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Encouraging people to vaccinate is a challenging endeavor, but one which has tremendous public health benefits. Doing so requires overcoming barriers of awareness, availability, and (sometimes) vaccine hesitancy. Here we focus on nudging people to vaccinate through online advertising. We conducted a pre-registered online ads campaign encouraging people to vaccinate against three diseases: influenza, human papillomavirus, and herpes zoster. Ads were shown to ~69,000 people and were compared to similar ads shown to 8.6 million people. Outcome measures were clicks on ads and future searches for relevant terms. We find that ads have two main effects: First, a congruence effect whereby ads increase the likelihood of clicks and future searches by up to 116% in people who express an interest in the disease or the vaccine. Most commercial vaccine advertising is aimed entirely at this population. Second, we observed a priming effect, where ads shown to people who were searching for terms unrelated to the vaccine could be encouraged to click on them (odds ratios of 7.5–33.0) and, more often, search for the vaccine later (hazard ratios of 6.9–157.3). We provide analysis for optimizing vaccine advertising campaign budgets to balance the two populations. These findings demonstrate that digital advertising campaigns should consider not just advertising to direct keywords or to individuals that look exactly like existing customers, but consider tangential keywords that draw a wider target population who are likely earlier in their conversion funnel, thus increasing the number of people who vaccinate and maximizing vaccines uptake.

Objective: Assess Instagram use for mental health disclosure in university students to assess the potential for Instagram use as mental health support-seeking.Participants: Twenty-one students using mental health services while attending a private, Mid-Atlantic university between 6/2017-12/2017.Methods: Collected qualitative interview and Instagram data and analyzed them in parallel. Instagram data supplemented interview themes and were coded and analyzed quantitatively to define features of participants' Instagram use.Results: Participants displayed aversions to posting mental health disclosures on Instagram, citing public and self-stigma as barriers to disclosure. Despite this, participants reported instances in which their Instagram posts directly or indirectly reflected their lived experiences. Some also maintained second anonymous accounts for fuller disclosure.Conclusions: Given the benefits of mental health disclosures to well-being and the predilection for social media use in university students, student and university-led initiatives to promote social media environments conducive to disclosures could have widespread mental health benefits.

Background : The expanding amount of information available from our use of technologies has led researchers to explore how this information can aid in the detection of mental health issues. We expand on past work in this area by exploring how browsing histories might be able to predict perceived barriers to psychological treatment. Methods : We obtained 10 days of browsing history data for 255 respondents as well as assessments of Perceived Barriers to Psychological Treatments and depression, the Patient Health Questionnaire. Results : We found that browsing histories enabled high performance classification of people with high levels of perceived barriers to psychological treatments (AUC average of 0.86). Limitations: Our high classification accuracy does not help understand why different features within the browsing histories are useful to classify people according to browsing history. We also look at people who decided to contribute their browsing history but the use of this data more generally presents additional ethical questions. Conclusions : Browsing histories might be useful to classify people's barriers to seeking psychological treatment. It is clinically relevant to find those who perceive barriers to seeking treatment to better design ways to address those concerns and help them find treatment.

Studies have shown that the traces people leave when browsing the internet may indicate the onset of diseases such as cancer. Here we show that the adaptive engines of advertising systems in conjunction with clinically verified questionnaires can be used to identify people who are suspected of having one of three types of solid tumor cancers. In the first study, 308 people were recruited through ads shown on the Bing search engine to complete a clinically verified risk questionnaire. A classifier trained to predict questionnaire response using only past queries on Bing reached an Area Under the Curve of 0.64 for all three cancer types, verifying that past searches could be used to identify people with suspected cancer. The second study was conducted using the Google ads system in the same configuration as in the first study. However, in this study the ads system was set to automatically learn to identify people with suspected cancer. A total of 70,586 people were shown the ads, and 6,484 clicked and were referred to complete the clinical questionnaires. People from countries with higher Internet access and lower life expectancy tended to click more on the ads. Over time the advertisement system learned to identify people who were likely to have symptoms consistent with suspected cancer, such that the percentage of people completing the questionnaires and found to have suspected cancer reached approximately 11\% at the end of the experiment. These results demonstrate the utility of using search engine queries to screen for possible cancer and the application of modern advertising systems to help identify people who are likely suffering from serious medical conditions. This is especially true in countries where medical services are less developed.

