como objetivo caracterizar los saludos dentro del contexto de los encuentros de servicio de alto contacto en la ciudad de Medellín -- Para lograr este cometido, el investigador hace uso de las entrevistas etnográficas, propias de los métodos etnográficos, y se vale de la teoría fundada como técnica de análisis

Francisco Pizarro' s banner of arms: an analytical work contributing to latin America's history

The study of textiles is an open area of scientific research, which for its variety of material components and physical chemical diversity of conditions, makes a field of interest for scientific studies in the cultural heritage field. Archaeological/historical textiles offer the possibility to carry out studies on organic materials such as fibers, adhesion elements, dyes, paper, etc., as well as on inorganic compounds for instance metals, alloys, precious stones and other added ornamentation. That variety of composition, allow to use a combination of analytical techniques to solve the questions coming from the object in an archaeometric research. One kind of textile object that provides a valuable cultural information because of its linguistic representation employed by its carrier societies, are the flags/banners/emblems, objects made with a nonverbal communication purpose. As long as depending on the use and/or purpose of each object, varies both the materials/techniques used in its production and its iconography (style, color, emblem, shape), its study gives the possibility to extract information through their materials and manufacturing techniques about a temporal-spatial frame, a particular event or a specific character. The flags/banners have been used since the eleventh century as representative objects of power, hierarchy, social or military organization, or as communicative media. The use of these objects has been spread throughout the world, possibly due to its easy interpretation and/or appropriation by different societies, making it part of their own culture. The flags as symbols of territorial control, using emblems that represent a family, order or army, were introduced to the New World (America) with the arrival of the European conquerors at the end of the fifteenth century. Flags/banners representing the Royal dominion over conquered territories, the Catholic Church and conquistadors’ armies were the first to arrive. One of those flags that have endured over time, that have an invaluable cultural meaning for both American and Iberian societies, is the so-called Francisco Pizarro’s Banner of Arms. It is a textile object with metal threads decoration over a Royal emblem. According to historical sources, this object was used by Francisco Pizarro in 1532 on the conquest process of Peru, after received the permission by King Charles V to on behalf of him, to conquer the lands of the New World today known as Peru. After Pizarro’s control of the Inca territory, it is believed that Pizarro left his banner on top of the Inca’s Sun’s Temple as symbol of his rule. Centuries later, in the America libertarian campaigns, General Sucre, military at charge of the independence army in Peru, reports have found what he considered the Pizarro’s Banner, sending it to Bogotá as a symbol of victory, being kept since that time until today by the National Museum of Colombia. Due to historical discrepancies in the different movements of the so-called Pizarro’s Banner of Arms, its real meaning has been under discussion and because of the passage of time its physical condition has suffer deterioration. That is because its scientific study is now an interesting case study to respond to both historical and conservation questions of it. Through a collaboration with the National Museum of Colombia, a set of 25 samples of so-called Pizarro’s Banner of Arms were collected, covering the various components and areas from the object of study. These samples were subjected to analytical studies for physical and chemical characterization. Microscopic observation, VSEM-EDS analysis, Raman spectroscopy, chromatographic analysis (HPLC-MS, GCMS) and radiocarbon dating were done. Similarly, was sought through a direct in situ physical inspection to the object and through a research into historical sources, adequate information to solve the object’s problems. Results obtained allowed to identify as silk the textile used in the elaboration of the Banner’s fabric, as well as the use of natural dyes for dyeing the fibers used on the emblem: use of cochineal and brazil wood as a source of red, luteolin plant-based for yellow color, indigotine plant-based for blue, and a mixture of yellow and blue dyes for green were identified. Similarly, the use of animal glue in the manufacturing process and the use of rag paper was evident. The metal threads study from the Banner give a confirmation to a silver core wire gilded with a thin gold sheet, being flattened and entwined with silk threads for their use. Finally, using the radiocarbon results, it was possible to postulate with huge accuracy that the Banner date manufacture was between the XV-XVI century and subject to restoration processes with addition of textiles in modern times. Together with, was evident that the state of degradation of the fabric is due to natural degradation in the silk fibers, having that its color has faded and its mechanical properties decreased, leading to loss of rigidity and disappearance of the physical structure. Similarly, it was clear the original colors of the emblem and highlight problems of detachment of paper due to crystallization of the adhesive. In the same way, was found that the metal threads suffer corrosion by sulfur and detachment of its crystals. Finally, combining the analytical results and the historical sources data found from the so-called Francisco Pizarro’s Banner of Arms, allows to postulate that its manufacture process was done in Europe employing precious materials to obtain a long-life object with a deep message for its viewers. Also, the data obtained helps to support the possible idea that the object was employed by Francisco Pizarro in the Peru conquest process. However, by the symbols present in the object, its elaboration date and materials, this object its clearly unique in its kind, and the most important, by its linguistic message, does not represent to Francisco Pizarro or his army, meanwhile, represents the Spanish crown. Therefore, instead to be labeled as Francisco Pizarro’s Banner of Arms, it should be called the Colonial Royal Banner of Charles V in the New World; RESUMEN: El estudio de textiles es un área abierta de investigación científica, la cual por su