Nicole Bernard

Maria Cantisano Rimé

Teresa Munoz Sastre

Coll: QC: Initial

Keywords: social sharing of emotions (SSE), HIV/AIDS, psychological adjustment, physical well-being, emotional inhibition AQ1 AQ3 AQ4 AQ2

Research shows that chronic illness patients encounter difficulties in the social sharing of emotions (SSE). Since most SSE studies focus on quantitative aspects, the present study, aimed, among others, to study the associations between the quality of SSE in people living with HIV/AIDS and patients' psychological and physical wellbeing. A total of 101 HIV/AIDS patients answered a questionnaire (Likert scale items) which assessed: shame, guilt, perceived stigma, reasons for non-disclosure of serostatus, physical health, mental health, SSE and quality of SSE. While no associations were found between quantitative aspects of SSE, physical health and mental health, the quality of SSE was negatively correlated to shame and guilt, and positively correlated to physical and mental health. Furthermore, mediation analyses showed the mediating role of the quality of SSE in the relationship between, on the one hand, shame and guilt; and on the other hand, physical and mental health. Findings suggest the importance of qualitative aspects of SSE in the emergence of positive outcomes linked to emotional expression in people living with HIV/AIDS.

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The importance of quality over in quantity in the social sharing of emotions (SSE) in people living with HIV/AIDS

Introduction

Research sustains that, following major negative life events, as well as daily life events, individuals turn towards significant others to share and talk about the emotion-eliciting event (for review see [START_REF] Rime | Emotion elicits the social sharing of emotion: Theory and empirical review[END_REF]. This propensity to speak about emotional experiences, denoted as the social sharing of emotions (SSE), is manifested during the hours, days, weeks or sometimes months following the emotional episode. With the exception of shame and guilt [START_REF] Finkenauer | Socially shared emotional experiences vs. emotional experiences kept secret: Differential characteristics and consequences[END_REF], evidence shows that 80-95% of emotional experiences, negative or positive, are socially shared [START_REF] Rimé | Beyond the emotional event: Six studies on the social sharing of emotion[END_REF][START_REF] Rimé | Long lasting cognitive and social consequences of emotion: Social sharing and rumination[END_REF]. Rime et al. (1998) have addressed several benefits and functions served by the SSE: (1) Constructing and consolidating memory of important events, (2) processing and completing the emotional memory, (3) enhancing interpersonal relationships and social integration, and (4) constructing and disseminating social knowledge on emotion. Thus, at the interpersonal level, social sharing may bring forth emotional contagion, empathy, attachment and strengthened social ties between sharing persons and their listeners (Christophe & Rimé, 1997;[START_REF] Rime | Emotion elicits the social sharing of emotion: Theory and empirical review[END_REF]; at the intrapersonal level, SSE may result in cognitive benefits such as making meaning of the situation when the sharing mode takes place in a cognitive reappraisal fashion [START_REF] Nils | Beyond the myth of venting: Social sharing modes determine the benefits of emotional disclosure[END_REF]. Furthermore, previous research has extensively demonstrated the negative consequences of emotional inhibition at the social, physical and psychological levels (Frattarolli, 2006;[START_REF] Kelly | The psychology of secrets[END_REF][START_REF] Larson | Self-concealment: Conceptualization, measurement, and health implications[END_REF]. Indeed, talking about stressful experiences in a suitable social environment allows individuals to construct an organized narrative which becomes part of individuals' cognitive representation of the stressor [START_REF] Lepore | Talking facilitates cognitive-emotional processes of adaptation to an acute stressor[END_REF]. Therefore, succeeding the emotional impact linked to HIV/AIDS, it is plausible to consider that SSE can provide positive outcomes both at interpersonal and intrapersonal levels.

Regarding emotions elicited by physical illnesses, patients undergoing acute stressors (e.g. cardiac surgery) are quite eager to share their illness-related emotions (Panagopoulou, [START_REF] Panagopoulou | Social sharing of emotion in anticipation of cardiac surgery: Effects on preoperative distress[END_REF]). Yet, findings demonstrate that chronic illness patients encounter difficulties in the social sharing of illness-related emotions linked to the perception of social constraints (e.g. [START_REF] Herbette | Verbalization of emotion in chronic pain patients and their psychological adjustments[END_REF]). In the specific case of HIV/AIDS, studies show that secrecy surrounding serostatus characterises this socially marked chronic condition (e.g. [START_REF] Ingram | Social Support and unsupportive social interactions: Their association with depression among people living with HIV[END_REF][START_REF] Landau | Keeping and disclosing a secret among people with HIV in Israel[END_REF]Varas-Díaz & Marzan-Rodriquez, 2007). Accordingly, a previous study evidenced that when compared to cancer and diabetes patients, HIV/AIDS patients experience the same desire to share their illness-related emotions yet they show a greater inhibition of the SSE [START_REF] Cantisano | The social sharing of emotions in HIV/ AIDS: A comparative study of HIV/AIDS, diabetes and cancer[END_REF]. The same study failed to demonstrate the negative outcomes of inhibiting the SSE concerning HIV/AIDS patients' social integration, mental rumination or intrusive thoughts. A plausible explanation to the absence of negative outcomes would rely upon the fact that, even if small, patients' social network seems to provide quality interactions sufficient to induce the positive effects of SSE.

To our knowledge, the numerous SSE studies focus on quantitative aspects of emotional expression such as the number of sharing partners or the number of conversations. Therefore, as raised by [START_REF] Kennedy-Moore | Expressing emotions: Myths, realities, and therapeutic strategies[END_REF] as well as [START_REF] Rimé | Mental rumination, social sharing, and the recovery from emotional exposure[END_REF], most empirical findings concerning emotional expression lay upon how much individuals shared their feelings but not on the way that emotional expression took place. Thus far, [START_REF] Pennebaker | Confronting a traumatic event: Toward an understanding of inhibition and disease[END_REF] demonstrated the difference between writing about emotional aspects versus factual ones following an emotional event. More recently, in an a study focused on anticipatory distress induced by cardiac surgery, [START_REF] Panagopoulou | Social sharing of emotion in anticipation of cardiac surgery: Effects on preoperative distress[END_REF] found that only the quality of interactions in the SSE was linked to reduced distress on the day before surgery. In the same study, no relation was found between quantitative aspects of SSE and pre-operative distress.

The present study had three main objectives. The first was to understand the reasons behind the inhibition of the SSE linked to the illness in HIV/AIDS patients. Thus, it was hypothesized that the non-SSE linked to the illness would be associated with perceived stigma, to the alleged reasons for not-disclosing serostatus [START_REF] Derlega | Perceived HIV-related stigma and HIV disclosure to relationship partners after finding out about the seropositive diagnosis[END_REF] and to shame and guilt [START_REF] Finkenauer | Socially shared emotional experiences vs. emotional experiences kept secret: Differential characteristics and consequences[END_REF]. The second objective was to study the consequences of the non-SSE in HIV/ AIDS patients concerning physical and mental health. Following previous findings [START_REF] Frattaroli | Experimental disclosure and its moderators: A meta-analysis[END_REF], it was predicted that the quantitative aspects of the non-SSE would be linked to poorer physical and mental health. The third objective was to explore the role of HIV/AIDS patients' perception of the interpersonal quality of SSE concerning their physical and mental health. Thus, along with findings brought forth by [START_REF] Panagopoulou | Social sharing of emotion in anticipation of cardiac surgery: Effects on preoperative distress[END_REF], it was expected that the quality of SSE would be associated with positive Coll: QC: Initial outcomes resulting from emotional expression. An additional objective of the present study, was to explore the role of shame and guilt, previously linked to the inhibition of the SSE [START_REF] Finkenauer | Socially shared emotional experiences vs. emotional experiences kept secret: Differential characteristics and consequences[END_REF] and to reduced physical and psychological health [START_REF] Tangney | Shame and guilt[END_REF].

Methods

Participants

The present study was conducted in two HIV/AIDS care units in the Dominican Republic's second largest city. A total of 101 HIV/AIDS outpatients under anti-retro-viral (ARV) therapy (inclusion criteria) participated in the study. Participants' mean age was 39.37 (SD = 11.40) years, ranging from 19 to 65 years; 49.50% (n = 50) were female and 50.50% (n = 51) were male.

Materials

A questionnaire (in Spanish) was administered. Most measures consisted of items to be rated upon Likert scales. Some consisted of existing measures previously validated in Spanish. Others were translated from English to Spanish or from French to Spanish due to the absence of previous translations. The final version of the entire questionnaire was reviewed by three Dominican lay-individuals to ensure the conceptual meaning of each question.

General Information and Illness History was obtained through questions concerning age, sex, level of education, professional occupation and marital status. Some open questions assessed information about patients' illness history: time since diagnosis, time since the beginning of ARV therapy and infection mode. The last CD4 count was obtained from medical records with patients' consent.

