YouTube vloggers set the stage: How public (non)compliance with COVID-19 regulations affects adolescents.

INTRODUCTION: YouTube vloggers may be important socialization figures, yet their influence on adolescents' health-related behaviors and cognitions is largely untested. In this two-study mixed-method project, we first assessed the extent of (non)compliance to COVID-19 regulations by vloggers on YouTube and how viewers reacted to this. Second, we experimentally assessed the effects of vlogger behavior paired with viewer evaluations on adolescents' COVID-19-related attitudes, intentions, and behavior. METHODS: For Study 1, we coded 240 vlogs of eight popular Dutch vloggers on YouTube recorded in the period of February 2020-March 2021. For our 2 × 2 between-subjects experiment in Study 2, Dutch adolescents (N = 285, Mage = 12.99, SD = 1.02, 41.8% girls) were randomly assigned to conditions in which they saw vlogs showing either compliance or noncompliance to COVID-19 regulations, and to conditions in which they saw either supportive or dismissive comments under these vlogs. RESULTS: Study 1: Vloggers' noncompliance with COVID-19 regulations was not uncommon and received relatively more viewer support than compliance, suggesting that portrayed noncompliance may be potentially influential. Study 2: Adolescents were more worried about COVID-19 after they watched a compliant (vs. noncompliant) vlogger. Also, vlogger noncompliance decreased adolescents' perceived importance of COVID-19 regulations and rule-setting for adolescents who identified strongly with the vloggers they watched. CONCLUSIONS: Vloggers' (non)compliance affects adolescents' COVID-19-related worrying, and attitudes and behavior of adolescents who identify with vloggers strongly. This seems concerning given the sometimes harmful and risky behaviors vloggers portray online but could potentially also be employed to encourage healthy behaviors.

Self-monitoring combined with patient-initiated care in RA patients with low disease activity: cost-effectiveness analysis of an RCT.

OBJECTIVES: Self-monitoring and patient-initiated care (PIC) leads to fewer outpatient clinic visits in patients with established RA with low disease activity (LDA) while healthcare outcomes are similar. This study assesses the cost-effectiveness of PIC with self-monitoring. METHODS: A 12-month randomized controlled trial was performed with 49 patients in the PIC with self-monitoring group (app-group) and 53 in usual care. The usual care group continued with preplanned visits. The app group had one planned follow-up visit after 12 months and monitored their RA disease activity in a smartphone app. Both groups could make additional appointments at liberty. We included adult RA patients with a disease duration of over 2 years, a disease activity score 28 (DAS28) below 3.2 that were stable on medication for at least 6 months. The effect measure, the DAS28, was measured at 12 months and healthcare resource usage and productivity losses were measured at 3, 6, 9 and 12 months. RESULTS: There was no significant difference in mean change of DAS28 (-0.04 mean difference, 95% CI: -0.39, 0.30), nor a statistically significant difference in total costs (mean difference €514, 95% CI:-€266, €3690) in the app group compared with the usual care group. The probability that the app was cost-effective was 0.37 and 0.57 at a willingness-to-pay threshold of 0 and 50 000 €/point improvement DAS28, respectively. CONCLUSION: Although rheumatic care costs were significantly lower in the app group, total costs and effects of PIC with self-monitoring were not different from usual care in RA patients with LDA.

Facilitators and barriers to adhere to monitoring disease activity with ePROs: a focus group study in patients with inflammatory arthritis.

Telemonitoring disease activity with electronic patient-reported outcomes (ePROs) may reduce the workload of rheumatic care by decreasing outpatient clinic visits. However, low adherence to reporting ePROs is frequently observed. Our objective was to identify facilitators and barriers to weekly monitoring of disease activity with ePROs. Patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), or ankylosing spondylitis (AS) who recently participated in one of the two telemonitoring studies with ePROs completed in a smartphone app, were invited to participate in focus group discussions (FGD). Thematic analysis was used to identify themes that play a role in the decision to continue or stop reporting weekly ePROs. A total of 22 patients participated in three FGDs. Five themes were identified that were of importance to adhere to telemonitoring: (1) questionnaire frequency, (2) discussing results of completed ePROs, (3) physical consultations, (4) patient insight into disease activity and (5) user experience of the app. All themes contained both barrier and facilitator elements. The results suggest that to improve adherence to telemonitoring of disease activity with ePROs, the perceived benefits of completing ePROs should be maximized. This can be done by providing patients the ability to skip (unneeded) physical consultations in case of low disease activity, and training clinicians to always discuss the completed ePROs. In addition, it is essential to reduce the effort to report ePROs, by tailoring the frequency of ePROs based on the patients' disease activity or preference, aiming for optimal app functionality as well as by sending notifications when new ePROs are available.