variedad de componentes materiales y la diversidad de condiciones físico-químicas presentes en estos objetos, lo hace un campo de interés para estudios científicos en el patrimonio cultural. Los textiles arqueológicos/históricos brindan la posibilidad de realizar estudios en materiales orgánicos como fibras, elementos de adhesión, tinturas, papel, etc., e inorgánicos como metales, aleaciones, piedras preciosas y demás materiales decorativos añadidos. Por su variedad de composición, es posible emplear diversas técnicas analíticas para resolver aquellas preguntas propias del objeto en una investigación arqueométrica. Uno de los objetos textiles que brinda gran información cultural debido a su representación lingüística empleada por las sociedades portadoras, son las banderas/estandartes/emblemas. Donde varía dependiendo de su uso y/o propósito, los materiales empleados en su elaboración, al igual que su iconografía (estilo, color, emblema, forma). El estudio de estos objetos construidos con un propósito de comunicación no verbal, da la posibilidad de extraer información a través de sus materiales y técnicas de elaboración sobre un rango temporal-espacial, un evento determinado en la historia o incluso a un personaje en específico. Las banderas han sido empleadas desde el siglo XI como objetos representativos de poder, jerarquía, organización social o militar, o como medio de comunicación. El uso de estos objetos se ha extendido a lo largo del mundo posiblemente debido a su fácil interpretación y/o apropiación por distintas sociedades, haciéndolo parte de su cultura. Las banderas como símbolos de control territorial, empleando símbolos que representan a una familia, orden o armada fueron introducidas a el Nuevo Mundo (América) con la llegada de los conquistadores europeos al final del siglo XV. Las banderas/estandartes que representaban el dominio Real sobre territorios dominados, la iglesia católica y las banderas de ejércitos y/o conquistadores fueron las primeras en llegar al nuevo mundo. Una de aquellas banderas que ha soportado el paso del tiempo, teniendo un gran valor cultural tanto para las sociedades americanas como para las ibéricas, es el denominado Estandarte de armas de Francisco Pizarro. Siendo un objeto textil con decoración en hilos metálicos sobre un emblema Real. De acuerdo a fuentes históricas, este objeto fue usado por Francisco Pizarro en 1532 en el proceso de conquista del Perú, quien recibe por parte del Rey Carlos V el poder para que, en su nombre, Pizarro pueda conquistar las tierras del nuevo mundo hoy conocidas como Perú. Luego del dominio de Pizarro sobre el territorio Inca, se cree que Pizarro dejó su estandarte en la cima del templo Inca del sol como símbolo de su control. Siglos más tarde, en las campañas libertarias de América, el General Sucre, militar encargado de la armada independentista en Perú, reporta haber encontrado lo que él considera como el estandarte de Pizarro, enviándolo a Bogotá como muestra de victoria, siendo custodiada desde ese momento por el Museo Nacional de Colombia hasta la actualidad. Debido a discrepancias históricas, el verdadero significado del llamado estandarte de Pizarro ha sido objeto de discusión y debido del pasar del tiempo su estado de conservación se ha deteriorado. Dejando de este modo, un caso de estudio interesante para que por medio de estudios científicos al objeto se pueda dar respuesta a preguntas tanto históricas como de conservación del mismo. De este modo, por medio de una colaboración con el Museo Nacional de Colombia, se obtuvo un juego de 25 muestras del llamado Estandarte de armas de Francisco Pizarro, abarcando los diferentes componentes y áreas del objeto de estudio. Dichas muestras fueron sometidas a estudios analíticos para su caracterización físico-química. Análisis de observación al microscopio, análisis VSEM-EDS, espectroscopia Raman, análisis cromatográficos (HPLC-MS, GC-MS) y datación por radiocarbono catorce fueron realizados. Del mismo modo, por medio de una inspección física al objeto in situ y una profunda investigación en fuentes históricas del mismo, se buscó la información adecuada para resolver sus problemáticas. Los resultados obtenidos permitieron identificar como seda el textil empleado en la elaboración del estandarte, así como el uso de colorantes naturales para teñir las fibras en el emblema: uso de cochinilla y palo de Brasil como fuente del color rojo, plantas a base de luteolin para el color amarillo, plantas a base de indigotina para el color azul y mezcla de colorantes amarillos y azules para el color verde fueron identificadas. Del mismo modo se evidencio el uso de adhesivos animales y el uso de papel de trapos en el proceso de manufactura. El estudio de los hilos metálicos, permitió evidenciar el uso de alambres con núcleos de plata con un fino recubrimiento de oro en su exterior, siendo aplanados y entrelazados con hilos de seda para su uso. Finalmente usando la datación por radiocarbono, fue posible conocer con alta precisión que el estandarte fue elaborado entre los siglos XV-XVI y sufrió procesos de restauración con añadidura de textiles en tiempos modernos. Junto a lo anterior, es posible postular que el estado de degradación de la tela es debido a degradación natural en las fibras de seda, teniendo así que su color se ha desvanecido y sus propiedades mecánicas disminuidas, conllevando a perdida de rigidez y desaparición de la estructura. Del mismo modo se pudo conocer los colores originales del emblema y evidenciar problemas de desprendimiento del papel debido a cristalización del adhesivo. Asimismo, se comprobó que los hilos metálicos presentan corrosión por azufre y desprendimiento de sus cristales. Finalmente, combinando los resultados analíticos y la información de fuentes históricas encontradas del llamado Estandarte de armas de Francisco Pizarro, se puede postular que su elaboración fue realizada en Europa, usando materiales preciosos para obtener un objeto de larga vida con un profundo mensaje para sus observadores. También, los datos obtenidos ayudan a dar soporte la posible idea de que este objeto fue usado por Francisco Pizarro en el proceso de conquista del Perú. Sin embargo, debido a los símbolos presentes en el objeto, fecha y materiales de elaboración, este objeto es claramente único en su tipo, y lo más importante, por su mensaje lingüístico, este no representa a Francisco Pizarro o su armada, al contrario, representa a la Corona de España. Por ende, en vez de denominarse como Estandarte de armas de Francisco Pizarro, este objeto debería nombrarse como el Estandarte Real de la Colonia de Carlos V en el Nuevo Mundo.