Shame and Guilt were assessed through five shame items and five guilt items from the State Shame and Guilt Scale [START_REF] Tangney | Shame and guilt[END_REF]. These items aim to estimate state feelings of shame, guilt and pride upon a five-point Likert scale (1 = not at all; 5 = extremely). For the purpose of this study, pride items were excluded. Thus, the five shame items (α = .72) and the five guilt items, (α = .74) were translated from English to Spanish.

Quality of Life and Physical Symptoms specific to the HIV/AIDS experience was assessed through the 35-item (α = .91) Spanish validation (Peña de León, Aguilar Gaytán, Suárez Mendoza, & Reyes Terán, 2007) of the MOS-HIV [START_REF] Wu | Evidence for reliability, validity and usefulness of the medical outcomes study HIV health survey (MOS-HIV)[END_REF]. Following recommendations from [START_REF] Revicki | Reliability and validity of physical and mental health summary scores from the medical outcomes study HIV health survey[END_REF], standardized mental health and physical health summary scores were calculated. A higher score indicates better health.

(Non)Disclosure of Diagnosis was considered and in order to assess patients' reasons for the non-disclosure of their serostatus, items from five scales of Reasons for and against HIV disclosure published by [START_REF] Derlega | Perceived HIV-related stigma and HIV disclosure to relationship partners after finding out about the seropositive diagnosis[END_REF] were translated from English to Spanish. Sub-scales concern the alleged reasons for concealing the HIV sero-5 status: (1) Privacy (α = .77), (2) self-blame and self-concept difficulties (α = .77), (3) communication difficulties (α = .90), (4) fear of rejection or fear of being misunderstood (α = .89) and (5) protecting the other (α = .88). Items were rated upon a five-point Likert scale (1 = not at all; 5 = extremely). In the present study, patients were asked to evaluate the different items in a general fashion, and not concerning the non-disclosure of HIV 10 status to specific targets (e.g. parent, friend or partner).

SSE linked to the illness was assessed through four items (α = .81), translated from French [START_REF] Rimé | Beyond the emotional event: Six studies on the social sharing of emotion[END_REF] to Spanish, concerning aspects of SSE specific to the illness: Coll: QC: Initial (1) Desire to share illness-related emotions, (2) frequency of SSE during the previous week, (3) number of sharing partners during the previous week and (4) number of sharing partners during the previous month. Participants rated their answers upon five-point scales (1 = not at all; 5 = extremely).

(Non) SSE linked to the illness was assessed through three items (α = .88) developed in Spanish for a previous study [START_REF] Cantisano | The social sharing of emotions in HIV/ AIDS: A comparative study of HIV/AIDS, diabetes and cancer[END_REF] to evaluate the non-sharing of illness-related emotions and emotional aspects kept secret: (1) Participants rated their answers upon five-point scales (1 = not at all; 5 = extremely).

Perception of the quality of SSE linked to the illness was examined by the means of the interpersonal dimension of the Quality of Sharing Inventory [START_REF] Panagopoulou | Social sharing of emotion in anticipation of cardiac surgery: Effects on preoperative distress[END_REF]. The nine items in this scale (α = .81), to be rated upon a five-point Likert scale (1 = not at all; 5 = extremely), were translated from English to Spanish.

Perceived Stigma specific to HIV/AIDS was assessed through the Spanish-validated abbreviated version [START_REF] Franke | Validation and abbreviation of an HIV Stigma scale in an adult Spanish-speaking population in urban Peru[END_REF] of the HIV Stigma Scale [START_REF] Berger | Measuring stigma in people with HIV: Psychometric assessment of the HIV Stigma scale[END_REF]. This shortened version includes 21 items to be rated upon a five-point Likert scale (1 = not at all; 5 = extremely) which discriminate into four dimensions: (1) Enacted Stigma (α = .85), (2) Disclosure concerns (α = .86), (3) Negative Selfimage (α = .88) and ( 4) Concerns with public attitudes (α = .81).

Procedure

Ethical approval was obtained from the Dominican Republic's Nations HIV/AIDS health care programme. Patients were sampled in two different health care institutions where a doctor, nurse or other medical staff informed patients about the study and proposed volunteer participation. Patients were told that the study was part of a broader international university research programme about emotional expression in chronic diseases. The length of the interviews (approximately 1 h) and their confidentiality were announced. If patients volunteered, one single researcher met with the patient. Questionnaires were administered in an interview modality to ensure comprehension. Respondents did not receive any kind of compensation for their participation. Informed consent was obtained from all participants.

Results

The present study implied an exercise in data mining. At first, the different variables studied were subjected to correlational analysis. Secondly, multiple regression and mediation analyses were undertaken using variables found to be significant in the correlational analyses.

Correlational analyses

As displayed in Table 2, the non-SSE showed significant positive correlations with three sub-scales of the HIV Stigma Scale: (1) Enacted Stigma (r = .45; p < .01), (2) disclosure concerns (r = .44; p < .01) and (3) concerns with public attitudes (r = .40; p < .001). The non-SSE showed significant positive correlations with four sub-scales of the alleged reasons for non-disclosure of HIV status: (1) Self-blame (r = .27; p < .001), ( 2) privacy (r = .42; p < .001), (3) fear of rejection (r = .37; p < .001) and ( 4) communication difficulties (r = .33; p < .001). Shame and guilt did not show any significant correlations with non-SSE. Coll: QC: Initial Correlation coefficients relating to non-SSE, and the MOS-HIV physical and mental health summary scores are displayed in Table 3. No significant correlations were found between non-SSE and these variables.

As displayed in Table 3, the perception of the interpersonal quality of SSE presented 5 significant correlations with shame (r = -.58; p < .001), guilt (r = -.53; p < .001), the MOS-HIV physical health summary score (r = .32, p < .001) and the MOS-HIV mental health summary score (r = .56, p < .001).

Multiple regression analysis

A multiple regression analysis was conducted to study the predictive value of the vari-10 ables presenting significant correlations with non-SSE (Table 4). Results showed one single significant predictor of non-SSE: the privacy sub-scale of the alleged reasons for non-disclosure (β = .27; p < .05). This variable predicted, positively, 35% of the variance (p < .001).

Mediation analyses

Given the significant associations between, on the one hand, shame and guilt and the quality of SSE; and on the other hand, shame and guilt and physical and mental health, mediation analyses were conducted to study the mediating role of the quality of SSE in the relationship between: Shame and physical health (MOS-HIV), guilt and physical health (MOS-HIV), shame and mental health (MOS-HIV) and guilt and mental health. As recommended for small samples, non-parametric bootstrapping analyses were conducted [START_REF] Preacher | SPSS and SAS procedures for estimating indirect effects in simple mediation models[END_REF]) using AMOS 20. All results were based on 2000 bootstrapped samples.

First, results revealed a significant mean indirect effect of shame on physical health through the quality of SSE (β = -.15; SE = .07; 95% CI [-.29, -.04]; p < .01) while the direct effect was no longer significant (β = -.12; SE = .10; p = .26). Thus, the quality of SSE strongly mediated the relationship between shame and physical health (Figure 1). Coll: QC: Initial Secondly, results evidenced a significant mean indirect effect of guilt on physical health through the quality of SSE (β = -.15; SE = .06; 95% CI [-.29, -.06]; p < .001) while the direct effect was no longer significant (β = -.75; SE = .11; p = .47). Accordingly, the quality of SSE strongly mediated the relationship between guilt and physical health (Figure 1). Third, results revealed a significant mean indirect effect of shame on mental health through the quality of SSE (β = -.25; SE = .8; 95% CI [-.42, -.13]; p < .01) while the direct effect was no longer significant (β = -.21; SE = .13; p = .09). Hence, the quality of SSE strongly mediated the relationship between shame and mental health (Figure 1). Finally, results evidenced a significant mean indirect effect of guilt on mental health through the quality of SSE (β = -.25; SE = .07; 95% CI [-.42, -.13]; p < .001) while the direct effect was no longer significant (β = -.18; SE = .11; p = .12). The quality of SSE strongly mediated the relationship between guilt and mental health (Figure 1).

Discussion

Three objectives were aimed. As to the first, our hypothesis was partially confirmed. Non-SSE linked to the illness was associated with perceived HIV-related stigma and to the alleged reasons of non-disclosure of serostatus. Yet, contrary to our hypotheses, no link was found between non-SSE and shame and guilt. This last finding opposes previous research which has demonstrated that shame and guilt episodes are inhibiting when it comes to social sharing [START_REF] Finkenauer | Socially shared emotional experiences vs. emotional experiences kept secret: Differential characteristics and consequences[END_REF].

Furthermore, results evidenced the predictive value of privacy (alleged reason for not disclosing serostatus) when it comes to the inhibition of SSE in HIV/AIDS patients. However, no other variables were found to be significantly predictive of SSE which could be partially explained by potential multicollinearity between independent variables.