Background: Mental illness (MI), and particularly, bipolar disorder (BD), are highly stigmatized. However, it is unknown if this stigma is also represented on social media.Aims: Characterize Twitter-based stigma and social support messaging ("tweets") about mental health/illness (MH)/MI and BD and determine which tweets garnered retweets.Methods: We collected tweets about MH/MI and BD during a three-month period and analyzed tweets from dates with the most tweets ("spikes"), an indicator of topic interest. A sample was manually content analyzed, and the remainder were classified using machine learning (logistic regression) by topic, stigma, and social support messaging. We compared stigma and support toward MH/MI versus BD and used logistic regression to quantify tweet features associated with retweets, to assess tweet reach.Results: Of the 1,270,902 tweets analyzed, 94.7% discussed MH/MI and 5.3% discussed BD. Spikes coincided with a celebrity's death and a MH awareness campaign. Although the sample contained more support than stigma messaging, BD tweets contained more stigma and less support than MH/MI tweets. However, stigma messaging was infrequently retweeted, and users often retweeted personal MH experiences.Conclusions: These findings demonstrate opportunities for social media advocacy to reduce stigma and increase displays of social support towards people living with BD.

To determine how mental illness (MI) stigma messaging on Twitter manifests after a mass shooting, using the Fort Lauderdale Airport shooting (January 6, 2017) as a case study, we collected publicly available tweets about mental health/illness between December 23, 2016 and January 20, 2017 published

This study aimed to quantify human papillomavirus (HPV) vaccine Twitter messaging addressing gay, bisexual and other men who have sex with men (GB+MSM) and describes messaging by vaccine sentiment (attitudes towards vaccine) and characteristics (topic of messaging). Between August 2014 and July 2015, we collected 193 379 HPV-related tweets and classified them by vaccine sentiment and characteristics. We analysed a subsample of tweets containing the terms ‘gay’, ‘bisexual’ and ‘MSM’ (N = 2306), and analysed distributions of sentiment and characteristics using chi-square. HPV-related tweets containing GB+MSM terms occupied 1% of our sample. The subsample had a largely positive vaccine sentiment. However, a proportion of ‘gay’ and ‘bisexual’ tweets did not mention the vaccine, and a proportion of ‘gay’ and ‘MSM’ tweets had a negative sentiment. Topics varied by GB+MSM term—HPV risk messaging was prevalent in ‘bisexual’ (25%) tweets, and HPV transmission through sex/promiscuity messaging was prevalent in ‘gay’ (18%) tweets. Prevention/protection messaging was prevalent only in ‘MSM’ tweets (49%). Although HPV vaccine sentiment was positive in GB+MSM messaging, we identified deficits in the volume of GB+MSM messaging, a lack of focus on vaccination, and a proportion of negative tweets. While HPV vaccine promotion has historically focused on heterosexual HPV transmission, there are opportunities to shape vaccine uptake in GB+MSM through public health agenda setting using social media messaging that increases knowledge and minimizes HPV vaccine stigma. Social media-based HPV vaccine promotion should also address the identities of those at risk to bolster vaccine uptake and reduce the risk of HPV-attributable cancers.