Development and evaluation of a program to improve clinician and patient communication during a telehealth consultation : C.R.I.S.P. Telehealth

Introduction: The delivery of health care in the 21st century will look like no other in the past. The fast paced technological advances that are being made will need to transition from the information age into clinical practice. The phenomenon of e-Health is the over-arching form of information technology and telehealth is one arm of that phenomenon. The uptake of telehealth both in Australia and overseas, has changed the face of health service delivery to many rural and remote communities for the better, removing what is known as the tyranny of distance. Many studies have evaluated the satisfaction and cost-benefit analysis of telehealth across the organisational aspects as well as the various adaptations of clinical pathways and this is the predominant focus of most studies published to date. However, whilst comments have been made by many researchers about the need to improve and attend to the communication and relationship building aspects of telehealth no studies have examined this further. The aim of this study was to identify the patient and clinician experiences, concerns, behaviours and perceptions of the telehealth interaction and develop a training tool to assist these clinicians to improve their interaction skills. Methods: A mixed methods design combining quantitative (survey analysis and data coding) and qualitative (interview analysis) approaches was adopted. This study utilised four phases to firstly qualitatively explore the needs of clients (patients) and clinicians within a telehealth consultation then designed, developed, piloted and quantitatively and qualitatively evaluated the telehealth communication training program. Qualitative data was collected and analysed during Phase 1 of this study to describe and define the missing 'communication and rapport building' aspects within telehealth. This data was then utilised to develop a self-paced communication training program that enhanced clinicians existing skills, which comprised of Phase 2 of this study to develop the interactive program. Phase 3 included evaluating the training program with 26 clinicians and results were recorded pre and post training, whilst phase 4 was the pilot for future recommendations of this training program using a patient group within a Queensland Health setting at two rural hospitals. Results: Comparisons of pre and post training data on 1) Effective communication styles, 2) Involvement in communication training package, 3) satisfaction pre and post training, and 4) health outcomes pre and post training indicated that there were differences between pre and post training in relation to effective communication style, increased satisfaction and no difference in health outcomes between pre and post training for this patient group. The post training results revealed over half of the participants (N= 17, 65%) were more responsive to non-verbal cues and were better able to reflect and respond to looks of anxiousness and confusion from a 'patient' within a telehealth consultation. It was also found that during post training evaluations, clinicians had enhanced their therapeutic communication with greater detail to their own body postures, eye contact and presentation. There was greater time spent looking at the 'patient' with an increase of 35 second intervals of direct eye contact and less time spent looking down at paperwork which decreased by 20 seconds. Overall 73% of the clinicians were satisfied with the training program and 61% strongly agreed that they recognised areas of their communication that needed improving during a telehealth consultation. For the patient group there was significant difference post training in rapport with a mean score from 42 (SD = 28, n = 27) to 48 (SD = 5.9, n = 24). For communication comfort of the patient group there was a significant difference between the pre and post training scores t(10) = 27.9, p = .002, which meant that overall the patients felt less inhibited whilst talking to the clinicians and more understood. Conclusion: The aim of this study was to explore the characteristics of good patient-clinician communication and unmet training needs for telehealth consultations. The study developed a training program that was specific for telehealth consultations and not dependent on a 'trainer' to deliver the content. In light of the existing literature this is a first of its kind and a valuable contribution to the research on this topic. It was found that the training program was effective in improving the clinician's communication style and increased the satisfaction of patient's within an e-health environment. This study has identified some historical myths that telehealth cannot be part of empathic patient centred care due to its technology tag.