Predictors for response to electronic patient-reported outcomes in routine care in patients with rheumatoid arthritis: a retrospective cohort study.

Routine collection of electronic patient-reported outcomes (ePROs) can improve clinical care. However, a low response rate may counteract the benefits. To optimize adoption, the aim of this study was to investigate which patient factors and/or timing of the invitation predicted response to ePROs sent prior to consultations in patients with rheumatoid arthritis. We performed a retrospective database study with clinical data collected as part of usual care from the electronic medical records at Reade Amsterdam. The dataset comprised the email invitations to complete the ePRO sent prior to consultation. Multiple patient factors and factors defining the timing of the invitation were investigated if they predicted response to the ePRO through a multivariable logistic generalized estimating equation analysis. In total, 17.070 ePRO invitations were sent to 3194 patients (mean age 60 (SD 14), 74% female), of which 40% was completed. Patients between 55 and 73 years (OR 1.39, 95%CI 1.09-1.77) and with higher social economic status (SES) (OR 1.51, 95%CI 1.22-1.88) had significantly higher odds for completing the ePRO, while patients living in an urban area had lower odds (OR 0.69, 95% CI 0.62-0.76). In year 4 after implementation, the OR was increased to 3.69 (95% CI 2.91-4.90). The implementation of ePROs in daily clinical practice needs improvement since 40% of the ePROs sent prior to consultations were completed. Patients that had higher odds to report the next ePRO were between the age of 55-73, had a higher socio-economic status, and were residents in a rural area. The adoption of reporting the PRO increased over time, but the timing of the prompt did not predict response. Additional research is needed to understand ePRO completion, especially for patients with lower socio-economic status.

Test-retest reliability of reinforcement learning parameters.

It has recently been suggested that parameter estimates of computational models can be used to understand individual differences at the process level. One area of research in which this approach, called computational phenotyping, has taken hold is computational psychiatry. One requirement for successful computational phenotyping is that behavior and parameters are stable over time. Surprisingly, the test-retest reliability of behavior and model parameters remains unknown for most experimental tasks and models. The present study seeks to close this gap by investigating the test-retest reliability of canonical reinforcement learning models in the context of two often-used learning paradigms: a two-armed bandit and a reversal learning task. We tested independent cohorts for the two tasks (N = 69 and N = 47) via an online testing platform with a between-test interval of five weeks. Whereas reliability was high for personality and cognitive measures (with ICCs ranging from .67 to .93), it was generally poor for the parameter estimates of the reinforcement learning models (with ICCs ranging from .02 to .52 for the bandit task and from .01 to .71 for the reversal learning task). Given that simulations indicated that our procedures could detect high test-retest reliability, this suggests that a significant proportion of the variability must be ascribed to the participants themselves. In support of that hypothesis, we show that mood (stress and happiness) can partly explain within-participant variability. Taken together, these results are critical for current practices in computational phenotyping and suggest that individual variability should be taken into account in the future development of the field.

Social influence in adolescence as a double-edged sword.

Social learning is fundamental to human development, helping individuals adapt to changing circumstances and cooperate in groups. During the formative years of adolescence, the social environment shapes people's socio-cognitive skills needed in adulthood. Although peer influence among adolescents is traditionally associated with risky and unruly conduct, with long-term negative effects on educational, economic and health outcomes, recent findings suggest that peers may also have a positive impact. Here, we present a series of experiments with 10-20-year-olds (n = 146) showing that positive and negative peer effects reflect a domain-general factor of social information use which declines during adolescence. Exposure to disobedient peers provoked rule breaking, and selfish peers reduced prosocial behaviour, particularly in early adolescence. However, compliant peers also promoted rule compliance and fair peers increased prosociality. A belief formation task further revealed that younger adolescents tend to assimilate social information, while older adolescents prioritize personal views. Our results highlight early adolescence as a key window for peer-based interventions to improve developmental trajectories.