Secondly, as brought forth by previous research (for review see [START_REF] Frattaroli | Experimental disclosure and its moderators: A meta-analysis[END_REF], we expected that the inhibition of SSE in HIV/AIDS patients would lead to negative consequences regarding their physical and psychological well-being. However, our results undermine this hypothesis. No association was found between non-SSE and the psychological and physical outcomes assessed in our study.

Third, we examined the role played by the perception of the quality of interactions in the SSE in HIV/AIDS patients. An association between the quality of SSE and psychological and physical well-being was expected. Our findings highly support this hypothesis. Indeed, results showed that the quality of SSE was positively associated with mental and physical health. Moreover, mediation analyses evidenced the mediating role of the quality of SSE in the relationship between, on the one hand, shame and guilt; and on the other hand, physical and psychological well-being. These later findings pertain to our additional objective concerning the associations between shame and guilt and physical and mental health. Yet, alternative causal pathways must be taken into consideration, thus, these results must be interpreted with caution. For instance, would personality variables (e.g. agreeableness) be predictive of an enhanced perception of the quality of SSE in these HIV/AIDS patients?

In this study, HIV/AIDS patients' desire to protect their privacy partially explained the inhibition of emotional experiences linked to their illness. These findings support the idea that secrets play a social function: the protection of individuals' social integration [START_REF] Kelly | The psychology of secrets[END_REF]. Yet, contrary to previous empirically based theories concerning disclosure and well-being [START_REF] Pennebaker | Opening up: The healing power of expressing emotion[END_REF], the non-SSE in these patients does not result in negative consequences concerning their physical and psychological Coll: QC: Initial well-being. One plausible explanation to this result may rely upon previous findings (Panagopoulou et al., 2004) which have suggested that it is the way that emotional expression takes place (quality), and not the amount of expression, which is accountable for health outcomes succeeding SSE. The present study's results regarding quality of SSE corroborate this elucidation.

Like Panagopoulou et al. (2004), quantitative SSE was not linked to the perceived interpersonal quality of SSE. Furthermore, even if non-SSE was not associated with shame nor guilt, quality of SSE was. These self-conscious emotions, negatively linked to well-being [START_REF] Dearing | Shame in the therapy hour[END_REF][START_REF] Tangney | Shame and guilt[END_REF] were mediated by the perception of the quality of SSE. Thus, results concerning the emotional expression of experiences linked to shame and guilt corroborate former evidence regarding the importance of the quality of interpersonal interactions in the context of chronic disease [START_REF] Smith | Workplace heterosexism and adjustment among lesbian, gay, and bisexual individuals: The role of unsupportive social interactions[END_REF].

Our results should be considered prudently due to some limitations of our research such as: the absence of personality variables, the translation of measures and the crosssectional nature. Furthermore, since quality of SSE was not assessed while targeting different members of patients' social networks, results should be considered with precautions. Future research should address this issue, for instance, studying the perception of SSE concerning spouses or close family members.

This study was one of the few attempts in exploring the relationship between quality of SSE and psychological and physical well-being in the context of chronic disease. Thus, our findings highlight the importance of considering the quality of interactions when studying emotional expression and well-being. Furthermore, findings suggest that shame and guilt seem to play a key role in HIV/AIDS patients' physical and mental well-being. Therefore, at the practical level, our findings suggest that HIV/AIDS patients could benefit from interventions focusing on shame and guilt, for instance, as suggested by [START_REF] Dearing | Shame in the therapy hour[END_REF].

  Correlation matrix non-SSE, SSE, quality of SSE, shame, guilt, HIV-related stigma and reasons for non-disclosure. : N = 101; RND = Reasons for non-disclosure. ***p < .001. **p < .01. *p < .05.

Figure 1 .

 1 Figure 1. Path diagrams, β (SE) and significance levels for the mediation models.

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  Nicole Cantisano a *, Bernard Rimé b and Maria Teresa Munoz Sastre a

	a Octogone-Cerpp, Université de Toulouse 2 Le Mirail, Toulouse, France; b Psychology, Université
	Catholique de Louvain, Louvain-la-Neuve, Belgium

  Table 1 displays participants' age, educational level and professional activity by gender. Patients' mean time since HIV status detection was 75.16 (SD = 60.05) months, ranging from 2 to 264 months (22 years). As to CD4 count, the sample's mean was 387.73 (cells/mm 3 ; SD = 242.83) assessed on average 4.88 (SD = 5.82) months before the study. The mean time since the beginning of ARV therapy was 46.02 (SD = 41.46) months, ranging from 1 month to 16 years. Table 1 displays (by gender) time since diagnosis, CD4 count, time since ARV, infection mode and other variables.

Table 1 .

 1 Patients' socio-economic variables and illness history by gender (N = 101).

	Male (n = 51)	Female (n = 50)

Table 3 .

 3 Correlation matrix Non-SSE, SSE, quality of SSE, shame, guilt, physical and mental health.

		1	2	3	4	5	6	7
	1. Non-SSE	1.00	-.47***	-.14	.15	.10	.0025	-.05
	2. SSE		1.00	-.12	.07	.12	-.16	-.15
	3. Quality of SSE			1.00	-.58***	-.54***	.32***	.56***
	4. Shame				1.00	.60***	-.26**	-.46***
	5. Guilt					1.00	-.22***	-.43***
	6. MOS-HIV: PHS						1.00	.56***
	7. MOS-HIV: MHS							1.00
	Notes: N = 101; PHS = Physical health score; MHS = Mental health score.
	***p < .001.
	**p < .01.
	*p < .05.

Table 4 .

 4 Multiple regression results for the prediction of non-SSE.

	CPHM 901544 18 March 2014	Initial		CE: ER QA: MA Coll: QC:
			Psychology, Health & Medicine	7
	AQ17
	Non-SSE
	F(11, 89) = 4.38; p < .001; R 2 = .35
		β	B	t (90)	p
	Age	-.05	-.02	-.49	NS
	Sex	-.05	-.42	-.54	NS
	Time since diagnosis	.08	.005	.80	NS
	RND: self-blame	.198	.19	1.53	NS
	RND: privacy	.27	.31	2.42	<.05
	RND: fear of rejection	.11	.07	.94	NS
	RND: communication difficulties	.07	.05	.51	NS
	Stigma: negative self-image	-.17	-.09	-1.32	NS
	Stigma: concerns with public attitudes	.18	.13	1.40	NS
	Stigma: enacted stigma	.02	.01	.21	NS
	Stigma: disclosure concerns	.13	.09	.86	NS
	Notes: N = 101; RND = reasons for non-disclosure.

Acknowledgement

We thank the National HIV/AIDS/STI Control Programme (DIGECITSS) of the Dominican Republic's Ministry of Health for their collaboration in the realization of this study.

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Nicole Cantisano
email: cantisanonicole@gmail.com

Bernard Rimé

Mohammad Hassan Afzali

María T Muñoz-Sastre

QUALITY OF SSE AND HEALTH IN PLWHA 1 Health outcomes resulting from the quality of emotional expression in HIV/AIDS patients Bénéfices liées à la santé résultants de la qualité de l'expression émotionnelle chez les personnes atteintes du VIH/SIDA

Keywords: Social Sharing of Emotions (SSE), HIV/AIDS, mental health, physical health

Introduction:

Studies on emotional expression and its impact upon health have mainly focused on quantitative aspects of interactions rather than on their quality. Objective: The present study aimed to examine the interpersonal quality of interactions in the Social Sharing of Emotions (SSE) in People Living With HIV/AIDS (PLWHA), and its impact on patients' physical and psychological well-being. Method: 101 PLWHA answered a questionnaire (Likert-scale items) which assessed the following: shame, guilt, perceived stigma, perceived physical health, perceived mental health, SSE and the interpersonal quality of SSE (IQSSE). The main hypotheses were compiled into a theoretical model which was tested by a series of Structural Equation Modeling (SEM) analyses. Results: The final solution resulted into a well-fit model which showed that: (1) shame predicted IQSSE, (2) perceived stigma mediated the relationship between IQSSE and guilt, and (3) perceived Mental Health mediated the relationship between IQSSE and perceived Physical Health. Conclusion: These results corroborate previous findings which demonstrate that (1) IQSSE is independent from quantitative aspects of SSE and that (2) the way the SSE takes place is crucial to the benefits it induces.