Background Men who have sex with men (MSM) increasingly use internet-based websites and geospatial apps to seek sex. Though these platforms may be useful for public health intervention, evaluations of such interventions are rare. We sought to evaluate the online behavior of young MSM of color in Philadelphia and the effectiveness of using ads to link them to DoYouPhilly.org, where users can order free condoms, lubricant, and sexually transmitted infection test kits delivered via the U.S. postal service. Method Data collection and analyses were conducted in two phases. First, we performed keyword research and analyzed web browser logs using a proprietary data set owned by Microsoft. Subsequently, we ran a Google Ads campaign using the keywords identified in the preliminary phase, and directed targeted users to the DoYouPhilly.org condom or test kit ordering pages. Results were analyzed using MATLAB 2018. Results Test kit advertisements received 5,628 impressions, 157 clicks, and 18 unique conversions. The condom advertisements received 128,007 impressions, 2,583 clicks, and 303 unique conversions. Correlation between the click-through rate and the conversion rate per keyword was ρ = −.35 ( P = .0096) and per advertisement was ρ = .40 ( P = .14). Keywords that directly related to condoms were most effective for condom ordering (42% conversion rate vs. ≤2% for other classes), while keywords emphasizing the adverse effects of unprotected sex were most effective in test kit ordering (91% conversion rate vs. 13% and 12% for other classes). Conclusions Online advertisements seemed to affect real-world sexual health behavior, as measured by orders of condoms and test kits, among a group of young MSM living in the same community.

Background Loneliness has become a public health problem described as an epidemic, and it has been argued that digital behavior such as social media posting affects loneliness. Objective The aim of this study is to expand knowledge of the determinants of loneliness by investigating online postings in a social media forum devoted to loneliness. Specifically, this study aims to analyze the temporal trends in loneliness and their associations with topics of interest, especially with those related to mental health determinants. Methods We collected a total of 19,668 postings from 11,054 users in the loneliness forum on Reddit. We asked seven crowdsourced workers to imagine themselves as writing 1 of 236 randomly chosen posts and to answer the short-form UCLA Loneliness Scale. After showing that these postings could provide an assessment of loneliness, we built a predictive model for loneliness scores based on the posts’ text and applied it to all collected postings. We then analyzed trends in loneliness postings over time and their correlations with other topics of interest related to mental health determinants. Results We found that crowdsourced workers can estimate loneliness (interclass correlation=0.19) and that predictive models are correlated with reported loneliness scores (Pearson r=0.38). Our results show that increases in loneliness are strongly associated with postings to a suicidality-related forum (hazard ratio 1.19) and to forums associated with other detrimental behaviors such as depression and illicit drug use. Clustering demonstrates that people who are lonely come from diverse demographics and from a variety of interests. Conclusions The results demonstrate that it is possible for unrelated individuals to assess people’s social media postings for loneliness. Moreover, our findings show the multidimensional nature of online loneliness and its correlated behaviors. Our study shows the advantages of studying a hard-to-reach population through social media and suggests new directions for future studies.

Existing frameworks have identified a range of intervention design features that may facilitate adherence to eHealth interventions; however, empirical data are lacking on whether intervention design features can predict user adherence in the real world-where the public access available tools-and whether some design aspects of behavioral eHealth interventions are more important than others in predicting adherence. This study examined whether intervention design qualities predict user adherence to behavioral eHealth interventions in real-world use and which qualities matter the most. We correlated the online activities of users of 30 web-based behavioral interventions-collected from a proprietary data set of anonymized logs from consenting users of Microsoft Internet Explorer add-on-with interventions' quality ratings obtained by trained raters prior to empirical examination. The quality ratings included: Usability, Visual Design, User Engagement, Content, Therapeutic Persuasiveness (i.e., persuasive design and incorporation of behavior change techniques), and Therapeutic Alliance. We found Therapeutic Persuasiveness (i.e., the incorporation of persuasive design/behavior change principles) to be the most robust predictor of adherence (i.e., duration of use, number of unique sessions; 40 ≤ rs ≤ .58, ps ≤ .005), explaining 42% of the variance in user adherence in our regression model. Results indicated up to six times difference in the percentage of users utilizing the interventions for more than a minimum amount of time and sessions based on Therapeutic Persuasiveness. Findings suggest the importance of persuasive design and behavior change techniques incorporation during the design and evaluation of digital behavioral interventions.

