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.

Identifying who adolescents prefer as source of information within their social network.

Adolescents are highly influenced by their peers within their social networks. This social influence can stem from both unsolicited peer pressure and the active search for guidance. While extensive research examined the mechanisms of peer pressure, little is known about who adolescents prefer as a source of information. To address this gap, we conducted two independent studies using a novel social search paradigm that allows participants to choose which social sources they wish to observe. In both studies, adolescents demonstrated a preference for their friends over non-friends, as well as for peers who were perceived as trustworthy. Across both studies, we found mixed evidence for the role of perceived popularity as a selection criterion. Notable, study 2 revealed the significance of "cool", "admirable" and "acting mean" as additional characteristics of preferred peers, traits that are often associated with elevated peer status. It also revealed an interest for peers perceived as being smart. These findings highlight the active role adolescents have in choosing social sources and emphasize the importance of multiple peer characteristics. Future research should investigate whether adolescents' interest in these types of peers is contingent upon specific social contexts, age groups, and peer cultures.

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.

Developmental changes in exploration resemble stochastic optimization.

Human development is often described as a 'cooling off' process, analogous to stochastic optimization algorithms that implement a gradual reduction in randomness over time. Yet there is ambiguity in how to interpret this analogy, due to a lack of concrete empirical comparisons. Using data from n = 281 participants ages 5 to 55, we show that cooling off does not only apply to the single dimension of randomness. Rather, human development resembles an optimization process of multiple learning parameters, for example, reward generalization, uncertainty-directed exploration and random temperature. Rapid changes in parameters occur during childhood, but these changes plateau and converge to efficient values in adulthood. We show that while the developmental trajectory of human parameters is strikingly similar to several stochastic optimization algorithms, there are important differences in convergence. None of the optimization algorithms tested were able to discover reliably better regions of the strategy space than adult participants on this task.

Periodic epidemic outbursts explained by local saturation of clusters.

Adding the notion of spatial locality to the susceptible-infected-recovered (or SIR) model, allows to capture local saturation of an epidemic. The resulting minimum model of an epidemic, consisting of five ordinary differential equations with constant model coefficients, reproduces slowly decaying periodic outbursts, as observed in the COVID-19 or Spanish flu epidemic. It is shown that if immunity decays, even slowly, the model yields a fully periodic dynamics.

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.

Adolescents seek social information under uncertainty.

Adolescence is a period of emerging independence, in which adolescents face difficult decisions, including those that involve risk for health and well-being. Previous research suggests that learning from others might be a prominent strategy of adolescents to inform these difficult decisions. However, there is a gap in the literature that addresses the active role adolescents may have in gaining information about others' behavior (i.e., social information search). Here, we investigated when and how much social information adolescents search before making decisions under risk and ambiguity, using a novel social search paradigm. In this paradigm, adolescents were able to reveal real information about their classmates' choices before deciding on their final choice. Our two experiments suggest that social information search can be broken down in two independent decisions: first the decision to initiate search, followed by the decision to continue search. Several factors motivated initiation of search, including: (a) the difficulty of the choice, (b) uncertainty about the outcome, and (c) the magnitude of the reward at stake. Search took generally longer when adolescents faced information not in line with their initial preference. Finally, we observed that adolescents used the sampled social information to inform their risky-choice behavior. Taken together, these results provide novel insights into the dynamics of peer influence in adolescence and stress the importance of treating adolescents not only as receivers, but as active agents searching for social information. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

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.

Network distance and centrality shape social learning in the classroom.

Social learning can help individuals to efficiently acquire knowledge and skills. In the classroom, social learning often takes place in structured settings in which peers help, support, and tutor each other. Several protocols have been developed to make peer-assisted learning (PAL) more efficient. However, little attention has been devoted to how the transfer of knowledge is shaped by the social relationship between peers, and their relative positions in the social network. To address this gap, we combined social network analysis with an experimental social learning task, in which pupils (N = 135; aged 11-19) could use social information from their peers to improve their performance. We show that pupils' tendencies to use social information substantially decrease with the peer's distance in the social network. This effect is mediated by subjective closeness: pupils report feeling much closer to their friends than to their non-friends, and closeness strongly enhances social learning. Our results further show that, above and beyond these effects of network distance, social information use increases with the peer's social status (network centrality) and perceived smartness. Our results provide empirical evidence in a naturalistic setting for the role of specific network attributes in shaping pupils' willingness to learn from their peers. These findings illustrate the value of a social network approach for understanding knowledge transfer in the classroom and can be used to structure more effective peer learning. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Social learning across adolescence: A Bayesian neurocognitive perspective.

