Randomized controlled trial of an intervention to prevent adherence failure among HIV-infected patients initiating antiretroviral therapy.

OBJECTIVE: Compare the efficacy of a multicomponent social support intervention to standard-of-care counseling on medication adherence among HIV-infected patients initiating antiretroviral therapy. DESIGN: Randomized controlled trial. Generalized estimating equations tested for differences in the percentage of participants achieving 90% adherence. MAIN OUTCOME MEASURES: Pill-taking, electronically monitored over 6 consecutive months; plasma viral load (VL), assessed at 3 and 6 months following initiation of therapy. RESULTS: Of 226 participants who were randomized and began the trial, 87 (38%) were lost to the study by 6 months. The proportion of adherent participants declined steadily over time, with no time by group interaction. Sustained adherence was associated with increased odds of achieving an undetectable VL (OR=1.78; 95% CI=1.01, 3.13). In intention-to-treat analyses, a larger proportion of the intervention group than the control group was adherent (40.15% vs. 27.59%, p=.02) and achieved an undetectable VL p=.04). However, the majority of participants who remained on study experienced some reduction in VL (>or=1-log drop or undetectable), regardless of experimental condition. CONCLUSION: The multicomponent social support intervention significantly improved medication adherence over standard-of-care counseling; evidence for improved virologic outcomes was inconsistent. Early discontinuation of care and treatment may be a greater threat to the health of HIV patients than imperfect medication-taking.     

Spiritual support for caregivers of dementia patients

Dementia is considered the major psychiatric disorder of old age and affects over 4 million people in the United States. As Alzheimer's disease and other dementias progress, the patient can become increasingly dependent on the family for care. This dependency can place the caregiver in a role that is both difficult and demanding. In this study coping strategies used by family caregivers of dementia patients and caregivers' sense of burden were assessed. Burden scores were significantly correlated with spiritual support, an external coping strategy. When spiritual well-being is integrated with medical and psychosocial needs, the clergy and spiritual community can play an integral role in the care for families and dementia patients.     

Musical notation for the keyboard: An examination of stimulus-response compatibility

A recent stimulus-response compatibility model was used to provide a performance evaluation of an experimental notation for the keyboard in which pitch varies horizontally in visual space. One hundred and twenty subjects performed a choice reaction time task using either the horizontal notation or a more traditional vertical notation. Half the subjects in each notation group received white noise and half received pitch-varying feedback with responses. A horizontal display advantage was revealed when rules of the model were applied to data analyses. Further, the horizontal display advantage was not dependent on the nature of the feedback. In a second experiment, performance of musicians and non-musicians was compared using the horizontal and vertical notations. Musicians' performance was uniformly better than that of non-musicians, and did not differ with notation orientation. The findings support the use of non-traditional horizontal notations for novice performance on a keyboard instrument.     

Color-based inhibition of return

The inhibition of return of visual attention based on stimulus color was examined in three experiments. In the first experiment, a discrete trial paradigm showed that subjects were slower to detect a color patch if the color matched that of a patch presented earlier in the same location. Experiment 2 showed that the inhibition only occurs if a neutral, nontarget distractor color is presented between presentation of the initial color cue and the subsequent target patch—explaining the previous failures to detect the phenomenon. Experiment 3 extended the results to a different combination of colors. Taken together, the results have important implications for the processing of stimulus attributes such as spatial location and color, and for the conditions necessary for producing inhibition of return.     

Sentence Context and Word Recognition in Children with Average Reading Ability and with a Specific Reading Disability

The inhibitory and facilitatory effects of context on word recognition were investigated in 24 8-to 10-year-old children with a specific reading disability in comparison with a group of 24 children matched for reading ability and a group of 24 children matched for chronological age. To avoid confounding the effects of reading level with those of word difficulty, target words of equivalent relative familiarity for each participant were presented in congruous, neutral, and incongruous sentence contexts. In agreement with previous studies, there was clear evidence of both general inhibitory and facilitatory effects. In contrast to previous findings, however, reading level did not have a major impact on the inhibition of word recognition in incongruous contexts compared with neutral contexts, although it may have led to greater facilitation in congruous contexts compared with neutral contexts. Although further research is required, these results suggest that if reading-age appropriate materials are selected, less skilled readers and those with a reading disability may not be as influenced by context as has been claimed previously.     