Résumé

Introduction : Les études qui s'intéressent à l'expression émotionnelle et son impact sur la santé ciblent davantage des aspects quantitatifs des interactions et non pas des aspects qualitatifs de celles-ci. Objective : La présente étude a eu comme objectif d'examiner la perception de la qualité interpersonnelle des interactions lors du partage social des émotions (PSE) chez les personnes atteintes du VIH/SIDA, et son impact au niveau du bien-être physique et psychologique chez ces patients. Méthode : 101 patients atteints du VHI/SIDA ont répondu à un questionnaire (items likert) évaluant les variables suivantes: honte, culpabilité, stigmatisation perçue, santé physique perçue, santé mentale perçue, PSE et la perception de la qualité interpersonnelle du PSE. Les hypothèses principales ont été regroupées dans un modèle théorique qui a été testé par une série d'analyses des modélisations en équations structurales. Résultats : Au final, la solution qui a résulté dans un modèle bien ajusté a montré que : (1) la honte est un prédicteur de la perception de la qualité interpersonnelle du PSE, (2) la perception de la stigmatisation est une médiatrice de la relation entre la perception de la qualité interpersonnelle du PSE et la culpabilité, et (3) la santé mentale perçue a été une variable médiatrice entre la perception de la qualité interpersonnelle du PSE et la santé physique perçue. Conclusion : Ces résultats corroborent des études précédentes qui ont mis en avant que (1) la perception de la qualité interpersonnelle du PSE est indépendante des aspects quantitatifs de celui-ci et (2) la façon dont le PSE a lieu est cruciale pour les bénéfices dont celui-ci est porteur. When people experience emotions, they subsequently turn towards significant others to share and talk about their emotional experience [START_REF] Rimé | Emotion Elicits the Social Sharing of Emotion: Theory and Empirical Review[END_REF]. This propensity to speak about emotional experiences was described as the Social Sharing of Emotions (SSE). Abundant data reveals that 80-95% of emotional experiences are socially shared (for review, [START_REF] Rimé | Emotion Elicits the Social Sharing of Emotion: Theory and Empirical Review[END_REF], regardless of the strength and whatever the type of emotion experienced. However, episodes involving shame or guilt were exceptions linked to inhibited social sharing or emotional secrecy [START_REF] Finkenauer | Socially shared emotional experiences vs. emotional experiences kept secret: Differential characteristics and consequences[END_REF]. Significantly, talking about stressful experiences (e.g., chronic disease) in a suitable social environment is associated with enhanced psychological adaptation [START_REF] Lepore | Talking facilitates cognitive-emotional processes of adaptation to an acute stressor[END_REF].

People living with a chronic illness (e.g., chronic pain or cancer) may experience difficulties with the social sharing of disease-related emotions due to the perception of social constraints [START_REF] Herbette | Verbalization of emotion in chronic pain patients and their psychological adjustments[END_REF][START_REF] Lepore | Talking facilitates cognitive-emotional processes of adaptation to an acute stressor[END_REF]. This seems to be particularly the case of People Living with HIV/AIDS (PLWHA). Cantisano, Rimé and Munoz-Sastre (2013) observed PLWHA to report the same willingness to share their illness-related emotions as respondents living with cancer or diabetes. However, PLWHA differed considerably from the latter, demonstrating greater inhibition of actual sharing linked to their illness. Several factors could account for this difference characterizing PLWHA; for instance, feelings of shame and/or guilt are often associated with the illness experience [START_REF] Landau | Keeping and disclosing a secret among people with HIV in Israel[END_REF]Tangney & Dearing, 2002). Furthermore, due to HIV-related stigma, these patients may perceive a particularly high level of social constraint in their social environment [START_REF] Bos | Sex differences in emotional and behavioral responses to HIV+ individuals' expression of distress[END_REF]. The question then arises of the consequences that this restricted emotional expression entails for PLWHA.

Findings reviewed so far lead to the conclusion that PLWHA patients manifest a deficit in the social sharing of their illness-related emotions, and that such deficits in emotional expression generally can lead to bio-psychosocial consequences (e.g. [START_REF] Petrie | Effect of written emotional expression on immune function in patients with human immunodeficiency virus infection: a randomized trial[END_REF]. Several authors [START_REF] Kennedy-Moore | Expressing emotions: Myths, realities, and therapeutic strategies[END_REF]Panagopoulou, Rimé, Maes & Montgomery, 2006) have emphasized that empirical studies on effects of emotional expression were predominantly focused on SSE quantity (i.e., how much individuals share their feelings) rather than on SSE quality (i.e., the way that emotional expression takes place). In a study on anticipatory distress among patients awaiting heart surgery, [START_REF] Panagopoulou | Social Sharing of Emotion in Anticipation of Cardiac Surgery: Effects on Preoperative Distress[END_REF] demonstrated that SSE quality-and not SSE quantity-predicted reduced distress on the day before surgery. The importance of analyzing the quality of interactions during the SSE was also evidenced in the investigation of the links between emotional expression and reduced distress following an emotional episode. While previous studies failed to support such a link, [START_REF] Nils | Beyond the myth of venting: Social sharing modes determine emotional and social benefits from distress disclosure[END_REF] found that the participants, who had benefitted from an addressee's cognitive reappraisal during the SSE, were the only ones reporting emotional recovery from the episode.

The present study aimed to examine the quality of SSE interactions in PLWHA, and its impact on these patients' perceived physical and psychological well-being. Given the differential impact of quality of social exchanges on psychological adjustment (e.g. [START_REF] Brooks | Social negativity and health: Conceptual and measurement issues[END_REF], it is plausible to consider that the quality of emotional disclosure could be determinant when it comes to psychological adjustment in chronic illness such as HIV/AIDS. While taking into consideration the relationships between emotional expression and variables such as shame, guilt, HIV-related stigma, as well as the associations between emotional expression and perceived mental/physical health, a theoretical model was proposed (Fig. 1).

First, this theoretical model links shame and guilt, in line with evidence-based theory (Tangney & Dearing, 2002) manifesting important correlations between these two self-conscious emotions. Second, in consistency with empirical evidence documenting shame and guilt to predict perceived HIV-related stigma [START_REF] Landau | Keeping and disclosing a secret among people with HIV in Israel[END_REF]; the proposed model includes shame and guilt as predictors of perceived HIV-related stigma. Third, following abundant data demonstrating the association between perceived HIV-related stigma and self-disclosure in PLWHA [START_REF] Derlega | Perceived HIVrelated Stigma and HIV Disclosure to Relationship Partners after Finding Out about the Seropositive Diagnosis[END_REF], perceived HIV-related stigma is expected to predict emotional expression. However, the model limits its predictions to the interpersonal quality of SSE (IQSSE) in accordance with [START_REF] Panagopoulou | Social Sharing of Emotion in Anticipation of Cardiac Surgery: Effects on Preoperative Distress[END_REF] findings where SSE quality but not quantity was linked to distress. Fourth, emotional expression, operationalized as IQSSE, is expected to predict PLWHA's perceived mental and physical health as a recognized consequence of emotional expression/inhibition upon individuals' health [START_REF] Frattaroli | Experimental disclosure and its moderators: A meta-analysis[END_REF][START_REF] Petrie | Effect of written emotional expression on immune function in patients with human immunodeficiency virus infection: a randomized trial[END_REF]. This theoretical model (Fig. 1) was tested using Structural Equation Modeling (SEM).

Methods

Procedure

Patients were sampled (purposive sampling) from two different health care institutions of the Dominican Republic's National HIV/AIDS health care program (DIGECITS). During patients' medical appointments, a doctor, nurse or other medical staff member informed patients about the study and proposed voluntary participation. The interviews' length (approximately one hour), content and confidentiality were explained while soliciting participation. If patients chose to volunteer, the researcher met with the patient following their medical appointment. Given high illiteracy rates, a written informed consent form was read and carefully explained to all participants.

Consent was obtained through patients' signature of this form. A questionnaire (in Spanish) was administered in an interview modality to ensure comprehension.

Participants

The present study was conducted in two HIV/AIDS care units in Santiago, Dominican Republic's second most populated city. Data was collected during a two-month period (July 14 th to September 8 th 2011). While 109 outpatients were approached, a total of 101 PLWHA outpatients (50 females, 51 males and no transgender) under anti-retroviral (ARV) therapy agreed to participate in the study (95.28% acceptance rate). and perceived physical health summary scores were calculated. First, scores were transformed into raw scale scores ranging from zero to 100. Then, these raw scores were transformed into zscores in order to be standardized to the Roche patient population (data from over 2,500 patients with HIV disease). Finally, the summary measures were transformed to have a mean of 50 and a standard deviation of 10, thus obtaining a perceived Mental Health Score (MHS) and a perceived Physical Health Score (PHS). Higher scores correspond to better perceived health.

Measures

SSE linked to the illness (quantity).

This variable was assessed through four items backtranslated from French [START_REF] Rimé | Beyond the emotional event: Six studies on the social sharing of emotion[END_REF] Perceived Stigma specific to HIV/AIDS. Using the Spanish validated abbreviated 21-items version of the HIV stigma Scale [START_REF] Franke | Validation and Abbreviation of an HIV Stigma Scale in an Adult Spanish-Speaking Population in Urban Peru[END_REF]) (1=not at all; 5=extremely), an overall stigma index (sum of all items) was calculated (α = 0.91). Higher scores reflect a higher perception of HIV/AIDS related stigma.