Adolescence is a period of social re-orientation in which we are generally more prone to peer influence and the updating of our beliefs based on social information, also called social learning, than in any other stage of our life. However, how do we know when to use social information and whose information to use and how does this ability develop across adolescence? Here, we review the social learning literature from a behavioral, neural and computational viewpoint, focusing on the development of brain systems related to executive functioning, value-based decision-making and social cognition. We put forward a Bayesian reinforcement learning framework that incorporates social learning about value associated with particular behavior and uncertainty in our environment and experiences. We discuss how this framework can inform us about developmental changes in social learning, including how the assessment of uncertainty and the ability to adaptively discriminate between information from different social sources change across adolescence. By combining reward-based decision-making in the domains of both informational and normative influence, this framework explains both negative and positive social peer influence in adolescence.

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.

Smartphone-Assisted Patient-Initiated Care Versus Usual Care in Patients With Rheumatoid Arthritis and Low Disease Activity: A Randomized Controlled Trial.

OBJECTIVE: We developed a smartphone application for patients with rheumatoid arthritis (RA) that allows them to self-monitor their disease activity in between clinic visits by answering a weekly Routine Assessment of Patient Index Data 3. This study was undertaken to assess the safety (noninferiority in the Disease Activity Score in 28 joints using the erythrocyte sedimentation rate [DAS28-ESR]) and efficacy (reduction in number of visits) of patient-initiated care assisted using a smartphone app, compared to usual care. METHODS: A 12-month, randomized, noninferiority clinical trial was conducted in RA patients with low disease activity and without treatment changes in the past 6 months. Patients were randomized 1:1 to either app-supported patient-initiated care with a scheduled follow-up consultation after a year (app intervention group) or usual care. The coprimary outcome measures were noninferiority in terms of change in DAS28-ESR score after 12 months and the ratio of the mean number of consultations with rheumatologists between the groups. The noninferiority limit was 0.5 difference in DAS28-ESR between the groups. RESULTS: Of the 103 randomized patients, 102 completed the study. After a year, noninferiority in terms of the DAS28-ESR score was established, as the 95% confidence interval (95% CI) of the mean ΔDAS28-ESR between the groups was within the noninferiority limit: -0.04 in favor of the app intervention group (95% CI -0.39, 0.30). The number of rheumatologist consultations was significantly lower in the app intervention group compared to the usual care group (mean ± SD 1.7 ± 1.8 versus 2.8 ± 1.4; visit ratio 0.62 [95% CI 0.47, 0.81]). CONCLUSION: Patient-initiated care supported by smartphone self-monitoring was noninferior to usual care in terms of the ΔDAS28-ESR and led to a 38% reduction in rheumatologist consultations in RA patients with stable low disease activity.

Adolescents sample more information prior to decisions than adults when effort costs increase.

Making better decisions typically requires obtaining information relevant to that decision. Adolescence is marked by increasing agency in decision-making and an accompanying increase in impulsive decisions, suggesting that one characteristic of adolescent decision-making is a tendency to make less-informed decisions. Adolescents could also be especially averse to the effort associated with acquiring relevant information to make decisions. To investigate this possibility, we recruited adolescents (Mage = 15.02 years) in upper-secondary schools and young adults (Mage = 20.53 years) attending university in the Netherlands to complete an effort-based information sampling task, in which participants could sample information until obtaining sufficient evidence to make a decision. Effort costs for sampling were systematically varied. Surprisingly, adolescents sampled more evidence than adults before making decisions when sampling effort costs were low. Further, adolescents obtained stronger evidence prior to their decisions than adults as effort costs increased, exhibiting less aversion to effort costs associated with information sampling. Exploratory computational models supported these findings. Both adolescents and adults used simple heuristics in deciding whether to sample additional information or make a final decision, and adolescents sought a higher evidence threshold before deciding compared with adults. These results suggest that adolescents may require more certainty to make decisions compared with adults and be less averse to effort costs when gathering information to aid decisions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

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.

TU Delft COVID-app: A tool to democratize CFD simulations for SARS-CoV-2 infection risk analysis.

This work describes a modelling approach to SARS-CoV-2 dispersion based on experiments. The main goal is the development of an application integrated in Ansys Fluent to enable computational fluid dynamics (CFD) users to set up, in a relatively short time, complex simulations of virion-laden droplet dispersion for calculating the probability of SARS-CoV-2 infection in real life scenarios. The software application, referred to as TU Delft COVID-app, includes the modelling of human expiratory activities, unsteady and turbulent convection, droplet evaporation and thermal coupling. Data describing human expiratory activities have been obtained from selected studies involving measurements of the expelled droplets and the air flow during coughing, sneezing and breathing. Particle Image Velocimetry (PIV) measurements of the transient air flow expelled by a person while reciting a speech have been conducted with and without a surgical mask. The instantaneous velocity fields from PIV are used to determine the velocity flow rates used in the numerical simulations, while the average velocity fields are used for validation. Furthermore, the effect of surgical masks and N95 respirators on particle filtration and the probability of SARS-CoV-2 infection from a dose-response model have also been implemented in the application. Finally, the work includes a case-study of SARS-CoV-2 infection risk analysis during a conversation across a dining/meeting table that demonstrates the capability of the newly developed application.