Probability of Medication Intensifications in Rheumatoid Arthritis Patients With Low Disease Activity Scores on Their Patient-Reported Outcomes: A Medical-Records Review Study.

BACKGROUND: Patients with rheumatoid arthritis require frequent consultations to monitor disease activity and intensify medication when treatment targets are not met. However, because most patients are in remission during follow-up, it should be possible to reduce the number of consultations for them. Electronic patient-reported outcomes (ePROs) could be used to identify patients who meet their treatment goal and who could therefore be eligible to skip their visit. OBJECTIVE: The aim of this study was to assess the probability that patients with low disease activity scores on their ePROs do not need a disease-modifying antirheumatic drug (DMARD) or steroid intensification in the first 2 weeks after completion of the ePROs. METHODS: This medical-records review study compared results of ePROs answered during routine care with DMARD or steroid intensifications collected from anonymized electronic medical record at Reade. The primary outcome was the positive predictive value (PPV) of having a low disease activity score on an ePRO for not receiving a DMARD or steroid intensifications within 2 weeks. The 3 studied ePROs (and respective low disease activity outcome) were the Routine Assessment of Patient Index Data 3 (RAPID3) (score <2), Patient Acceptable Symptom State (PASS) (yes), and the flare question (no). The secondary aim of the study was to assess which combination of ePROs resulted in the best PPV for DMARD or steroid intensifications. RESULTS: Of the 400 randomly selected records, ultimately 321 were included (302 unique patients). The PPV of a RAPID3 <2, being in PASS, and a negative answer on the flare question were, respectively, 99%, 95%, and 83% to not receive a DMARD or steroid intensification within 2 weeks. The combination of a RAPID3 <2 and a negative flare question resulted in a PPV of 100%; this combination was present in 29% (93/321) of the total study population. CONCLUSION: The RAPID3, PASS, and flare question have a high diagnostic accuracy to identify individuals who will not receive a DMARD or steroid intensification in the following 2 weeks. The combination of the RAPID3 and flare question yielded the best combination of diagnostic accuracy and highest percentage of patients who could be eligible to skip a visit. These results suggest that accurate identification of patients who meet their treatment goal with ePROs is possible.

Telemedicine for patients with rheumatic and musculoskeletal diseases during the COVID-19 pandemic; a positive experience in the Netherlands.

To describe the delivery of care for patients with rheumatic and musculoskeletal diseases (RMDs) from the perspective of rheumatologists in the Netherlands during the first months of the COVID-19 pandemic. A mixed methods design was used with quantitative and qualitative data from a cross-sectional survey sent to all members of the Dutch Rheumatology Society in May 2020. The survey contained questions on demographics, the current way of care delivery, and also on usage, acceptance, facilitators and barriers of telemedicine. Quantitative data were analyzed descriptively. The answers to the open questions were categorized into themes. Seventy-five respondents completed the survey. During the COVID-19 pandemic, continuity of care was guaranteed through telephone and video consultations by 99% and 9% of the respondents, respectively. More than 80% of the total number of outpatient visits were performed exclusively via telephone with in-person visits only on indication. One-quarter of the respondents used patient reported outcomes to guide telephone consultations. The top three facilitators for telemedicine were less travel time for patients, ease of use of the system and shorter waiting period for patients. The top three barriers were impossibility to perform physical examination, difficulty estimating how the patient is doing and difficulty in reaching patients. During the COVID-19 epidemic, care for patients with RMDs in the Netherlands continued uninterrupted by the aid of telemedicine. On average, respondents were content with current solutions, although some felt insecure mainly because of the inability to perform physical examination and missing nonverbal communication with their patients.

Strategies for integrating disparate social information.

