Head Nodding Research Articles

Conceptualizing Illness: Nodding Syndrome in Northern Uganda


 
 
 This paper presents an ethnographic study of conceptualizations of nodding syndrome (NS) in Uganda. NS is a poorly understood condition characterized by repetitive nodding of the head, mental retardation and stunted growth, which affects thousands of children in northern Uganda, South Sudan and Tanzania. Although extensive research for causative agents has been conducted, no convincing single cause has been reported. This study establishes an understanding of different representations of NS and argues that the episodes of head nodding are related to the socio-political body in which they are manifested. Three interwoven approaches towards NS take main stage whereby the syndrome is presented as a biomedical, spiritual and/or political problem. The conceptualizations are linked to different notions of healing and affected families combine various forms of therapy. Through the examination of different narratives, this study disrupts the idea of a singular perspective on illness and pleads for a focus on motion and plurality.
 KEY WORDS: NODDING SYNDROME, UGANDA, HEALTH, CONCEPTUALIZATION, ANTHROPOLOGY
 
 

Automatic Nonverbal Mimicry Detection and Analysis in Medical Video Consultations

ABSTRACT Effective medical consultation requires good nonverbal communication between patients and doctors. Nonverbal behavior (NVB) mimicry, when a person imitates the NVB of the conversation partner, has been associated with building rapport between people. We study how NVB mimicry influences the quality of a medical consultation in a video conference. Computer vision algorithms were used to analyze 2027.75 minutes of recorded medical video consultations between medical students (N = 130) and volunteers who acted as Simulated Patients (SP, N = 29). We automatically detected students’ NVB mimicry to the SP and investigated the relationship between the NVB mimicry and students’ overall communication skills performance. The results highlighted the positive correlation between head nodding mimicry and assessed communication skills. In addition, we also identified NVB mimicry styles by cluster analysis and found that certain NVB mimicry styles have associated with better communication performance. These findings provide insights into the future design of systems that offer automatic feedback in communication skills training.

COVID-19 and Educational Engagement

COVID-19 and Educational Engagement

EUTHANASIA OF ACUTE NEUROLGIC CANINE DISTEMPER VIRUS AFFECTED PET DOG ADJACENT TO PROTECTED FOREST AREA

Adult male non-descript bred dog presented with a history of circling motion, frequent head nodding, crusty muzzle, muscle twitching, seizure, vomiting, inappetence, coughing, inability to walk, watery pustular discharge from eyes and blood stained left ears and on further examination of foot pads showed thick, crusty or hardened sole and based on the clinical signs and symptoms, provisionally diagnosed as Canine distemper and advised euthanasia due to close geographic onset of the disease epidemic and to prevent Canine distemper-associated deaths in wild canids and felids.

CARIN

Recent studies have proposed to use the Channel State Information (CSI) of WiFi wireless channel for human gesture recognition. As an important application, CSI-based driver activity recognition in passenger vehicles has received increasing research attention. However, a serious limitation of almost all the existing WiFi-based recognition solutions is that they can only recognize the activity of a single person at a time, because the activities of other people (if performed at the same time) can interfere with the WiFi signals. In a sharp contrast, there can often be one or more passengers in any vehicles. In this paper, we propose CARIN, CSI-based driver Activity Recognition under the INterference of passengers. CARIN features a combination-based solution that profiles all the possible activity combinations of driver and (one or more) passengers in offline training and then performs recognition online. To attack possible combination explosion, we first leverage in-car pressure sensors to significantly reduce combinations, because there are only limited seating options in a passenger vehicle. We then formulate a distance minimization problem for fast runtime recognition. In addition, a period analysis methodology is designed based on the kNN classifier to recognize activities that have a sequence of body movements, like continuous head nodding due to driver fatigue. Our results in a real car with 3,000 real-world traces show that CARIN can achieve an overall F1 score of 90.9%, and outperforms the three state-of-the-art solutions by 32.2%.