Effectiveness of electronic drug monitoring feedback to increase adherence in patients with RA initiating a biological DMARD: a randomised clinical trial.

OBJECTIVE: Medication non-adherence in rheumatoid arthritis (RA) is associated with disease flares, increased disability and increased costs. This study assessed the effectiveness of electronic monitoring feedback (EMF) on medication adherence in patients with RA starting with or switching to a new biological disease-modifying antirheumatic drug (bDMARD). METHODS: In this randomised controlled trial, bDMARD starters were assigned to the intervention or control group and followed for 1 year. The intervention group received a needle container with a Medication Event Monitoring System (MEMS) cap registering patient's adherence to injections. Scores were calculated every 3 months with MEMS and motivational interviewing feedback was given. The control group received usual care. Effectiveness of EMF on adherence was measured with the medication possession ratio (MPR). RESULTS: 104 consecutive intervention patients were included and 102 controls. MPR was 0.95 (SD: 0.10) and 0.90 (0.16) after 12 months (B: 0.036, 95% CI: 0.001 to 0.007, p=0.045). bDMARD-naive patients receiving EMF achieved low disease activity (LDA) sooner compared with the control group, adjusted for baseline DAS (HR: 1.68, 95% CI: 1.00 to 2.81, p=0.050). Side effects and DAS28 were similar. CONCLUSION: EMF increased adherence for patients with RA starting with or switching to a bDMARD. Especially bDMARD-naive patients achieved LDA sooner compared with the control group, which holds promise for the future.

Social information use in adolescents with conduct problems and varying levels of callous-unemotional traits.

Background: Adolescents with conduct problems (CP) are characterised by difficulties with social relationships and display atypical social cognition, such as when interpreting emotional expressions or engaging in social problem-solving. One important aspect of social cognition that warrants investigation is the degree to which these adolescents factor others' views into their already held beliefs, and strategies used to do so. Effective social information use enables attunement to social environment, cooperation, and social problem-solving. Difficulties in this regard could contribute to problems in social interactions in adolescents with CP, and may vary with adolescents' high (CP/HCU) versus low levels of callous-unemotional traits (CP/LCU). Methods: We compared social information use in boys (11-16 years) with CP/HCU (n = 32), CP/LCU (n = 31) and typically developing (TD) peers (n = 45), matched for IQ. Participants provided estimates of numbers of animals on a screen, saw another adolescent's estimate, and could adjust their initial estimate. We compared two aspects of social information use: (1) degree of adjustment of initial estimate towards another's estimate and (2) strategy use when adjusting estimates. Results: Degree of adjustment towards another's estimate did not vary across groups, but strategy use did. Adolescents with CP/LCU compromised less following social information than TD peers. Conclusions: Findings suggest that while adolescents with CP are able to take social information into account, those with CP/LCU use this information in a way that differs from other groups and could be less efficient. This warrants further systematic investigation as it could represent a target for behaviour management strategies. Overall, this study highlights the need for more research delineating the social-cognitive profile of adolescents with CP/LCU.

Associations of Irritability With Functional Connectivity of Amygdala and Nucleus Accumbens in Adolescents and Young Adults With ADHD.

OBJECTIVE: Irritability is a common characteristic in ADHD. We examined whether dysfunction in neural connections supporting threat and reward processing was related to irritability in adolescents and young adults with ADHD. METHOD: We used resting-state fMRI to assess connectivity of amygdala and nucleus accumbens seeds in those with ADHD (n = 34) and an age- and gender-matched typically-developing comparison group (n = 34). RESULTS: In those with ADHD, irritability was associated with atypical functional connectivity of both seed regions. Amygdala seeds showed greater connectivity with right inferior frontal gyrus and caudate/putamen, and less connectivity with precuneus. Nucleus accumbens seeds showed altered connectivity with middle temporal gyrus and precuneus. CONCLUSION: The irritability-ADHD presentation is associated with atypical functional connectivity of reward and threat processing regions with cognitive control and emotion processing regions. These patterns provide novel evidence for irritability-associated neural underpinnings in adolescents and young adults with ADHD. The findings suggest cognitive and behavioral treatments that address response to reward, including omission of an expected reward and irritability, may be beneficial for ADHD.