Statistical analysis

The Theoretical Model presented in Figure 1 was tested through a series of SEM analyses conducted with the 20 th version of the AMOS computer program [START_REF] Arbuckle | Amos16.0 User's Guide[END_REF]. Before testing the model, gender differences were explored for all outcome variables. The only significant difference found (F(1, 99) = 4.47; p < 0.05) was for the MOS-HIV Mental Health Score (MHS), where male participants (M = 51.70; SD = 8.45) reported higher scores than female participants (M = 47.97; SD = 9.26). Given that this was the only significant difference, it was not considered necessary to conduct two separate models.

Five models were tested while evaluating the adequacy of each competing model through a number of "goodness-of-fit" statistics that are frequently used within the Confirmatory Factor Analysis (CFA), and that reflect the fit between the hypothesized statistical model and the actual data set [START_REF] Bentler | Significance tests and goodnessof fit in the analyses of covariance structures[END_REF]. Fit indices for each model are displayed in Table 2. Although the sample size may seem small for SEM, both the number of variables in the model [START_REF] Bowen | Structural equation modeling[END_REF], and the cohesion in the co-variance matrix legitimize the use of SEM in the case of the present study.

Results

Socio-Demographic Characteristics

Participants' mean age was 39.37 (SD = 11.40) years old (range 19 -65). With respect to relationship status, 45.54% (n = 46) of participants were single and 53.47% (n = 55) of participants were in a legal union. As to the level of education, the highest level reached was assessed, and the sample's distribution was as follows: 3.96% (n = 5) did not receive an education, 43.56% (n = 44) of participants did not complete elementary school, 35.64% (n = 36) finished elementary school, 4.95%% (n = 5) had a high school diploma, 5.94% (n = 6) had a technical degree and 5.94% (n = 6) had a university degree. Concerning participants' professional occupation, the sample's distribution was as follows: 29. 70% (n = 30) were unemployed, 32.67% (n = 33) had a full time job, 15.84% (n = 16) had a part time job, 19.80% (n = 20) were house makers, and one patient was on professional disability. Mean time since HIV diagnosis was 6.26 (SD = 5.00) years (range 2 months -22 years). The sample's mean CD4+ cells count was 387.73 cells/mm 3 (SD = 242.83), assessed on average 4.88 (SD = 5.82) months before the study. Mean time since the start of ARV therapy was 3.83 (SD = 3.46) years (range 1 month -16 years). The reported modes of infection were heterosexual intercourse for 76.23% (n = 77), unknown for 19.80% (n = 20), other for 2.97% (n = 3) and homosexual intercourse for 0.96% (n = 1).

Correlational analysis

Means, standard deviations and inter-correlations of all measures are presented in Table 1.

No significant correlation was found between SSE and IQSSE. SSE was not correlated with any other measure. IQSSE positively correlated with perceived PHS and MHS, and negatively correlated with shame, guilt and perceived stigma. Regarding the CD4+ cells count, one single significant correlation was found, that between CD4 + cells counts and perceived PHS.

Structural equation modeling

As to the first model (Fig. 1), all tested paths were significant with the exception of the guilt/IQSSE link. Therefore, this association was removed in a new model (Model 2a). As seen in Table 2, this second model showed that in the absence the guilt/IQSSE relation, guilt continued to have some indirect effect on IQSSE through perceived stigma (β = -0.131; p ≤ 0.001), but the relationship between shame and perceived stigma was found to be non-significant. In order to achieve a more parsimonious model, a new model (2b) was tested taking out the relationship between shame and perceived stigma. The X 2 /df ratio of model 2b (see Table 2) showed that the model is indeed more parsimonious. However, modification indexes indicated that there was a strong relationship between the residual variances of perceived mental (MHS) and physical health (PHS) scores. This illustrates a relationship between perceived MHS and PHS that is not completely determined by IQSSE. Furthermore, modification indexes showed that there was a large part of the variance of perceived PHS that is determined by perceived MHS. As a consequence, a third model (3a; see table 2) was tested taking into account this relationship.

Model 3a showed that when the prediction of perceived PHS by perceived MHS is taken into consideration, the relation between QSI and perceived PHS was found to be non-significant.

Thus, results show that perceived MHS completely mediates the relationship between IQSSE and perceived PHS. Therefore, in order to have a more precise final model, the prediction of perceived PHS by IQSSE was taken out, and a new model (3b) was tested. This final model (3b; see Table 2) showed the best fit and is the most efficiently effective, while no modifications were proposed. All tested relations were significant (Fig. 2).

Discussion

The present study expected to find the predictive value of shame, guilt and perceived stigma on HIV/AIDS patients' IQSSE, as well as the impact of the IQSSE on HIV/AIDS patients' perceived physical and psychological wellbeing. SEM analysis results support these expectations: results showed that shame, guilt and perceived stigma have a predictive value regarding the interpersonal quality of SSE, and the interpersonal quality of SSE has a predictive value with regards to perceived mental and physical health. However, the final solution differs from the hypothesized model in that shame is not linked to perceived stigma, and that the relationship between guilt and QSSE is fully mediated by perceived stigma. A plausible explanation for this unexpected finding is that while shame is linked to the perceived unworthy self, guilt is linked to the perceived unworthy behavior (Tangney & Dearing, 2002). Therefore, feelings of guilt concerning HIV-infection-in regards to one's own behavior involved in contamination and transmission-could be likely linked to perceived HIV-related stigma.

Additionally, the final standardized solution demonstrates that the relationship between IQSSE and perceived physical health is fully mediated by perceived mental health scores. This finding was not explicitly hypothesized by the present study's theoretical model, yet one explanation might rely upon a methodological issue previously stressed by [START_REF] Revicki | Reliability and validity of physical health and mental health summary scores from the MOS HIV Health[END_REF]: correlations between perceived MHS and PHS might compromise the independence of these two aspects of health-related quality of life in HIV/AIDS patients.

Given the sample size, result generalizations must be avoided. However, the present study's findings corroborate with [START_REF] Panagopoulou | Social Sharing of Emotion in Anticipation of Cardiac Surgery: Effects on Preoperative Distress[END_REF] demonstrating that the IQSSE is not linked at all to quantitative aspects of SSE. Furthermore, similar to patients anticipating cardiac surgery-where SSE quantity was not linked to preoperative distress-quantity of SSE was not associated at all to PLWHA's perceived physical and mental health scores. A recent experimental study [START_REF] Nils | Beyond the myth of venting: Social sharing modes determine emotional and social benefits from distress disclosure[END_REF]-which showed that, indeed, individuals' ways of sharing emotions along with listeners' responses (e.g., socio-affective or cognitive re-framing) is crucial to the type benefits induced by the SSE including emotional recovery-could clarify these important results pertaining to IQSSE. Further research should continue to focus on qualitative aspects of SSE when studying outcomes resulting from emotional expression.

One of the present study's limitations is the global assessment of IQSSE; specific members of the social network were not targeted. For example, in the case of cancer patients and perceived social support, Dakoff and Taylor (1990) demonstrated that support behaviors were found to be dependent on the source (e.g., particular actions can be perceived to be helpful by some but not all network members). Moreover, in an experimental study concerning breast cancer patients and these patients' spouses, [START_REF] Manne | Couples' support-related communication, psychological distress, and relationship satisfaction QUALITY OF SSE AND HEALTH IN PLWHA 16 among women with early stage breast cancer[END_REF] showed that partners' responses during illness-related self-disclosure play a key role when it came to patients' psychological distress. Future research should address this issue studying the perception of the quality of SSE in PLWHA with regards to spouses or close family members, as well as within a larger sample.

Furthermore, another limitation that can be highlighted is the research bias linked to self-reported health measures; future studies should address these research questions while including objective health measures and experimental methodologies. Finally, the present study was conducted with a sample majorly composed by heterosexual participants (99.04%). Yet, HIV infection is highly present among other populations such as men who have sex with men, sex workers or people who inject drugs (WHO & Unaids, 2015). Thus, the present study's results are limited to a specific population, are not representative of the HIV/AIDS epidemic, and should not be generalized to other HIV/AIDS patient populations.

Practice and intervention implications can be drawn from the present study's findings.