Social information use is widespread in the animal kingdom, helping individuals rapidly acquire useful knowledge and adjust to novel circumstances. In humans, the highly interconnected world provides ample opportunities to benefit from social information but also requires navigating complex social environments with people holding disparate or conflicting views. It is, however, still largely unclear how people integrate information from multiple social sources that (dis)agree with them, and among each other. We address this issue in three steps. First, we present a judgement task in which participants could adjust their judgements after observing the judgements of three peers. We experimentally varied the distribution of this social information, systematically manipulating its variance (extent of agreement among peers) and its skewness (peer judgements clustering either near or far from the participant's judgement). As expected, higher variance among peers reduced their impact on behaviour. Importantly, observing a single peer confirming a participant's own judgement markedly decreased the influence of other-more distant-peers. Second, we develop a framework for modelling the cognitive processes underlying the integration of disparate social information, combining Bayesian updating with simple heuristics. Our model accurately accounts for observed adjustment strategies and reveals that people particularly heed social information that confirms personal judgements. Moreover, the model exposes strong inter-individual differences in strategy use. Third, using simulations, we explore the possible implications of the observed strategies for belief updating. These simulations show how confirmation-based weighting can hamper the influence of disparate social information, exacerbate filter bubble effects and deepen group polarization. Overall, our results clarify what aspects of the social environment are, and are not, conducive to changing people's minds.

Generation of Atmospheric Turbulence with Unprecedentedly Large Reynolds Number in a Wind Tunnel.

Generating laboratory flows resembling atmospheric turbulence is of prime importance to study the effect of wind fluctuations on objects such as buildings, vehicles, or wind turbines. A novel driving of an active grid following a stochastic process is used to generate velocity fluctuations with correlation lengths, and, thus, integral scales, much larger than the transverse dimension of the wind tunnel. The combined action of the active grid and a modulation of the fan speed allows one to generate a flow characterized by a four-decade inertial range and an integral scale Reynolds number of 2×10^{7}.

Victory is its own reward: oxytocin increases costly competitive behavior in schizophrenia.

BACKGROUND: Aberrant sensitivity to social reward may be an important contributor to abnormal social behavior that is a core feature of schizophrenia. The neuropeptide oxytocin impacts the salience of social information across species, but its effect on social reward in schizophrenia is unknown. METHODS: We used a competitive economic game and computational modeling to examine behavioral dynamics and oxytocin effects on sensitivity to social reward among 39 men with schizophrenia and 54 matched healthy controls. In a randomized, double-blind study, participants received one dose of oxytocin (40 IU) or placebo and completed a 35-trial Auction Game that quantifies preferences for monetary v. social reward. We analyzed bidding behavior using multilevel linear mixed models and reinforcement learning models. RESULTS: Bidding was motivated by preferences for both monetary and social reward in both groups, but bidding dynamics differed: patients initially overbid less compared to controls, and across trials, controls decreased their bids while patients did not. Oxytocin administration was associated with sustained overbidding across trials, particularly in patients. This drug effect was driven by a stronger preference for winning the auction, regardless of monetary consequences. Learning rate and response variability did not differ between groups or drug condition, suggesting that differences in bidding derive primarily from differences in the subjective value of social rewards. CONCLUSIONS: Our findings suggest that schizophrenia is associated with diminished motivation for social reward that may be increased by oxytocin administration.

Neurocognitive Development of Motivated Behavior: Dynamic Changes across Childhood and Adolescence.

The ability to anticipate and respond appropriately to the challenges and opportunities present in our environments is critical for adaptive behavior. Recent methodological innovations have led to substantial advances in our understanding of the neurocircuitry supporting such motivated behavior in adulthood. However, the neural circuits and cognitive processes that enable threat- and reward-motivated behavior undergo substantive changes over the course of development, and these changes are less well understood. In this article, we highlight recent research in human and animal models demonstrating how developmental changes in prefrontal-subcortical neural circuits give rise to corresponding changes in the processing of threats and rewards from infancy to adulthood. We discuss how these developmental trajectories are altered by experiential factors, such as early-life stress, and highlight the relevance of this research for understanding the developmental onset and treatment of psychiatric disorders characterized by dysregulation of motivated behavior.