CRISPR/Cas9-mediated mutation of asparagine-linked glycosylation 13 transcript variant 1 causes epilepsy in mice

Abstract Objective: The asparagine-linked glycosylation 13 homolog (Alg13) has been identified as causative for congenital disorders of glycosylation type I with epilepsy. The aim of this study was to determine whether mice carrying a mutated version of Alg13 could be used as a model for epileptic encephalopathies or congenital disorders of glycosylation type I. Methods: A model of epileptic encephalopathy was established in C57BL/6 mice by introducing mutations in Alg13 via the clustered regularly interspaced palindromic repeats (CRISPR)/CRISPR-associated protein 9 (CRISPR/Cas9) system. All surgical procedures were approved by the Institutional Animal Care and Use Committee of Shanghai Jiao Tong University (A2016084) on October 8, 2016. Results: Mice with 3 different mutations, Alg13 –54nt , Alg13 –5nt and Alg13 –4nt , all of which are located in Alg13 transcript variant 1, were created. The Alg13 –5nt mice exhibited spontaneous seizures similar to patients with Alg13 mutations, suggesting that they could be used as a model for epilepsy. Western blot analysis demonstrated that Alg13 –5nt mice had lower levels of Alg13 expression than wild-type mice. Video observations showed that two of the 17 Alg13 –5nt mice had stage 5 seizures involving jumping and falling, while 12 had stage 3 seizures with head nodding. Conclusion: The Alg13 mouse model provides an outstanding tool for studying epileptic encephalopathies and investigating different aspects of defects in glycosylation or other post-translational modification that cannot be assessed in patients or cell culture systems.

Conceptualizing Illness: Nodding Syndrome in Northern Uganda

This paper presents an ethnographic study of conceptualizations of nodding syndrome (NS) in Uganda. NS is a poorly understood condition characterized by repetitive nodding of the head, mental retardation and stunted growth, which affects thousands of children in northern Uganda, South Sudan and Tanzania. Although extensive research for causative agents has been conducted, no convincing single cause has been reported. This study establishes an understanding of different representations of NS and argues that the episodes of head nodding are related to the socio-political body in which they are manifested. Three interwoven approaches towards NS take main stage whereby the syndrome is presented as a biomedical, spiritual and/or political problem. The conceptualizations are linked to different notions of healing and affected families combine various forms of therapy. Through the examination of different narratives, this study disrupts the idea of a singular perspective on illness and pleads for a focus on motion and plurality.

Aetiologies and therapies of nodding syndrome: a systematic review and meta-analysis

# Background Nodding syndrome (NS) is a childhood epileptic disorder of unknown aetiology confined to parts of South Sudan, Uganda and the United Republic of Tanzania. Patients suffer from atonic seizures that result in characteristic head nodding, and may develop other neurological, endocrinological and psychiatric manifestations. The objective of this study was to adopt a non-judgemental approach to review the hypothesised aetiologies and therapeutic options available for NS. To explore the reported association between NS and *Onchocerca volvulus* (OV) a meta-analysis of the prevalence of OV among NS cases and controls was performed. # Methods Systematic searching of five electronic databases yielded 26 articles that addressed potential aetiologies of NS and 12 that explored the treatment of NS. # Results Nine articles contained data about the prevalence of OV in NS cases that was suitable for inclusion in the meta-analysis. Four broad aetiological themes were identified. 1) Nutritional associations included biomarkers of malnutrition and conflicting reports regarding the consumption of some foodstuffs. 2) Regional conflict and the associated psychological trauma have led to consideration of psychiatric aetiologies. 3) There is a strong epidemiological association between NS and *Onchocerca volvulus*. The meta-analysis in this study revealed that 68.0% (95% confidence interval (CI)=45.2-87.0) of 416 NS patients were OV+, compared to 46.6% (95% CI=16.4-78.1) of 321 controls. Heterogeneity among both cases (*I^2^*=95.5%, 95% CI=93.3-97.0) and controls (*I^2^*=97.1%, 95% CI=95.5-98.2) was high. The difference of 21.4% in OV prevalence between the pooled populations was significant (*P*\<0.0001). It is thought that NS represents a form of onchocerciasis-associated epilepsy, however there are also reported associations with *Mansonella pestans* and measles virus. 4) Autoantibodies against leiomodin-1 and the voltage-gated potassium channel have been associated with NS. Molecular mimicry between leiomodin-1 and *O. volvulus* tropomyosin is a recently suggested aetiology. Without a clear aetiology treatment is symptomatic and patients have been shown to improve with a combination of anti-epileptic medication and supportive therapy. # Conclusions The aetiology of NS remains unclear. The leading theory is that NS represents a form of onchocerciasis-associated epilepsy secondary to autoimmunity driven by molecular mimicry. Alternatively, it has been suggested that NS may represent a post-infectious sequelae of measles virus infection. However, each theory currently leaves some questions unanswered. It remains important to understand the aetiology of NS to better prevent or treat future outbreaks.