The gap effect for eye and hand movements

A temporal gap between fixation point offset and stimulus onset typically yields shorter saccadic latencies to the stimulus than if the fixation stimulus remained on. Several researchers have explored the extent to which this gap also reduces latencies of other responses but have failed to find a gap effect isolated from general warning effects. Experiment 1, however, showed a robust gap effect for aimed hand movements (which required determination of a precise spatial location), regardless of whether the hand moved alone or was accompanied by a saccadic eye movement. Experiment 2 replicated this aimed hand gap effect and also showed a smaller effect for choice manual keypress responses (which required determination of the direction of response only). Experiment 3 showed no gap effect for simple manual keypress responses (which required no spatial determination). The results are consistent with an interpretation of the gap effect in terms of facilitation of spatially oriented responses.     

Application of modal logic to programming

The modal logician's notion of possible world and the computer scientist's notion of state of a machine provide a point of commonality which can form the foundation of a logic of action. Extending ordinary modal logic with the calculus of binary relations leads to a very natural logic for describing the behavior of computer programs.This research was supported by NSF Grant No. MSC - 7804338.     

The development of young children's awareness of logical inconsistencies

Research by Markman (1979) suggests that children up to 12 years of age do not spontaneously detect logical inconsistencies. The present study was directed to factors which may limit children's ability to recognize their failures to understand. A task was devised which involved materials that were clearly based on children's experiences, and which involved premises and conclusions which were presented contiguously, rather than being interspersed among other sentences. Ninety-six 5-, 6-, and 7-year-old children were asked to judge the acceptability of eight three-sentence “stories” told by a puppet, and were asked to justify their responses. The stories differed in whether they were consistent or inconsistent, and in whether the principle upon which a story's consistency depended was implicitly or explicitly stated. The results showed developmental differences. By Age 7 years, most children were quite capable of evaluating sentences for their logical consistency. Five-year-olds, however, did not perform as well on the task, especially when the information upon which the logical cohesiveness of the stories rested was implicitly, rather than explicitly, stated. An examination of the justifications provided by these children revealed that they tended to question the empirical validity of individual sentences, rather than integrate the story as a whole and examine its overall logical structure.     

Control of responding by location of auditory stimuli: adjacency of sound and response.

Four rhesus monkeys were trained to respond on one key when a one-second noise burst was presented through one speaker and to respond on a second key when the noise burst was presented through a second speaker. The acquisition of stimulus control was studied under three conditions, in each of which the relationship between the sound source and the response-key positions varied: an adjacent condition in which the noise burst was presented through the key and a response on this key was reinforced; a reversed-adjacent condition in which the noise burst was presented through one key and responding on the other key was reinforced: and a nonadiacent condition in which responding on the key nearer the sound was reinforced. Under adjacent conditions, stimulus control developed within one or two sessions. Under reversed and nonadjacent conditions, 10 sessions were required for the development of control. The asymptote of correct responding was the same under each condition in all animals.     

The Zax Information Profile: a measure of college adjustment

Evaluated the effectiveness of the Zax Information Profile (ZIP), a personality test based on general fund of information, in discriminating between college students who sought mental health services and those who did not, Three successive classes of freshmen students at the Eastman School of Music of the University of Rochester were administered the ZIP. Help-seeking students were matched with non-help-seeking students for sex, age, and intellectual ability. The hypothesis that ZIP scores would differentiate between these two groups was supported by the data. The potential use of the ZIP as a predictor of college adjustment and as a useful entrance screening device was discussed.