Time ambiguity during intertemporal decision-making is aversive, impacting choice and neural value coding.

We are often presented with choices that differ in their more immediate versus future consequences. Interestingly, in everyday-life, ambiguity about the exact timing of such consequences frequently occurs, yet it remains unknown whether and how time-ambiguity influences decisions and their underlying neural correlates. We developed a novel intertemporal fMRI choice task in which participants make choices between sooner-smaller (SS) versus later-larger (LL) monetary rewards with systematically varying levels of time-ambiguity. Across trials, delay information of the SS, the LL, or both rewards was either exact (e.g., in 5 weeks), of low ambiguity (4 week range: e.g., in 3-7 weeks), or of high ambiguity (8 week range: e.g., in 1-9 weeks). Choice behavior showed that the majority of participants preferred options with exact delays over those with ambiguous delays, indicating time-ambiguity aversion. Consistent with these results, the ventromedial prefrontal cortex showed decreased activation during ambiguous versus exact trials. In contrast, intraparietal sulcus activation increased during ambiguous versus exact trials. Furthermore, exploratory analyses suggest that more time-ambiguity averse participants show more insula and dorsolateral prefrontal cortex activation during subjective value (SV)-coding of ambiguous versus exact trials. Lastly, the best-fitting computational choice models indicate that ambiguity impacts the SV of options via time perception or via an additive ambiguity-related penalty term. Together, these results provide the first behavioral and neural signatures of time-ambiguity, pointing towards a unique profile that is distinct from impatience. Since time-ambiguity is ubiquitous in real-life, it likely contributes to shortsighted decisions above and beyond delay-discounting.

Power fluctuations in turbulence.

To generate or maintain a turbulent flow, one needs to introduce kinetic energy. This energy injection necessarily fluctuates and these power fluctuations act on all turbulent excited length scales. If the power is injected using forces proportional to the velocity, such as those common in shear flows, or with a force acting at the largest scales only, the spectrum of these fluctuations is shown to have a universal inertial range, proportional to the energy spectrum.

The computational basis of following advice in adolescents.

Advice taking helps one to quickly acquire knowledge and make decisions. This age-comparative study (in children [8- to 10-year-olds], adolescents [13- to 15-year-olds], and adults [18- to 22-year-olds]) investigated developmental differences in how advice, experience, and exploration influence learning. The results showed that adolescents were initially easily swayed to follow peer advice but also switched more rapidly to exploring alternatives like children. Whereas adults stayed with the advice over the task, adolescents put more weight on their own experience compared with adults. A social learning model showed that although social influence most strongly affects adolescents' initial expectations (i.e., their priors), adolescents showed higher exploration and discovered the other good option in the current task. Thus, our model resolved the apparently conflicting findings of adolescents being more and less sensitive to peer influence and provides novel insights into the dynamic interaction between social and individual learning.

Adolescent impatience decreases with increased frontostriatal connectivity.

Adolescence is a developmental period associated with an increase in impulsivity. Impulsivity is a multidimensional construct, and in this study we focus on one of the underlying components: impatience. Impatience can result from (i) disregard of future outcomes and/or (ii) oversensitivity to immediate rewards, but it is not known which of these evaluative processes underlie developmental changes. To distinguish between these two causes, we investigated developmental changes in the structural and functional connectivity of different frontostriatal tracts. We report that adolescents were more impatient on an intertemporal choice task and reported less future orientation, but not more present hedonism, than young adults. Developmental increases in structural connectivity strength in the right dorsolateral prefrontal tract were related to increased negative functional coupling with the striatum and an age-related decrease in discount rates. Our results suggest that mainly increased control, and the integration of future-oriented thought, drives the reduction in impatience across adolescence.

Neural mechanisms of individual differences in temporal discounting of monetary and primary rewards in adolescents.