BELF expert users: Making understanding visible in internal BELF meetings through the use of nonverbal communication strategies

The worldwide use of English as a Business Lingua Franca (BELF) has led to increased research of BELF that seeks to elucidate its complexities, and the multiple competencies of its users that contribute to its success. As much of previous BELF research has focused on verbal communication, little is known of how nonverbal conduct contributes to facilitating shared understanding in the business context. This paper focuses on the nonverbal communication strategies (NVCS) participants use as shared repertoire and resources in formal internal meeting interactions for successful and effective communication. Combining Community of Practice (CofP) and Conversation Analysis (CA) frameworks, and applying a multimodal approach, three video-recorded meetings were analyzed. The paper explores three salient NVCS: head nod, hand pointing gesture, and eye contact and gaze; each serves specific functions such as contextualizing or enhancing verbal communication, providing clarity and feedback, and making understanding visible. The findings not only contribute to the existing understanding of BELF but also offer an empirical basis regarding NVCS that may inform ESP: in business communication courses, raising awareness of effective NVCS based on authentic use in specific settings could provide valuable insights on communicative competence as part of the multiple competencies of BELF expert users.

Noggin Nodding: Head Movement Correlates With Increased Effort in Accelerating Speech Production Tasks.

Movements of the head and speech articulators have been observed in tandem during an alternating word pair production task driven by an accelerating rate metronome. Word pairs contrasted either onset or coda dissimilarity with same word controls. Results show that as production effort increased, so did speaker head nodding, and that nodding increased abruptly following errors. More errors occurred under faster production rates, and in coda rather than onset alternations. The greatest entrainment between head and articulators was observed at the fastest rate under coda alternation. Neither jaw coupling nor imposed prosodic stress was observed to be a primary driver of head movement. In alternating pairs, nodding frequency tracked the slower alternation rate rather than the syllable rate, interpreted as recruitment of additional degrees of freedom to stabilize the alternation pattern under increasing production rate pressure.

Use of Physical Self-Experience forTeaching Lameness Evaluation: Short-Term Effects on Lameness Evaluation ofHorses with Mild Forelimb Lameness by Novice Veterinary Students.

Lameness evaluation (LE) is an important veterinary skill, but it can be a challenging task to teach. Acoustic and visual input in conjunction with acting are the three major learning channels for acquiring new information. Acting (e.g., physical self-experience) has not been reported as a didactic tool for LE; therefore, we investigated two physical self-experience techniques, imitation of lameness during LE instruction and head nod during LE. Undergraduate veterinary students (N = 78) who had not yet received any instructions for LE underwent standard instruction for LE, followed by instructions to head nod, instructions to imitate lameness, or neither. Students' subjective LE skills were then tested against those of senior clinicians on two horses that were either sound or mildly forelimb lame. In more than 80%, there was agreement on the presence or absence of lameness independent of instruction, and we found no significant evaluation differences between didactic strategies. Specific instructions for head nodding did not significantly influence the quality of LE, possibly because head nodding was widespread even when no specific instructions had been given. Veterinary students who had been taught to imitate lameness without instructions to head nod were consistently closest to the assessment of the senior clinicians, and in walk these students were significantly better at LE than students additionally instructed to head nod. This finding indicates that imitation of lameness, but not necessarily head nodding, may be beneficial for understanding body movement such as mild equine forelimb lameness.

