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When people observe one another, behavioural alignment can be detected at many levels, from the physical to the mental. Likewise, when people process the same highly complex stimulus sequences, such as films and stories, alignment is detected in the elicited brain activity. In early sensory areas, shared neural patterns are coupled to the low-level properties of the stimulus (shape, motion, volume, etc.), while in high-order brain areas, shared neural patterns are coupled to high-levels aspects of the stimulus, such as meaning. Successful social interactions require such alignments (both behavioural and neural), as communication cannot occur without shared understanding. However, we need to go beyond simple, symmetric (mirror) alignment once we start interacting. Interactions are dynamic processes, which involve continuous mutual adaptation, development of complementary behaviour and division of labour such as leader–follower roles. Here, we argue that interacting individuals are dynamically coupled rather than simply aligned. This broader framework for understanding interactions can encompass both processes by which behaviour and brain activity mirror each other (neural alignment), and situations in which behaviour and brain activity in one participant are coupled (but not mirrored) to the dynamics in the other participant. To apply these more sophisticated accounts of social interactions to the study of the underlying neural processes we need to develop new experimental paradigms and novel methods of data analysis

The traditional view on the cerebellum is that it controls motor behavior. Although recent work has revealed that the cerebellum supports also nonmotor functions such as cognition and affect, only during the last 5 years it has become evident that the cerebellum also plays an important social role. This role is evident in social cognition based on interpreting goal-directed actions through the movements of individuals (social “mirroring”) which is very close to its original role in motor learning, as well as in social understanding of other individuals’ mental state, such as their intentions, beliefs, past behaviors, future aspirations, and personality traits (social “mentalizing”). Most of this mentalizing role is supported by the posterior cerebellum (e.g., Crus I and II). The most dominant hypothesis is that the cerebellum assists in learning and understanding social action sequences, and so facilitates social cognition by supporting optimal predictions about imminent or future social interaction and cooperation. This consensus paper brings together experts from different fields to discuss recent efforts in understanding the role of the cerebellum in social cognition, and the understanding of social behaviors and mental states by others, its effect on clinical impairments such as cerebellar ataxia and autism spectrum disorder, and how the cerebellum can become a potential target for noninvasive brain stimulation as a therapeutic intervention. We report on the most recent empirical findings and techniques for understanding and manipulating cerebellar circuits in humans. Cerebellar circuitry appears now as a key structure to elucidate social interactions.

Social cognition relies on the integration of sensory information, emotional cues, and internal bodily signals to guide behavior toward others. The insular cortex (IC) is anatomically and functionally well positioned to support this integration, as it receives interoceptive input and connects sensory, limbic, and autonomic systems. Accumulating evidence across species suggests that the IC contributes to social behavior through at least two complementary modes of processing: emotional mirroring, which links observed social cues to internal affective states, and contextual modulation, which adjusts social behavior according to familiarity, prior experience, and internal state. In this Mini Review, we discuss how neuromodulatory systems shape these modes of IC processing, with a particular focus on oxytocin (OXT). In rodents, OXT signaling within the IC influences social affective behaviors under specific social conditions, whereas human studies report heterogeneous and context-dependent effects of OXT on IC activity. Altered IC function and OXT signaling have also been implicated in neurodevelopmental disorders characterized by social deficits, including autism spectrum disorder. We propose that OXT modulates IC function in a context- and state-dependent manner, shaping social cognition by influencing how interoceptive, emotional, and contextual information is integrated.

Mu desynchronization is the attenuation of EEG power in the alpha frequency range recorded over central scalp locations thought to reflect motor cortex activation. Mu desynchronization during observation of an action is believed to reflect mirroring system activation in humans. However, this notion has recently been questioned because, among other reasons, the potential contamination of mu rhythm and occipital alpha activity induced by attention processes following presentation of visual stimuli in observation conditions. This study examined the validity of mu desynchronization as a measure of mirroring system activation in infants and further investigated the pattern of functional connectivity between the central and occipital regions during execution and observation of movement. EEG was recorded while 46 9-month-old infants executed grasping actions and observed an experimenter grasping. Current source density (CSD) was applied to EEG data and, time-frequency and connectivity analyses were performed in CSD transformed data. Mu desynchronization was evident over central regions during both execution and observation of movements. Independent alpha desynchronization over occipital region was also present in both conditions. The connectivity analyses revealed that central-occipital areas were functionally more connected compared to other areas of the brain during observation of movements. Collectively, the results demonstrate the validity of mu desynchronization as an index of infant mirroring system activity and support the proposal of a functional connection between distinct mirroring and attention processes during observation of action. •Observation of a movement evoked mirroring activity in infants.•Mirroring activity began before observed movement suggesting anticipation the movement.•Motor and occipital areas were functionally coupled during movement observation.•Mu desynchronization can be used as a valid index of mirroring activity in infant.