The Analogical Peacock Hypothesis: The Sexual Selection of Mind-Reading and Relational Cognition in Human Communication

This integrative review presents a novel hypothesis as a basis for integrating two evolutionary viewpoints on the origins of human cognition and communication, the sexual selection of human mental capacities, and the social brain hypothesis. This new account suggests that mind-reading social skills increased reproductive success and consequently became targets for sexual selection. The hypothesis proposes that human communication has three purposes: displaying mind-reading abilities, aligning and maintaining representational parity between individuals to enable displays, and the exchange of propositional information. Intelligence, creativity, language, and humor are mental fitness indicators that signal an individual’s quality to potential mates, rivals, and allies. Five features central to the proposed display mechanism unify these indicators, the relational combination of concepts, large conceptual knowledge networks, processing speed, contextualization, and receiver knowledge. Sufficient between-mind alignment of conceptual networks allows displays based upon within-mind conceptual mappings. Creative displays communicate previously unnoticed relational connections and novel conceptual combinations demonstrating an ability to read a receiver’s mind. Displays are costly signals of mate quality with costs incurred in the developmental production of the neural apparatus required to engage in complex displays and opportunity costs incurred through time spent acquiring cultural knowledge. Displays that are fast, novel, spontaneous, contextual, topical, and relevant are hard-to-fake for lower quality individuals. Successful displays result in elevated social status and increased mating options. The review addresses literatures on costly signaling, sexual selection, mental fitness indicators, and the social brain hypothesis; drawing implications for nonverbal and verbal communication.

Research review: reading comprehension in developmental disorders of language and communication

Background: Deficits in reading airment (SLI), Down syndrome (DS) and autism spectrum disorders (ASD). Methods: In this review (based on a search of the ISI Web of Knowledge database to 2011), the Simple View of Reading is used as a framework for considering reading comprehension in these groups. Conclusions: There is substantial evidence for reading comprehension impairments in SLI and growing evidence that weaknesses in this domain are common in DS and ASD. Further, in these groups reading comprehension is typically more impaired than word recognition. However, there is also evidence that some children and adolescents with DS, ASD and a history of SLI develop reading comprehension and word recognition skills at or above the age appropriate level. This review of the literature indicates that factors including word recognition, oral language, nonverbal ability and working memory may explain reading comprehension difficulties in SLI, DS and ASD. In addition, it highlights methodological issues, implications of poor reading comprehension and fruitful areas for future research.

Communication that values patient autonomy is associated with satisfaction with care: a systematic review

Question: Which communication factors used by clinicians during patient-clinician interactions are associated with satisfaction with care? Design: Systematic review with meta-analysis of studies investigating the association of verbal or nonverbal factors or interaction styles used by clinicians with patient satisfaction during an encounter between clinician and patient. Participants: Clinicians interacting with patients in primary care or rehabilitation settings. Results: Twenty-seven studies investigated 129 verbal, nonverbal, and interaction style factors. of these, 38 factors were consistently associated with satisfaction. Verbal factors concerning clinicians involving, facilitating, and supporting patients were associated with satisfaction with care. Most communication factors presented a fair correlation (r >= 0.21 but < 0.41) with satisfaction with care. Nonverbal factors such as time spent discussing prevention and time spent reading patient charts had a fair association with satisfaction with care (correlations range from 0.21 to 0.40). A moderate association was found between interaction styles such as caring (pooled r = 0.51, 95% CI 0.42 to 0.60) and satisfaction with care. Over half (58%) of the 129 identified factors never associated with satisfaction with care and the remainder associated inconsistently. Conclusion: The number of potential modifiable communication factors associated with satisfaction with care and the magnitude of their association partially support interventions to train clinicians in communication skills that value patient autonomy. [Oliveira VC, Refshauge KM, Ferreira ML, Pinto RZ, Beckenkamp PR, Negrao Filho RF, Ferreira PH (2012) Communication that values patient autonomy is associated with satisfaction with care: a systematic review. Journal of Physiotherapy 58: 215-229]