Adolescents are generally characterized as impulsive. However, impulsivity is a multi-dimensional construct that involves multiple component processes. Which of these components contribute to adolescent impulsivity is currently unclear. This study focused on the neural mechanisms underlying individual differences in distinct components of temporal discounting (TD), i.e., the preference for smaller immediate rewards over larger delayed rewards. Participants were 58 adolescents (12-16 years-old) who performed an fMRI TD task with both monetary and snack rewards. Using mixed-effects modeling, we determined participants' average impatience, and further decomposed TD choices into: 1) amount sensitivity (unique contribution of the magnitude of the immediate reward); and 2) delay sensitivity (unique contribution of delay duration). Adolescents' average impatience was positively correlated with frontoparietal and ventral striatal activity during delayed reward choices, and with ventromedial prefrontal cortex activity during immediate reward choices. Adolescents' amount sensitivity was positively associated with ventral striatal and dorsal anterior cingulate cortex activity during immediate reward choices. Delay sensitivity was positively correlated with inferior parietal cortex activity during delayed reward choices. As expected, snacks were discounted more steeply than money, and TD of both reward types was associated with overlapping activation in the inferior parietal cortex. Exploring whether testosterone or estradiol were associated with TD and its neural correlates revealed no significant associations. These findings indicate that distinct components contribute uniquely to TD choice and that individual differences in amount sensitivity are uniquely associated with activation of reward valuation areas, while individual differences in delay sensitivity are uniquely associated with activation of cognitive control areas.

Individual differences in social desirability are associated with white-matter microstructure of the external capsule.

Humans tend to present themselves in a positive light to gain social approval. This behavioral trait, termed social desirability, is important for various types of social success. Surprisingly, investigation into the neural underpinnings of social desirability has been limited and focused only on interindividual differences in dopamine receptor binding. These studies revealed reduced dopamine receptor binding in the striatum of individuals who are high in trait social desirability. Interestingly, high dopamine signaling has been associated with low white-matter integrity, irrespective of social desirability. Based on these findings, we hypothesized that a positive association exists between trait social desirability and the white-matter microstructure of the external capsule, which carries fibers to the striatum from the prefrontal cortex. To test this hypothesis, we collected diffusion tensor imaging data and examined the relationship between fractional anisotropy of the external capsule and participants' social desirability-our analysis revealed a positive association. As a second exploratory step, we examined the association between social desirability and white-matter microstructure throughout the whole brain. Our whole-brain analysis revealed associations within multiple major white-matter tracts, demonstrating that socially desirable behavior relies on connectivity between distributed brain regions.

Early adversity and learning: implications for typical and atypical behavioral development.

BACKGROUND: Children who experience early adversity often develop emotion regulatory problems, but little is known about the mechanisms that mediate this relation. We tested whether general associative learning processes contribute to associations between adversity, in the form of child maltreatment, and negative behavioral outcomes. METHODS: Eighty-one participants between 12 and 17 years of age were recruited for this study and completed a probabilistic learning Task. Forty-one of these participants had been exposed to physical abuse, a form of early adversity. Forty additional participants without any known history of maltreatment served as a comparison group. All participants (and their parents) also completed portions of the Youth Life Stress Interview to understand adolescent's behavior. We calculated measures of associative learning, and also constructed mathematical models of learning. RESULTS: We found that adolescents exposed to high levels of adversity early in their lives had lower levels of associative learning than comparison adolescents. In addition, we found that impaired associative learning partially explained the higher levels of behavioral problems among youth who suffered early adversity. Using mathematical models, we also found that two components of learning were specifically affected in children exposed to adversity: choice variability and biases in their beliefs about the likelihood of rewards in the environment. CONCLUSIONS: Participants who had been exposed to early adversity were less able than their peers to correctly learn which stimuli were likely to result in reward, even after repeated feedback. These individuals also used information about known rewards in their environments less often. In addition, individuals exposed to adversity made decisions early in the learning process as if rewards were less consistent and occurred more at random. These data suggest one mechanism through which early life experience shapes behavioral development.

Digital health assessment in rheumatology: current and future possibilities.

Digital assessment and graphical feedback of patient-reported outcome measures such as the Health Assessment Questionnaire (HAQ) could increase empowerment and involvement of patients in their own care process. The App ecosystem that Reade is building is an example of how digital assessment using mobile devices can be integrated into existing hospital IT infrastructure.