  Mots clés: Partage Social des Emotions (PSE); VIH/SIDA; santé mentale; santé physique Health Outcomes Resulting from the Quality of Emotional Expression in HIV/AIDS Patients Living in the Dominican Republic

  General information and illness history. Following questions relating to respondent's age, sex, level of education, professional occupation, and marital status, open-ended questions assessed time since diagnosis, time since the beginning of ARV therapy and infection mode. The last CD4+ cells count was obtained from medical records under patients' consent. Current shame and guilt. The five shame items (α = 0.72) and five guilt items (α = 0.74) were used from the State Shame and Guilt Scale (Tangney & Dearing, 2002), which were backtranslated from English to Spanish for the purpose of this study. Items were to be rated on a 5point Likert scale (1 = not at all; 5 = extremely). Higher scores indicate higher levels of shame and guilt respectively. Quality of life and physical symptoms specific to the HIV/AIDS experience. These variables were assessed through the 35-item (α = 0.91) Spanish validation (Peña de León et al., 2010) of the Medical Outcomes Study HIV Health Survey (MOS-HIV). Following recommendations from Revicki, Sorensen and Wu (1998), standardized perceived mental health

  to Spanish, and previously adapted to the illness context by Cantisano, Rimé & Muñoz-Sastre (2013): (1) desire to share illness-related emotions ('During the past week, have you felt the desire to talk about your feelings and emotions related to your illness?'), (2) frequency of SSE during the previous week ('During the past week, how many times have you talked about your feelings and emotions related to your illness?') , (3) number of sharing partners during the previous week ('During the past week, with how many different people have you talked about your emotions and worries related to your illness?'), and (4) number of sharing partners during the previous month ('During the last month, with how many different people have you talked about your emotions and worries related to your illness?') . These four items were summed up into a total score (α = 0.81), higher scores indicate a higher propensity to the SSE. Perception of the interpersonal quality of SSE linked to the illness. The interpersonal subscale of the Quality of Sharing Inventory (Panagopoulou et al., 2006) was used to determine this variable. The nine items (e.g., 'The persons I share my thoughts and feelings with, understand exactly what I mean'; 'During the conversation I feel comfortable') in this scale (α = 0.81) backtranslated from English to Spanish for the purpose of this study assessed respondents' perception of the appropriateness of the sharing listener, as well as of privacy and comfort of the sharing context (1=not at all; 5=extremely). Higher scores indicate an enhanced perception of the interpersonal quality of SSE. The Spanish translation of all nine items is displayed on the Appendix 1.

First

  , results concerning the predictive value of shame when it comes to the perception of the quality of SSE in PLWHA, could justify interventions focused on this self-conscious emotion as suggested by Dearing and Tangney (2011). Additionally, given the mediating role of perceived stigma (between guilt and emotional expression) in these patients, interventions focused on selfforgiveness specific to the HIV/AIDS experience (Temoshok & Ward, 2005) would be relevant. Finally, due to the key role played by shame and guilt when it comes to emotional expression in these patients, interventions such as Greenberg's (2002) Emotion Focused Therapy would be pertinent in PLWHA's care. Temoshok, L. & Wald, R. (2005).Forgiveness and health in persons living with HIV/AIDS. In E.L. Worthington (Ed).Handbook of Forgiveness (pp. 335-348). New York: Brunner-Routledge. Tangney, J.P. & Dearing, R.L. (2002). Shame and Guilt, New York, Guilford Press. World Health Organisation (WHO) & Unaids (2015). Global AIDS response progress reporting 2015. Geneva: WHO Press.

FigureFigure 2 :

 2 Figure 1 : Theoretical Model

Table 1

 1 Means, standard deviations, and inter-correlations (Pearson's r) of measures included in the study .B.RMSEA = root mean squared error of approximation; NFI = Bentler-Bonett normed fit index; CFI = comparative fit index

		M	1	2	3	4	5	6	7	8
		(SD)
	1. Interpersonal Quality of SSE (α = 0.82)	34.14 (8.54)	1.00 -.12 -.58**** -.53**** -.53****	.31***	.56****	.09
	2. SSE (α = 0.81)	5.26 (4.99)		1.00	.07	.11	-.07	-.16	-.15 .0005
	3. Shame (α = 0.72)	7.21 (3.79)			1.00	.60****	.36****	-.26** -.46****	.02
	4. Guilt (α = 0.74)	9.90 (5.25)				1.00	.44****	-.22* -.43****	-.13
	5. Perceived Stigma (α = 0.91)	64.19 (19.87)					1.00	-.27** -.38****	-.09
	6. Physical Health Score	50.04 (9.46)						1.00	.56****	.22*
	7. Mental Health Score	49.85 (9.01)							1.00	.12
	8. CD4+ cells Count (cells/mm3)	387.73 (242.83)								1.00

( N = 101) N.B.**** p ≤ 0.0001; *** p ≤ 0.001; ** p ≤ 0.01; * p ≤ 0.05 N

Appendix 1. Spanish Translation of the Quality of Inventory items (interpersonal dimension)

Instrucciones: Las siguientes frases se refieren a los momentos en los cuales usted suele hablar de sus pensamientos y emociones relacionados a su enfermedad. Por favor indique en qué medida (1-5) suele sucederle lo que describimos.

1. Cuando comparto con otros mis pensamientos y sentimientos yo siento que las personas no me entienden y me malinterpretan * 2. Durante las conversaciones que tengo me siento cómodo/a 3. Las personas con las que comparto mis pensamientos y sentimientos entienden exactamente lo que yo quiero decir 4. Cuando hablo con las otras personas siento que hay una distancia entre nosotros* 5. Durante las conversaciones hay muchas discusiones con desacuerdos 6. Cada vez que hablo sobre mis pensamientos y sentimientos Las otras personas siempre me dicen lo mismo* 7. Cuando hablo de mis pensamientos y sentimientos, siento que las otras personas se llevan una idea equivocada de lo que soy 8. Durante las conversaciones que tengo me encuentro en una posición incómoda, como si no supiera que decir* 9. Yo hubiese preferido compartir mis pensamientos y sentimientos con otras personas, distintas a esas con las que comparto ahora *Items to be reverse coded.


Ibrahim Djemai

Sid Ahmed Fezza

Wassim Hamidouche

Olivier Déforges

Extending 2D Saliency Models for Head Movement Prediction in 360-degree Images using CNN-based Fusion

Keywords: Saliency prediction, Head movement, 360 image, CNN, Cubemap projection, Fusion

Saliency prediction can be of great benefit for 360degree image/video applications, including compression, streaming, rendering and viewpoint guidance. It is therefore quite natural to adapt the 2D saliency prediction methods for 360degree images. To achieve this, it is necessary to project the 360-degree image to 2D plane. However, the existing projection techniques introduce different distortions, which provides poor results and makes inefficient the direct application of 2D saliency prediction models to 360-degree content. Consequently, in this paper, we propose a new framework for effectively applying any 2D saliency prediction method to 360-degree images. The proposed framework particularly includes a novel convolutional neural network based fusion approach that provides more accurate saliency prediction while avoiding the introduction of distortions. The proposed framework has been evaluated with five 2D saliency prediction methods, and the experimental results showed the superiority of our approach compared to the use of weighted sum or pixel-wise maximum fusion methods.

I. INTRODUCTION

Omnidirectional or 360-degree image/video represents an essential type of virtual reality (VR) content which meets an increasing success. This type of content offers an immersive experience to viewers with the use of head mounted displays (HMDs), providing a limited field of view and three degrees of freedom (roll, yaw and pitch). This allows the viewer to explore the scene by freely turning his head, as humans do in the real world. Being close to the viewer's eyes, the HMD must provide high-resolution content (4K or above) in order to offer high quality of experience. Furthermore, to avoid motion sickness, the frame rate should also be high [START_REF] Chen | Recent advances in omnidirectional video coding for virtual reality: Projection and evaluation[END_REF]. Therefore, in sight of the huge amount of data created by such omnidirectional images (ODIs), their storage and transmission over existing bandwidth-limited infrastructures pose a great challenge.

Since only a fraction of 360-degree images can catch the viewer attention, namely the viewport, prediction of head movement in ODI is very useful to overcome the aforementioned limitations, and can be exploited in different applications, including compression, streaming, rendering and viewpoint guidance. For instance, compressing the non-viewed parts of the scene using high compression level is a way of reducing the amount of data sent over the network, and it is done by predicting where the user is most likely going to rotate his head, i.e., prediction of head fixations. Some works have proposed saliency models suited for this kind of content. These methods can be grouped under two different approaches: those who perform the prediction of saliency directly on the sphere [START_REF] Zhang | Saliency detection in 360 videos[END_REF], and those attempting to extend the existing 2D saliency prediction methods to 360degree content by applying them to one or more omnidirectional content projections [START_REF] Chao | Salgan360: visual saliency prediction on 360 degree images with generative adversarial networks[END_REF]- [START_REF] Biswas | Towards light-compensated saliency prediction for omnidirectional images[END_REF], e.g., EquiRectangular Projection (ERP) or CubeMap Projection (CMP).