Background Although autism is often characterized in literature by the presence of repetitive behavior, in structured decision tasks, individuals with autism spectrum disorder (ASD) have been found to examine more options in a given time period than controls. Objective We aimed to examine whether this investigative tendency emerges in information searches conducted via the internet. Methods In total, 1746 search engine users stated that they had ASD in 2019. This group’s naturally occurring responses following 1491 unique general queries and 78 image queries were compared to those of all other users of the search engine. The main dependent measure was scrolled distance, which denoted the extent to which additional results were scanned beyond the initial results presented on-screen. Additionally, we examined the number of clicks on search results as an indicator of the degree of search outcome exploitation and assessed whether there was a trade-off between increased search range and the time invested in viewing initial search results. Results After issuing general queries, individuals with self-stated ASD scanned more results than controls. The scrolled distance in the results page of general queries was 45% larger for the group of individuals with ASD (P Conclusions Individuals who self-stated that they had ASD scrutinized more general search results and fewer image search results than the controls. Thus, our results at least partially support the notion that individuals with ASD exhibit investigative behaviors and suggest that textual searches are an important context for expressing such tendencies.

Experts are concerned about the spread and recalcitrance of vaccine misinformation and its contribution to vaccine hesitancy. Despite this risk, little research attention has been paid to understanding how individuals seek vaccine information online and evaluate its trustworthiness. Here, we hypothesized that when vaccine-hesitant parents seek information about vaccines, they prefer trustworthy sources based on their competence, integrity and benevolence. We explored this issue using 4910 questions and 2583 answers retrieved from two social question-and-answer (QA) platforms: "Yahoo! Answers" and the Facebook group "Talking about Vaccines." We examined what kinds of questions are asked about vaccines, to what extent they are explicitly directed at health professionals or parents, and what features of the answers predict perceived answer quality, based on the theory of epistemic trust. The findings indicate that on different platforms, vaccine-related questions focus on different topics; namely, questions on one platform focused on the risks and benefits of vaccination, whereas they dealt with vaccine schedules on the other. On both platforms, most questions did not specify that an answer should be based on professional expertise or parents' experience. Both pro-vaccine and anti-vaccine answers were proportionately represented among the "best answers". However, if an answer was written by a health professional, the askers and the community on "Yahoo! Answers" were twice as likely to choose it as the "best answer" to a vaccine-related question, irrespective of whether it encouraged or discouraged vaccination. By contrast, an online experiment revealed that both the identity of the respondent and the stance towards vaccination affected the perceived trustworthiness of the answers. These findings indicate that despite the proliferation of anti-vaccine messages, epistemic trust in mainstream science and medicine is robust. User responses to expert answers suggest that expert outreach in online environments may be an effective intervention to address vaccine hesitancy.

Understanding processes that lead people to invest a certain amount of time in challenging tasks is important for theory and practice. In particular, researchers often assume strong linear associations between confidence, consensuality (the degree to which an answer is independently given by multiple participants), and response time. The Diminishing Criterion Model (DCM; Ackerman, 2014) is a metacognitive model which explains the stopping rules people employ under uncertainty in terms of the confidence-time association. This model is unique in predicting a curvilinear rather than a linear confidence-time association. Using consensuality as an alternative to confidence for predicting response time offers theoretical and practical opportunities. In four experiments, including replications and variations, we examined confidence (where collected) and consensuality as predictors of the time people invest in three problem-solving tasks and in real-life web searching. The results using consensuality, like those for confidence, fitted the curvilinear time pattern predicted by the DCM, with one exception: at least 30% of the population must endorse a potential answer for consensuality to predict response time based on the stopping rules in the DCM. Beyond examining consensuality as a predictor, the study brings converging evidence supporting the DCM's curvilinear confidence-time association over alternative models. The methodology used for analyzing web searching offers new directions for metacognitive research in naturally-performed tasks.

Background: Adolescents use social media for information on medical and social aspects of maturation. Objective: The aim of this study was to investigate the concerns and information needs of adolescents regarding menarche and first sexual intercourse. Methods: Questions about menarche or first sexual intercourse were obtained from Yahoo Answers, a community-based social media question-and-answer website. A total of 1226 questions were analyzed. We focused on 123 question pairs made by users who asked questions on both topics and reported their ages at each. Quantitative and qualitative analyses were performed on these question pairs. Results: Qualitative analysis identified uncertainty as a significant theme for both menarche and first intercourse. Quantitative analysis showed that uncertainty was expressed in 26% (13/50) of menarche questions and 14% (7/50) of intercourse questions. Lack of communication was expressed in 4% (2/50) of menarche questions, compared with 8% (4/50) of intercourse questions. Ages at menarche and at first sexual intercourse were correlated, with women reporting menarche at the age of 13 years or younger being 2.6 times more likely to experience first sexual intercourse before the age of 16 years (P