Affiliation in interpreter-mediated therapeutic talk

AbstractThe aim of this article is to explore how affiliation (Stivers 2008) with the patient is displayed and interactionally achieved in the context of an interpreter-mediated therapeutic dialogue. More specifically, we focus on the interplay between affiliative listener responses – especially head nods – and gaze in this setting. Interpreter-mediated therapeutic talk is not only a setting that has received very little systematic scrutiny in the literature, but it is also particularly interesting for the study of listener responses. Drawing on the insights from Conversation Analysis, a naturally occurring interpreter-mediated therapeutic session was analysed that had been recorded using mobile eye-tracking technology. This approach allowed for a detailed analysis of the interlocutors’ synchronous gaze behaviour in relation to speech and head nods during the interaction. The results revealed differences in the interpreter’s and the therapist’s affiliative listener responses that were linked to the interactional goals of the encounter and to their social roles. Moreover, we found a strong relationship between mutual gaze and head nods as tokens of affiliation. Thus, these findings provide support for the inclusion of gaze in studies of interpreter-mediated dialogue and, more broadly, in the study of affiliation in social interaction.

Finding phrases: On the role of co-verbal facial information in learning word order in infancy.

The input contains perceptually available cues, which might allow young infants to discover abstract properties of the target language. Thus, word frequency and prosodic prominence correlate systematically with basic word order in natural languages. Prelexical infants are sensitive to these frequency-based and prosodic cues, and use them to parse new input into phrases that follow the order characteristic of their native languages. Importantly, young infants readily integrate auditory and visual facial information while processing language. Here, we ask whether co-verbal visual information provided by talking faces also helps prelexical infants learn the word order of their native language in addition to word frequency and prosodic prominence. We created two structurally ambiguous artificial languages containing head nods produced by an animated avatar, aligned or misaligned with the frequency-based and prosodic information. During 4 minutes, two groups of 4- and 8-month-old infants were familiarized with the artificial language containing aligned auditory and visual cues, while two further groups were exposed to the misaligned language. Using a modified Headturn Preference Procedure, we tested infants’ preference for test items exhibiting the word order of the native language, French, vs. the opposite word order. At 4 months, infants had no preference, suggesting that 4-month-olds were not able to integrate the three available cues, or had not yet built a representation of word order. By contrast, 8-month-olds showed no preference when auditory and visual cues were aligned and a preference for the native word order when visual cues were misaligned. These results imply that infants at this age start to integrate the co-verbal visual and auditory cues.

A Flexible Multimodal Sensor That Detects Strain, Humidity, Temperature, and Pressure with Carbon Black and Reduced Graphene Oxide Hierarchical Composite on Paper.

Flexible sensors (FSs) are the key components of intelligent equipment and wearable devices, thus attracting increasing research interests in recent years. However, the preparation of multifunctional FS with good degradability in a natural environment is still challenging. In this work, we fabricated a flexible multimodal sensor that can detect multiple stimuli with only one device by spraying the mixture of carbon black (CB) and reduced graphene oxide (rGO) on a paper substrate. Scanning electron microscopy visualization indicated the CB particles absorbed on the surface of rGO, which then overlayered together, constructing a hierarchical structure. Benefiting from this unique structure, the obtained FS was demonstrated to have good sensitivity for strain, humidity, temperature, and pressure as well as multiple stimuli and was used to monitor human respirations as well as body motions, such as finger and elbow bending and head nodding. Besides, the sensor can be easily degraded in water being free of electronic pollution, but it also can be reused after the soaking-drying process, implying its reliability. This degradable and multimodal FS may find great potential in flexible electronics.