The ODI is shown to the user through the HMD as a sphere, but it has to be stored as a regular 2D content in order to be processed. Many projections exist to transform the ODI from spherical format to a flat one [START_REF] Li | State-of-the-art in 360 • video/image processing: Perception, assessment and compression[END_REF], and the ERP and CMP projections are the widely used ones for saliency prediction on ODIs, as illustrated in Figure 1. The ERP is represented with a single patch, but it suffers from geometric distortions in the poles, making it inappropriate to detect salient regions directly, since it is different from what observers really perceive. While CMP content suffers less from this issue, but it introduces image boundaries being represented with 6 faces, i.e., border artifacts. In other words, given the discontinuities between faces, applying the 2D saliency prediction method independently on the 6 faces takes into account only the local context of the scene, thus providing insufficient results.

Thus, in order to compensate these geometric distortion and border artifacts due to sphere-to-plane projections, different approaches have been proposed. Some works proposed to combine both ERP and CMP projections [START_REF] Chao | Salgan360: visual saliency prediction on 360 degree images with generative adversarial networks[END_REF], [START_REF] Startsev | 360-aware saliency estimation with conventional image saliency predictors[END_REF]. For instance, authors in [START_REF] Chao | Salgan360: visual saliency prediction on 360 degree images with generative adversarial networks[END_REF] used the CMP projection to estimate local saliency maps, while the ERP projection has been exploited for global context saliency prediction. Other approaches proposed to apply a single projection, ERP or CMP, but with different rotations [START_REF] Abreu | Look around you: Saliency maps for omnidirectional images in vr applications[END_REF]- [START_REF] Startsev | 360-aware saliency estimation with conventional image saliency predictors[END_REF]. This rotation procedure is used in order to take into account only the distortion-free regions of the ERP, i.e., middle portion, or to deal with the border artifacts in the CMP projection.

However, all these approaches generate a set of intermediate saliency maps, resulting from different rotations or from different projection procedures [START_REF] Chao | Salgan360: visual saliency prediction on 360 degree images with generative adversarial networks[END_REF]- [START_REF] Fang | A novel superpixel-based saliency detection model for 360-degree images[END_REF], which requires a fusion block to merge them to provide a single final saliency map. This is usually done either by a weighted sum or a pixel-wise maximum between the resulted saliency maps. In addition, this fusion is performed after a re-projection of the saliency maps to ERP format. Thereby, these approaches are static and do not provide an optimal result.

Given the rich literature and the significant advances reached by the 2D saliency prediction approaches, consequently, in this paper, we propose a novel framework to effectively extend any 2D saliency prediction method for 360degree images. To reach this goal, as a first step, the 2D saliency prediction method is applied on cube face images (CMP images for short) under several orientations. Then, in contrast to conventional approaches, the resulting saliency maps are optimally merged using a convolutional neural network (CNN) based fusion approach. This CNN has been trained with CMP images using a new loss function including different saliency evaluation metrics. This framework is modular and can be used with any 2D saliency prediction approach. The experiments with five 2D saliency prediction methods have shown that the proposed adaptation method outperforms baseline methods using a weighted sum or pixelwise maximum.

The rest of the paper is organized as follows. Section II presents a review of the saliency prediction methods for 360degree images. Section III describes the proposed approach. The experimental results are presented in Section IV. Finally, Section V concludes the paper.

II. RELATED WORK

Most of the methods proposed to predict the visual saliency of 360-degree content are extensions of 2D saliency models. The difference between them lies mainly in the choice of the type of sphere-to-plane projection and, if the exploited 2D saliency method is hand-crafted or deep neural features based approach.

For instance, Abreu et al. [START_REF] Abreu | Look around you: Saliency maps for omnidirectional images in vr applications[END_REF] proposed to apply a 2D saliency prediction method on several ERP images obtained with four horizontal translations. Then, the obtained saliency maps are fused using a weighted averaging to derive the final saliency map of the 360-degree image. Inspired by this work, Lebreton et al. [START_REF] Lebreton | Gbvs360, bms360, prosal: Extending existing saliency prediction models from 2d to omnidirectional images[END_REF] proposed an extension of two 2D saliency models, Graph-Based Visual Saliency (GBVS) [START_REF] Harel | Graph-based visual saliency[END_REF] and Boolean Map Saliency (BMS) [START_REF] Zhang | Saliency detection: A boolean map approach[END_REF], called GBVS360 and BMS360, in which the same fusion procedure proposed in [START_REF] Abreu | Look around you: Saliency maps for omnidirectional images in vr applications[END_REF] is used.

In order to avoid the border artifacts due to the CMP format, in [START_REF] Maugey | Saliency-based navigation in omnidirectional image[END_REF], the authors proposed to use a double cube projection, which consists of projecting the spherical image into two cubes, such that the cube face centers are pointing towards the corners of the other cube. Next, the 2D saliency is estimated for all faces of both cubes and are projected back to the ERP plane and then fused using a weighted average. The 2D saliency map of each face of each cube is obtained by aggregating the saliency maps computed by 5 state-of-art models, including GBVS [START_REF] Harel | Graph-based visual saliency[END_REF], Image Signature (ImgSig) [START_REF] Hou | Image signature: Highlighting sparse salient regions[END_REF], Adaptive Whitening Saliency (AWS) [START_REF] Garcia-Diaz | Saliency from hierarchical adaptation through decorrelation and variance normalization[END_REF] and BMS [START_REF] Zhang | Saliency detection: A boolean map approach[END_REF].

In contrast to the previous described works that exploited only one type of projection, Startsev et al. [START_REF] Startsev | 360-aware saliency estimation with conventional image saliency predictors[END_REF] considered both CMP and ERP projections for the saliency prediction of 360degree images. Specifically, they used two ERP images in addition to two CMP faces generated at several different rotations. Then, the saliency maps of CMP images are projected back to the ERP format. Finally, all ERP saliency maps of all orientations are fused together through pixel-wise maximum. In the same vein, Chao et al. [START_REF] Chao | Salgan360: visual saliency prediction on 360 degree images with generative adversarial networks[END_REF] proposed to use the original ERP image to derive the global saliency map, while CMP images with different rotations have been used to generate the local saliency maps. Finally, the global and local saliency maps are linearly combined to generate the final saliency map in the ERP format.

In [START_REF] Battisti | A feature-based approach for saliency estimation of omni-directional images[END_REF], based on the viewport images, both low-and highlevel feature maps are generated using low-level features and high-level or semantic features. Finally, both maps are fused in order to obtain the final saliency map. Similarly, in [START_REF] Zhu | The prediction of head and eye movement for 360 degree images[END_REF], the authors proposed a combination between the output of bottomup and top-down saliency maps, which operate on a special projection that simulates the user's viewport. Fang et al. [START_REF] Fang | A novel superpixel-based saliency detection model for 360-degree images[END_REF] proposed to predict the saliency map of 360-degree image by combining the feature contrast and boundary connectivity. The feature contrast is computed on superpixel level by lowlevel features, while the boundary connectivity is defined as background measure to extract background map.

III. PROPOSED APPROACH

This section presents the proposed framework, as shown in Figure 2, which includes cubemap projections, application of the 2D saliency prediction model, CNN-based fusion and post-processing. The details of each of these steps are provided below.

A. Cubemap Projections

Since the ERP suffers from geometric distortions, applying a regular 2D saliency model on it would produce poor results. Therefore, the input ERP image is converted into CMP faces. However, CMP introduces image boundaries to the resulting cube faces. To deal with this issue, we perform several CMPs with different rotations. As shown in Figures 2 and3 This setup insures covering all directions with respect to the central rotation (0 • , 0 • ).

More formally, given an input equirectangular image ERP ∈ R c×w×h , where c is the number of channels, while w and h represent the width and height, respectively. The projection function P transforms the ERP to a cubemap format CM P j ∈ R 6×c×l×l under the rotation j, where l is the edge length of the cube and CM P j represents a stack of six faces. Given the projections have been performed using 5 different rotations, this provides a set of CMP images, where CM P = {CM P j i |i = 1, ..., 6, j = 1, ..., 5}.

B. 2D saliency model

Once the CMP faces have been generated, we apply on them a regular 2D saliency model. We have considered 5 models to evaluate our appraoch, namely Graph-Based Visual Saliency (GBVS) [START_REF] Harel | Graph-based visual saliency[END_REF], Boolean Map Saliency (BMS) [START_REF] Zhang | Saliency detection: A boolean map approach[END_REF], Unsupervised Hierarchical Model (UHM) [START_REF] Tavakoli | Bottom-up fixation prediction using unsupervised hierarchical models[END_REF], Contextual Encoder-Decoder (CED) [START_REF] Kroner | Contextual encoder-decoder network for visual saliency prediction[END_REF] and Saliency GAN (SalGAN) [START_REF] Pan | Salgan: Visual saliency prediction with generative adversarial networks[END_REF], which are listed as one of the top performing models in the MIT300 Benchmark [START_REF] Bylinskii | Mit saliency benchmark[END_REF]. The output of the 2D saliency model are local saliency maps, and the different rotations covering the surroundings of the central position should provide the global context of the scene.