Background: Search engines display helpline notices when people query for suicide-related information. Objective: In this study, we aimed to examine if these notices and other information displayed in response to suicide-related queries are correlated with subsequent searches for suicide prevention rather than harmful information. Methods: Anonymous suicide-related searches made on Bing and Google in the United States, the United Kingdom, Hong Kong, and Taiwan in a span of 10 months were extracted. Descriptive analyses and regression models were fit to the data to assess the correlation with observed behaviors. Results: Display of helpline notices was not associated with an observed change in the likelihood of or future suicide searches (P=.42). No statistically significant differences were observed in the likelihood of people making future suicide queries (both generally and specific types of suicide queries) when comparing search engines in locations that display helpline notices versus ones that do not. Pages with higher rank, being neutral to suicide, and those shown among more antisuicide pages were more likely to be clicked on. Having more antisuicide Web pages displayed was the only factor associated with further searches for suicide prevention information (hazard=1.18, P=.002). Conclusions: Helpline notices are not associated with harm. If they cause positive change in search behavior, it is small. This is possibly because of the variability in intent of users seeking suicide-related information. Nonetheless, helpline notice should be displayed, but more efforts should be made to improve the visibility and ranking of suicide prevention Web pages.

In the aftermath of the 2016 election, many Democrats reported significant increases in stress, depression, and anxiety. Were these increases real, or the product of expressive reporting? Using a unique data set of searches by more than 1 million Bing users before and after the election, we examine the changes in mental-health-related searches among Democrats and Republicans. We then compare these changes to shifts in searches among Spanish-speaking Latinos in the United States. We find that while Democrats may report greater increases in post-election mental distress, their mental health search behavior did not change after the election. On the other hand, Spanish-speaking Latinos had clear, significant, and sustained increases in searches for “depression,” “anxiety,” “therapy,” and antidepressant medications. This suggests that for many Democrats, expressing mental distress after the election was a form of partisan cheerleading.

Background There is a debate about the effects of pro-anorexia (colloquially referred to as pro-ana) websites. Research suggests that the effect of these websites is not straightforward. Indeed, the actual function of these sites is disputed, with studies indicating both negative and positive effects. Aim This is the first study which systematically examined the differences between pro-anorexia web communities in four main aspects: web language used (posts); web interests/search behaviors (queries); users' self-reported weight status and weight goals; and associated self-reported mood/pathology. Methods We collected three primary sources of data, including messages posed on three pro-ana websites, a survey completed by over 1000 participants of a pro-ana website, and the searches made on the Bing search engine of pro-anorexia users. These data were analyzed for content, reported demographics and pathology, and behavior over time. Results Although members of the main pro-ana website investigated appear to be depressed, with high rates of self-harm and suicide attempts, users are significantly more interested in treatment, have wishes of procreation and reported the highest goal weights among the investigated sites. In contrast, users of other pro-ana websites investigated, are more interested in morbid themes including depression, self-harm and suicide. The percentage of severely malnourished website users, in general, appears to be small (20%). Conclusions Our results indicate that a new strategy is required to facilitate the communication between mental health specialists and pro-ana web users, recognizing the differences in harm associated with different websites.