Coverbal speech gestures signal phrase boundaries: A production study of Japanese and English infant- and adult-directed speech

ABSTRACTThe acoustic realization of phrasal prominence is proposed to correlate with the order of V(erbs) and O(bjects) in natural languages. The present production study with 15 talkers of Japanese (OV) and English (VO) investigates whether the speech signal contains coverbal visual information that covaries with auditory prosody, in Infant- and Adult-Directed Speech (IDS and ADS). Acoustic analysis revealed that phrasal prominence is carried by different acoustic cues in the two languages and speech styles, while analyses of motion showed that this acoustic prominence is not accompanied by coverbal gestures. Instead, the talkers of both languages produced eyebrow movements to mark the boundaries of target phrases within elicited utterances in combination with head nods. These results suggest that the signal might contain multimodal information to phrase boundaries, which could help listeners chunk phrases from the input.

“It has the ability to make the other person feel comfortable”: L1 Japanese speakers’ folk descriptions of aizuchi

Aizuchi refers to particular verbal and non-verbal listening behaviours in Japanese. Listeners perform these behaviours during interaction while the speaker has the floor. These responses attend to the speaker’s talk, by demonstrating understanding, continuation and other interactional functions. These responses include verbalisations such as un (‘yeah’), aa (‘right), ee (‘uh huh’) and non-verbal movements such as head nods. Previous researchers have claimed that L1 Japanese speakers have a heightened sense of awareness of aizuchi when compared to speakers of other languages. However, researchers have yet to formally establish the ways in which Japanese speakers are aware of this phenomenon. As a result, this study reports on L1 Japanese speaking participants’ descriptions of aizuchi. These descriptions were elicited through semi-structured reflective interviews and were folk linguistically analysed. The results indicate that participants can articulate accurate and detailed descriptions of aizuchi, when they were compared to previous research findings. Specifically, participants described aizuchi as a particular form, as an affective function, and/or as an interactional function. Participants also distinguished aizuchi responses from other forms of verbal and non-verbal listening behaviours, which they typically described as “reactions”. Consequently, a taxonomy of listening responses in Japanese is proposed in this study. Overall, this research establishes L1 Japanese speakers’ explicit knowledge about aizuchi, which may have implications for other languages, interactional-oriented studies, and Japanese second language classrooms.

Head nodding: An unusual presentation of congenital brain tumor

Congenital brain tumors (CBTs) in neonates are defined as tumors presenting within 60 days after birth. Teratoma is the most common type of CBT. A 37-day-old baby was presented to pediatric emergency with complaints of difficulty in breathing, refusal of feed, and lethargy. The baby had continuous head nodding, drooling of saliva, and slight hypotonia of lower limbs which mother, then confirmed, was present since birth. There was a history of admission to another hospital with similar complaints at day 15 of life, where the child was discharged after 5 days of hospitalization with a diagnosis of nasal block. Magnetic resonance imaging brain showed a large mass located centrally suggestive of either pilocytic astrocytoma or medulloblastoma. The patient expired after 6 months in a private hospital. The present case report aims to focuse the importance of an early diagnosis based on the clinical presentation and imaging studies followed by timely intervention which is critical as the prognosis is very poor.

Investigation of Guide's Perception and Understanding of Nonverbal behavior employed by Foreign Guesses during transactional Negotiation at Lembar Harbour

The importance of using nonverbal communication (NVC) is as a complement to spoken expressions when especially communicating with people of different background. On one hand, NVC is used to convey meaning in which verbal words can’t convey meaning, and is used to express attitudes and emotions in interpersonal relations. On the other hand, NVC is used to convey intended meaning when the addressor can’t fully understand against the addresse with different socioculture. Since NVC is very important in conversation particularly when communicating with foreigners. Therefore, this study concerns with guide’s understanding and perception on NVC in transactional negotiation. The paper used quailitative and quantitative research trying to see the common forms of NVC expressed by two sides. The sample is all guides and is taken from the field in which conversation takes place. This research used observation to see actual data of on going discourse and used camera recorder to see the common NVC employed by guides and foreign guesses and asking guide’s understanding through questionnaires and perception through interview. The result showed that most of guides about 90% understand the basic forms of NVC such as head nodding and shaking, hand shaking, finger sign and eye contact while other forms, 73% of guides doesn’t understand nonverbal sign used by guesses during conversation, and about 89 % of them said that the involvement of Nonverbal Communication is very important to bridge words and lack of vocabulary. However, because majority of them lack of knowledge on nonverbal signs leads them to ignore such things.

