Effectiveness of community-based oral antiviral treatments against severe COVID-19 outcomes in people 70 years and over in Victoria, Australia, 2022: an observational study.

Background: Oral Antiviral (OAV) COVID-19 treatments are widely used, but evidence for their effectiveness against the Omicron variant in higher risk, vaccinated individuals is limited. Methods: Retrospective study of two vaccinated cohorts of COVID-19 cases aged ≥70 years diagnosed during a BA.4/5 Omicron wave in Victoria, Australia. Cases received either nirmatrelvir-ritonavir or molnupiravir as their only treatment. Data linkage and logistic regression modelling was used to evaluate the association between treatment and death and hospitalisation and compared with no treatment. Findings: Of 38,933 individuals in the mortality study population, 13.5% (n = 5250) received nirmatrelvir-ritonavir, 51.3% (n = 19,962) received molnupiravir and 35.2% (n = 13,721) were untreated. Treatment was associated with a 57% (OR = 0.43, 95% CI 0.36-0.51) reduction in the odds of death, 73% (OR = 0.27, 95% CI 0.17-0.40) for nirmatrelvir-ritonavir and 55% (OR = 0.45, 95% CI 0.38-0.54) for molnupiravir. Treatment was associated with a 31% (OR = 0.69, 95% CI 0.55-0.86) reduction in the odds of hospitalisation, 40% (OR = 0.60, 95% CI 0.43-0.83) for nirmatrelvir-ritonavir and 29% (OR = 0.71, 95% CI 0.58-0.87) for molnupiravir. Cases treated within 1 day of diagnosis had a 61% reduction in the odds of death (OR = 0.39, 95% CI 0.33-0.46) compared with 33% reduction for a delay of 4 or more days (OR = 0.67, 95% CI 0.44-0.97). Interpretation: Treatment with both nirmatrelvir-ritonavir or molnupiravir was associated with a reduction in death and hospitalisation in vaccinated ≥70 years individuals during the Omicron era. Timely, equitable treatment with OAVs is an important tool in the fight against COVID-19. Funding: There was no funding for this study.

Combining error-driven models of associative learning with evidence accumulation models of decision-making.

As people learn a new skill, performance changes along two fundamental dimensions: Responses become progressively faster and more accurate. In cognitive psychology, these facets of improvement have typically been addressed by separate classes of theories. Reductions in response time (RT) have usually been addressed by theories of skill acquisition, whereas increases in accuracy have been explained by associative learning theories. To date, relatively little work has examined how changes in RT relate to changes in response accuracy, and whether these changes can be accounted for quantitatively within a single theoretical framework. The current work examines joint changes in accuracy and RT in a probabilistic category learning task. We report a model-based analysis of changes in the shapes of RT distributions for different category responses at the level of individual stimuli over the course of learning. We show that changes in performance are determined solely by changes in the quality of information entering the decision process. We then develop a new model that combines an associative learning front end with a sequential sampling model of the decision process, showing that the model provides a good account of all aspects of the learning data. We conclude by discussing potential extensions of the model and future directions for theoretical development that are opened up by our findings.

To err is (perfectly) human: behavioural and neural correlates of error processing and perfectionism.

The attitude towards one's own imperfection strongly varies between individuals. Here, we investigated variations in error-related activity depending on two sub-traits of perfectionism, Personal Standard Perfectionism (PSP) and Evaluative Concern Perfectionism (ECP) in a large scale functional magnetic resonance imaging study (N = 75) using a digit-flanker task. Participants with higher PSP scores showed both more post-error slowing and more neural activity in the medial-frontal gyrus including anterior cingulate cortex after errors. Interestingly, high-EC perfectionists with low PSP showed no post-error slowing and the highest activity in the middle frontal gyrus, whereas high-EC perfectionists with high PSP showed the lowest activity in this brain area and more post-error slowing. Our findings are in line with the hypothesis that perfectionists with high concerns but low standards avoid performance monitoring to avoid the worry-inducing nature of detecting personal failure and the anticipation of poor evaluation by others. However, the stronger goal-oriented performance motivation of perfectionists with high concerns and high standards may have led to less avoidance of error processing and a more intense involvement with the imperfect behaviour, which is essential for improving future performance.