Background Parents are likely to seek Web-based communities to verify their suspicions of autism spectrum disorder markers in their child. Automated tools support human decisions in many domains and could therefore potentially support concerned parents. Objective The objective of this study was to test the feasibility of assessing autism spectrum disorder risk in parental concerns from Web-based sources, using automated text analysis tools and minimal standard questioning. Methods Participants were 115 parents with concerns regarding their child's social-communication development. Children were 16- to 30-months old, and 57.4% (66/115) had a family history of autism spectrum disorder. Parents reported their concerns online, and completed an autism spectrum disorder-specific screener, the Modified Checklist for Autism in Toddlers-Revised, with Follow-up (M-CHAT-R/F), and a broad developmental screener, the Ages and Stages Questionnaire (ASQ). An algorithm predicted autism spectrum disorder risk using a combination of the parent's text and a single screening question, selected by the algorithm to enhance prediction accuracy. Results Screening measures identified 58% (67/115) to 88% (101/115) of children at risk for autism spectrum disorder. Children with a family history of autism spectrum disorder were 3 times more likely to show autism spectrum disorder risk on screening measures. The prediction of a child's risk on the ASQ or M-CHAT-R was significantly more accurate when predicted from text combined with an M-CHAT-R question selected (automatically) than from the text alone. The frequently automatically selected M-CHAT-R questions that predicted risk were: following a point, make-believe play, and concern about deafness. Conclusions The internet can be harnessed to prescreen for autism spectrum disorder using parental concerns by administering a few standardized screening questions to augment this process.

In this paper, we suggest people use anonymous online forums as platforms for self-disclosing actions they feel guilty about—such as transgressions and unethical behaviors—with the goal of achieving guilt relief through others’ reactions. We support this proposition by analyzing field data extracted from Yahoo Answers, an online question-and-answer website. Our analysis shows the level of guilt relief an answer is expected to offer the “asker” (the self-disclosing person) is positively associated with the asker’s likelihood of selecting that answer as the “best” response to the self-disclosure. Furthermore, following receipt of a guilt-relieving answer, an asker becomes less likely to engage in prosocial behavior, which is another type of guilt-relieving action.

Background: Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder, prevalent among 2-10% of the population. Objective: The objective of this study was to describe where, what, and when people search online for topics related to ADHD. Methods: Data were collected from Microsoft’s Bing search engine and from the community question and answer site, Yahoo Answers. The questions were analyzed based on keywords and using further statistical methods. Results: Our results revealed that the Internet indeed constitutes a source of information for people searching the topic of ADHD, and that they search for information mostly about ADHD symptoms. Furthermore, individuals personally affected by the disorder made 2.0 more questions about ADHD compared with others. Questions begin when children reach 2 years of age, with an average age of 5.1 years. Most of the websites searched were not specifically related to ADHD and the timing of searches as well as the query content were different among those prediagnosis compared with postdiagnosis. Conclusions: The study results shed light on the features of ADHD-related searches. Thus, they may help improve the Internet as a source of reliable information, and promote improved awareness and knowledge about ADHD as well as quality of life for populations dealing with the complex phenomena of ADHD. [J Med Internet Res 2017;19(4):e126]

Objective Links between media portrayals of celebrities and participation in activities related to anorexia are of interest to both researchers and practitioners but are difficult to study over long time periods and in large populations. Here we aim to determine the links between media portrayals of celebrities and online practices related to anorexia. Method We examined the Internet searching activities of 9.2 million people, focusing on searches related to known celebrities, especially those perceived by the public as suffering from anorexia, and on searches indicative of anorexic practices. Additionally, we tracked media attention of individual celebrities by monitoring all messages from Twitter related to those celebrities. Results We found that a subset of users focus their browsing activities on celebrities perceived as anorexic. There was an increase of 14% in the hazard of performing anorexia-related searches after searching for information on the celebrities most perceived as anorexic. Media attention of a celebrity was a trigger for search activity, and when focused on a celebrity perceived as anorexic, resulted in a 33% increase in hazard for carrying out anorexic searches. Strikingly, when media attention included a reference to anorexia, the hazard decreased by 22%. Discussion Our findings suggest that it would be beneficial for media, when reporting on those celebrities who are known to suffer from anorexia, to include this information in their reporting. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2014; 47:196-202)

In the original version of the published Article, there was an error in the caption to Table 1 which stated “None of the differences are statistically significant (χ2, two-sided, p > 0.05)”. This has been changed to “The 18–24 year old are over-represented in the all user treatment population, while the 50–64 year old are underrepresented in both tracked and all user population, p-values were