Digital twins have emerged as a groundbreaking concept in personalized medicine, offering immense potential to transform health care delivery and improve patient outcomes. It is important to highlight the impact of digital twins on personalized medicine across the understanding of patient health, risk assessment, clinical trials and drug development, and patient monitoring. By mirroring individual health profiles, digital twins offer unparalleled insights into patient-specific conditions, enabling more accurate risk assessments and tailored interventions. However, their application extends beyond clinical benefits, prompting significant ethical debates over data privacy, consent, and potential biases in health care. The rapid evolution of this technology necessitates a careful balancing act between innovation and ethical responsibility. As the field of personalized medicine continues to evolve, digital twins hold tremendous promise in transforming health care delivery and revolutionizing patient care. While challenges exist, the continued development and integration of digital twins hold the potential to revolutionize personalized medicine, ushering in an era of tailored treatments and improved patient well-being. Digital twins can assist in recognizing trends and indicators that might signal the presence of diseases or forecast the likelihood of developing specific medical conditions, along with the progression of such diseases. Nevertheless, the use of human digital twins gives rise to ethical dilemmas related to informed consent, data ownership, and the potential for discrimination based on health profiles. There is a critical need for robust guidelines and regulations to navigate these challenges, ensuring that the pursuit of advanced health care solutions does not compromise patient rights and well-being. This viewpoint aims to ignite a comprehensive dialogue on the responsible integration of digital twins in medicine, advocating for a future where technology serves as a cornerstone for personalized, ethical, and effective patient care.

Abstract Choices on discount rates have important implications for the outcomes of economic evaluations of health interventions and policies. In global health, such evaluations typically apply a discount rate of 3% for health outcomes and costs, mirroring guidance developed for high-income countries, notably the USA. The article investigates the suitability of these guidelines for global health [i.e. with a focus on low- and middle-income countries (LMICs)] and seeks to identify best practice. Our analysis builds on an overview of the academic literature on discounting in health evaluations, existing academic or government-related guidelines on discounting, a review on discount rates applied in economic evaluations in global health, and cross-country macroeconomic data. The social discount rate generally applied in global health of 3% annually is inconsistent with rates of economic growth experienced outside the most advanced economies. For low- and lower-middle-income countries, a discount rate of at least 5% is more appropriate, and one around 4% for upper-middle-income countries. Alternative approaches—e.g. motivated by the returns to alternative investments or by the cost of financing—could usefully be applied, dependent on policy context. The current practise could lead to systematic bias towards over-valuing the future costs and health benefits of interventions. For health economic evaluations in global health, guidelines on discounting need to be adapted to take account of the different economic contexts of LMICs.

Collective rituals are present in all known societies, but their function is a matter of long-standing debates. Field observations suggest that they may enhance social cohesion and that their effects are not limited to those actively performing but affect the audience as well. Here we show physiological effects of synchronized arousal in a Spanish fire-walking ritual, between active participants and related spectators, but not participants and other members of the audience. We assessed arousal by heart rate dynamics and applied nonlinear mathematical analysis to heart rate data obtained from 38 participants. We compared synchronized arousal between fire-walkers and spectators. For this comparison, we used recurrence quantification analysis on individual data and cross-recurrence quantification analysis on pairs of participants' data. These methods identified fine-grained commonalities of arousal during the 30-min ritual between fire-walkers and related spectators but not unrelated spectators. This indicates that the mediating mechanism may be informational, because participants and related observers had very different bodily behavior. This study demonstrates that a collective ritual may evoke synchronized arousal over time between active participants and bystanders. It links field observations to a physiological basis and offers a unique approach for the quantification of social effects on human physiology during real-world interactions.

This study empirically examines the roles that mothers play in daughters’ income across different birth cohorts. While existing studies mostly focus on the relationship between fathers’ roles and sons’ status, we test two different maternal roles in explaining daughters’ performance. The first role is based on the mirroring effect; i.e., the positive effect of a mother’s stronger position in the labor market on her daughter(s). Meanwhile, the second role is based on the educational manager effect; i.e., the negative effect of mother’s labor market participation. This research focuses on South Korea by utilizing the Korean Labor Panel Study. In order to investigate the cohort effect, subjects born between 1975 and 1979 were allocated to birth cohort 1, while subjects born between 1980 and 1990 were allocated to birth cohort 2. This study found that father’s income had a significant effect in both cohorts, though it was a bit weaker in the second cohort. Interestingly, the study’s ‘educational manager mom’ hypothesis was confirmed in the first cohort, whereas the mirroring effect was verified in the second cohort. These findings imply that daughters tend to be increasingly inspired by their mothers as role models over time. An increase in mothers’ mirroring effect could be seen as positive; however, it could also suggest a decrease in social mobility. Ultimately, this study found that further policy reforms are required to facilitate social mobility and improve gender equality in the labor market.

According to research studying the processes underlying decisions, a two-channel mechanism connects attention and choices: top-down and bottom-up processes. To identify the magnitude of each channel, we exogenously varied information intake by systematically interrupting participants’ decision processes in Study 1 (N = 116). Results showed that participants were more likely to choose a predetermined target option. Because selection effects limited the interpretation of the results, we used a sequential-presentation paradigm in Study 2 (preregistered, N = 100). To partial out bottom-up effects of attention on choices, in particular, we presented alternatives by mirroring the gaze patterns of autonomous decision makers. Results revealed that final fixations successfully predicted choices when experimentally manipulated (bottom up). Specifically, up to 11.32% of the link between attention and choices is driven by exogenously guided attention (1.19% change in choices overall), while the remaining variance is explained by top-down preference formation.