"Those who died are the ones that are cured". Walking the political tightrope of Nodding Syndrome in northern Uganda: Emerging challenges for research and policy.

BackgroundNodding Syndrome was first reported from Tanzania in the 1960s but appeared as an epidemic in Northern Uganda in the 1990s during the LRA civil war. It is characterized by repetitive head nodding, often followed by other types of seizures, developmental retardation and growth faltering with onset occurring in children aged 5–15 years. More than 50 years after the first reports, the aetiology remains unknown and there is still no cure. The recent hypothesis that Nodding Syndrome is caused by onchocerciasis also increases the relevance of onchocerciasis control. Northern Uganda, with its unique socio-political history, adds challenges to the prevention and treatment for Nodding Syndrome. This article aims to show how and why Nodding Syndrome has been politicised in Uganda; how this politicisation has affected health interventions including research and dissemination; and, the possible implications this can have for disease prevention and treatment.MethodologyEthnographic research methods were used triangulating in-depth interviews, focus group discussions, informal conversations and participant observation, for an understanding of the various stakeholders’ perceptions of Nodding Syndrome and how these perceptions impact future interventions for prevention, treatment and disease control.Principal findingsDistrust towards the government was a sentiment that had developed in Northern Uganda over several decades of war and was particularly linked to the political control and ethnic divisions between the north and south. This coincided with the sudden appearance of Nodding Syndrome, an unknown epidemic disease of which the cause could not be clearly identified and optimal treatment had not clearly been established. Additionally, the dissemination of the inconclusive results of research conducted in the area lacked sufficient community involvement which further fueled this political distrust. Disease perceptions revolved around rumours that the entire Acholi ethnic group of the north would be annihilated, or that international researchers were making money by stealing study samples. This discouraged some community members from participating in research or from accepting the mass drug administration of ivermectin for prevention and treatment of onchocerciasis. Such rumour and distrust led to suspicions concerning the integrity of the disseminated results, which may negatively impact future disease management and control interventions.Conclusions and recommendationsTrust must be built up gradually through transparency and by de-politicising interventions. This can be done by engaging the community at regular intervals during research and data collection and the dissemination of results in addition to involvement during service delivery for prevention and treatment. Maintaining a regular feedback loop with the community will help control rumours, build trust, and improve the preparations for adequate dissemination.

Quality of nurses’ communication with mechanically ventilated patients in a cardiac surgery intensive care unit

Objective. To describe the quality of the relationship between nurses and patients under mechanical ventilation. Methods. This observational study, performed in a cardiac surgery intensive care unit in Iran, selected 10 nurses and 35 patients through simple random and convenience sampling, respectively. One of the researchers observed 175 communications between nurses and patients in different work shifts and recorded the results according to a checklist. Nurse and patient satisfaction with the communication was assessed by using a six-item Likert scale, 8 to 12 h after extubation. Results. Most of the patients were male (77.1%), while most of the nurses were female (60%). Patients started over 75% of the communications observed. The content of the communication was related mostly to physical needs and pain. Besides, the majority of patients used purposeful stares and hand gestures, and head nod for communication. Most of the communications between patients and nurses were satisfied ′very low′ (45.7% in nurses, versus 54.3% in patients). However, ′complete satisfaction′ was lower in nurses (0%), compared with patients (5.7%). No statistically significant correlation was found between patients’ and nurses’ satisfaction and demographic variables. Conclusion. The results showed that communication between nurses and mechanically ventilated patients was built through traditional methods and was based on the patients’ requests. This issue might be the cause of an undesirable level of their satisfaction with the communication, given that effective communication can lead to understanding and meeting the needs of the patients.