Background The influence of pro-anorexia (pro-ana) websites is debated, with studies indicating both negative and positive effects, as well as significant variation in the effects of different websites for those suffering from eating disorders (EDs) and the general population. Online advertising, known to induce behavioral change both online and in the physical world, has not been used so far to modify the search behavior of people seeking pro-ana content. Objective The objective of this randomized controlled trial (RCT) was to examine if online advertisements (ads) can change online search behaviors of users who are looking for online pro-ana content. Methods Using the Bing Ads system, we conducted an RCT to randomly expose the searchers for pro-ana content to 10 different ads referring people to one of the three websites: the National Eating Disorders Association, the National Institutes of Mental Health, and MyProAna. MyProAna is a pro-ana website that was found in a previous study to be associated with less pathological online behaviors than other pro-ana websites. We followed participants exposed and unexposed to the ads to explore their past and future online searches. The ads were shown 25,554 times and clicked on 217 times. Results Exposure to the ads was associated with a decrease in searches for pro-ana and self-harm content. Reductions were greatest among those referred to MyProAna (reduction of 34.0% [73/215] and 37.2% [80/215] for pro-ana and self-harm, respectively) compared with users who were referred elsewhere (reduction of 15.47% [410/2650] and 3.21% [85/2650], respectively), and with users who were not shown the ads, who increased their behaviors (increase of 57.12% [6462/11,314] and 4.07% [461/11,314], respectively). In addition, those referred to MyProAna increased their search for treatment, as did control users, who did so to a lesser extent. However, users referred elsewhere decreased their searches for this content. Conclusions We found that referring users interested in ED-related content to specific pro-ana communities might lessen their maladaptive online search behavior. This suggests that those who are preoccupied with EDs can be redirected to less pathological online searches through appropriate pathways. Trial Registration ClinicalTrials.gov NCT03439553; https://clinicaltrials.gov/show/NCT03439553 (Archived by WebCite at http://www.webcitation.org/6xNYnxYlw)

BackgroundMood disorders affect a significant portion of the general population. Cycling mood disorders are characterized by intermittent episodes (or events) of the disease. ObjectiveUsing anonymized Web search logs, we identify a population of people with significant interest in mood stabilizing drugs (MSD) and seek evidence of mood swings in this population. MethodsWe extracted queries to the Microsoft Bing search engine made by 20,046 Web searchers over six months, separately explored searcher demographics using data from a large external panel of users, and sought supporting information from people with mood disorders via a survey. We analyzed changes in information needs over time relative to searches on MSD. ResultsQueries for MSD focused on side effects and their relation to the disease. We found evidence of significant changes in search behavior and interests coinciding with days that MSD queries are made. These include large increases (>100%) in the access of nutrition information, commercial information, and adult materials. A survey of patients diagnosed with mood disorders provided evidence that repeated queries on MSD may come with exacerbations of mood disorder. A classifier predicting the occurrence of such queries one day before they are observed obtains strong performance (AUC=0.78). ConclusionsObserved patterns in search behavior align with known behaviors and those highlighted by survey respondents. These observations suggest that searchers showing intensive interest in MSD may be patients who have been prescribed these drugs. Given behavioral dynamics, we surmise that the days on which MSD queries are made may coincide with commencement of mania or depression. Although we do not have data on mood changes and whether users have been diagnosed with bipolar illness, we see evidence of cycling in people who show interest in MSD and further show that we can predict impending shifts in behavior and interest.

Objectives : A method by which potentials related to voluntary movement can be recorded noninvasively from the human spinal cord is presented. Methods : A novel signal processing technique performed on signals recorded by surface electrodes placed over the spinal column was used to filter time-locked back muscle noise, so that the only remaining signals were the spinal movement-related potentials from the brain to the limbs and vice versa. Results : The signals obtained from 7 subjects using this technique are shown and temporally compared with movement-related cortical potentials (MRCP) and muscle electromyogram. It is demonstrated that the spinal signal starts approximately 600 ms before the actual movement, and that some features of this signal correspond to changes in cortical potentials. Conclusions : These findings imply that the spinal cord is not a simple command-carrying medium from the brain to the limbs, and implies that some computational activities take place at the spinal cord level.