C. Input Fusion CNN

The output of the previous step are saliency maps for all the CMP faces. These CMP saliency maps are organized in order to feed the CNN that merges them together to obtain one saliency map by face. This operation is performed by arranging the corresponding faces with similar indexes channel-wise, i.e., the ones that face the same direction but with different rotation. This will provide tensors with a shape of l × l × 5.

The fusion method is used to combine the information from different contexts, and to improve the performance of the saliency prediction, especially when the used projection is with a limited field of view. The proposed fusion method is a CNN-based approach. There are several ways to merge information from different sources: input fusion, early fusion, late fusion, ad-hoc fusion and hyper-dense fusion [START_REF] Zhang | Hyperfusion-net: Hyperdensely reflective feature fusion for salient object detection[END_REF]. We adopted in this work the input fusion CNN approach. This kind of CNN performs fusion channel-wise, where the images are stacked together with the respect of the third dimension before feeding them into the network, and the output is shaped according to one of the stacked images. The training procedure highlighted by the blue dotted lines in the Figure 2 as well as the architecture of the input fusion CNN block are provided below.

1) Architecture: as shown in Table I, the CNN has six padded convolution layers, with batch normalization after each convolution. The input tensor is with a shape of l × l × 5, and the output is a single flattened saliency map corresponding to the central CMP rotation (0 • , 0 • ).

2) Training: the CNN has been trained using datasets from the ICME Grand Challanges 2017 and 2018 [START_REF] Rai | A dataset of head and eye movements for 360 degree images[END_REF], [START_REF] Gutiérrez | Introducing un salient360! benchmark: A platform for evaluating visual attention models for 360 contents[END_REF]. The details about the training set are provided in Section IV. The loss function L used in the training process, given by Eq. ( 1), consists of a linear combination of different saliency evaluation metrics, namely Kullback-Leiber Divergence (KLD), Correlation Coefficient (CC) and Binary Cross Entropy (BCE). As mentionned in [START_REF] Bruckert | Deep saliency models: the quest for the loss function[END_REF], this combination can lead to significant improvements in performance.

L(y, ŷ) = α KLD(y, ŷ) + β (1 -CC(y, ŷ)) + γ BCE(y, ŷ), (1)
where y is the ground truth saliency map that is converted into CMP according to the central rotation (0 • , 0 • ), and ŷ is the output of the CNN-base fusion block, while α, β and γ are three scalars used to balance the considered saliency evaluation metrics.

D. Post-Processing

After obtaining the saliency maps from the Input Fusion CNN block in the CMP format, a series of operations are carried out to project back the faces to the ERP in order to obtain the final saliency map. It has been shown statistically that the viewer tends to direct his attention towards the equator when exploring an omnidirectional scene [START_REF] Abreu | Look around you: Saliency maps for omnidirectional images in vr applications[END_REF]. Therefore, the introduction of the equator bias is an essential operation to increase the performance. We explored several ways to apply equator bias, and we have obtained the best performance by averaging the ground-truth training data as an equator bias [START_REF] Suzuki | Saliency map estimation for omnidirectional image considering prior distributions[END_REF]. Thus, the estimated saliency map after conversion to ERP format, denoted as S ini , is multiplied by the equator bias EB, resulting in the final saliency map S F inal defined as follows:

S F inal = S ini EB, with EB = 1 N N k=1 GT (k) , (2)
where GT (k) is the k th ground truth saliency map and N is the number of images in the training set.

IV. EXPERIMENTAL RESULTS

To evaluate the performance of our proposed framework, we used the datasets of Salient!360 ICME 2017 & 2018 Grand Challenges [START_REF] Rai | A dataset of head and eye movements for 360 degree images[END_REF], [START_REF] Gutiérrez | Introducing un salient360! benchmark: A platform for evaluating visual attention models for 360 contents[END_REF] for head only prediction, where the salient!360 2017 dataset contains 20 ERP images, and the salient!360 2018 dataset has 85 ERP training images. We converted each ERP image into 6 fixed-size 512×512 CMP faces For testing stage, we used the test set of Salient!360 2017 challenge, which consists of 25 ERP images and their corresponding head saliency maps. In order to show the effectiveness of the proposed CNN-based fusion approach, we compared it to the weighted average merge method. For the latter, the same steps as those adopted in the proposed method are used, except that the CMP saliency maps are linearly combined, i.e., average. For this evaluation, we have considered 5 models, namely GBVS [START_REF] Harel | Graph-based visual saliency[END_REF], BMS [START_REF] Zhang | Saliency detection: A boolean map approach[END_REF], UHM [START_REF] Tavakoli | Bottom-up fixation prediction using unsupervised hierarchical models[END_REF], CED [START_REF] Kroner | Contextual encoder-decoder network for visual saliency prediction[END_REF] and SalGAN [START_REF] Pan | Salgan: Visual saliency prediction with generative adversarial networks[END_REF]. Table II shows clearly that the simple linear combination of the CMP saliency maps, as is widely performed in the literature, does not achieve optimal results. In contrast, the proposed method clearly outperforms the weighted average merge method, for all the considered 2D saliency models. The obtained results demonstrate that the increase in performance is not mainly related to the used 2D saliency models, but thanks to the use of CNN-based fusion of stacked CMP saliency maps.

Given that the best performance have been achieved with SalGAN method. We compared these results against the stateof-the-art head movement prediction models. Specifically, we considered the top-5 methods [START_REF] Lebreton | Gbvs360, bms360, prosal: Extending existing saliency prediction models from 2d to omnidirectional images[END_REF], [START_REF] Startsev | 360-aware saliency estimation with conventional image saliency predictors[END_REF], [START_REF] Battisti | A feature-based approach for saliency estimation of omni-directional images[END_REF], [START_REF] Zhu | The prediction of head and eye movement for 360 degree images[END_REF], [START_REF] Ling | A saliency prediction model on 360 degree images using color dictionary based sparse representation[END_REF] from Salient!360 2017 and we used the same evaluation metrics KLD and CC. The reported result in table III shows the high efficiency of our framework compared to the stat-of-theart methods.

V. CONCLUSION

This paper presented a novel framework to extend any 2D saliency prediction method for 360-degree images. Our contribution mainly focused on the fusion method of CMP saliency maps using CNN-based approach. The proposed method has been compared to the weighted average merge approach using five 2D saliency methods. The results clearly showed the effectiveness and the added value of the proposed fusion block.

In addition, the modularity of the proposed framework allows for improving it for better performance, especially if it is combined with high performing 2D saliency methods and other enhancements in the rest of the chain. These points will be the subject of future contributions.

Fig. 1 .

 1 Fig. 1. Examples of equirectangular (top) and cubemap (bottom) projections for omnidirectional content.

  , we have chosen 5 different rotations (in yaw and pitch) of the ERP input image to be converted to CMP, which are respectively (0 • , 0 • ), (20 • , 20 • ), (-20 • , 20 • ), (20 • , -20 • ) and (-20 • , 20 • ).

Fig. 2 .

 2 Fig. 2. Architecture of the proposed framework. The blue dotted lines represent the training procedure.

Fig. 3 .

 3 Fig. 3. Cubemap projections with 5 different rotations.

TABLE II PERFORMANCE

 II EVALUATION OF THE SALIENCY MAPS MERGE METHODS.

	Saliency Model	Fusion Method	KLD↓	CC↑
	CED	Input Fusion CNN Average method	0.71 1.01	0.74 0.72
	UHM	Input Fusion CNN Average method	0.47 0.51	0.74 0.72
	BMS	Input Fusion CNN Average method	0.99 2.57	0.66 0.48
	GBVS	Input Fusion CNN Average method	0.49 0.46	0.75 0.73
	SalGAN	Input Fusion CNN Average method	0.47 1.84	0.76 0.64

TABLE III COMPARISON

 III AGAINST EXISTING HEAD MOVEMENT PREDICTION METHODS. THE TWO BEST RESULTS ARE IN BOLD.

	Method	KLD↓ CC↑
	Startsev et al. [7]	0.75	0.62
	Lebreton et al. [5]	0.44	0.69
	Zhu et al. [10]	0.65	0.67
	Ling et al. [28]	0.51	0.71
	Battisti et al. [8]	0.81	0.52
	Our method	0.47	0.76

with 5 rotations and stack them channel-wise as described in subsection III-C. Thus, we generated 105 × 6 × 5 = 3150 training CMP faces. We trained the input fusion CNN model using random initialization, weight regularization, and Adam Optimization algorithm

[START_REF] Kingma | Adam: A method for stochastic optimization[END_REF]

for 20 epochs. Loss function parameters α, β and γ were empirically set to 0.5, 0.25 and 0.25, respectively.