Internet users notoriously take an assumed identity or masquerade as someone else, for reasons such as financial profit or social benefit. But often the converse is also observed, where people choose to reveal true features of their identity, including deeply intimate details. This work attempts to explore several of the conditions that allow this to happen by analyzing the content generated by these users. We examine multiple social media on the Web, specifically focusing on Yahoo! Answers, encompassing more than a billion answers posted since 2006. Our analysis covers discussions of personal topics such as body measurements and income, and of socially sensitive subjects such as sexual behaviors. We offer quantitative proof that people are aware of the fact that they are posting sensitive information, and yet provide accurate information to fulfill specific information needs. Our analysis further reveals that on community question answering sites, when users are truthful, their expectation of an accurate answer is met.

Movement-related potentials (MRPs) recorded from the brain are thought to vary during learning of a motor task. However, since MRPs are recorded at a very low signal-to-noise ratio, it is difficult to measure these variations. In this study we attempt to remove most of the accompanying noise thus enabling the tracking of transient phenomena in MRPs recorded during learning of a motor task. Subjects performed a simple motor task which required learning. A modified version of the matching pursuit algorithm was used in order to remove a significant portion of the electroencephalographic noise overlapping the MRPs recorded in the experiment. Small groups of MRPs were then averaged according to experimental parameters. Our results show that the power of the MRPs does not decay uniformly during learning. Instead, there is a significant peak in their power after 4 or 5 repetitions of the task. This peak is noticeable especially in electrodes placed over the prefrontal region of the cortex at times subsequent to the actual movement. The observed pattern of activity may indicate problem solving related to comprehension of the force against which the user performed the task. It is possible that this problem solving occurs in the prefrontal cortex.

We present a case study of involuntary motion in one part of the body induced by a voluntary motion in another part. The case investigated was that of a steady-state motion of the fingers at various frequencies, which induced a similar kind of motion in the legs. These phenomena were observed in a subject practicing sphincter gymnastics, a physical therapy method in which repetitive motion of different muscles is exercised, and is known to induce motions in other muscles of the body. We show that a linear model, for which we give an experimental transfer function and demonstrate its validity, can describe the generation of the induced periodic motions by the voluntary motions. We compare the results of the transfer function with those of Von Holst's statistical analysis.

BackgroundThere is widespread use of the Internet to promote anorexia as a lifestyle choice. Pro-anorexia content can be harmful for people affected or at risk of having anorexia. That movement is actively engaged in sharing photos on social networks such as Flickr. ObjectiveTo study the characteristics of the online communities engaged in disseminating content that encourages eating disorders (known as “pro-anorexia”) and to investigate if the posting of such content is discouraged by the posting of recovery-oriented content. MethodsThe extraction of pro-anorexia and pro-recovery photographs from the photo sharing site Flickr pertaining to 242,710 photos from 491 users and analyzing four separate social networks therein. ResultsPro-anorexia and pro-recovery communities interact to a much higher degree among themselves than what is expected from the distribution of contacts (only 59-72% of contacts but 74-83% of comments are made to members inside the community). Pro-recovery users employ similar words to those used by pro-anorexia users to describe their photographs, possibly in order to ensure that their content appears when pro-anorexia users search for images. Pro-anorexia users who are exposed to comments from the opposite camp are less likely to cease posting pro-anorexia photographs than those who do not receive such comments (46% versus 61%), and if they cease, they do so approximately three months later. Our observations show two highly active communities, where most interaction is within each community. However, the pro-recovery community takes steps to ensure that their content is visible to the pro-anorexia community, both by using textual descriptions of their photographs that are similar to those used by the pro-anorexia group and by commenting to pro-anorexia content. The latter activity is, however, counterproductive, as it entrenches pro-anorexia users in their stance. ConclusionsOur results highlight the nature of pro-anorexia and pro-recovery photo sharing and accentuate the need for clinicians to be aware of such content and its effect on their patients. Our findings suggest that some currently used interventions are not useful in helping pro-anorexia users recover. Thus, future work should focus on new intervention methods, possibly tailored to individual characteristics.