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.     

Rabbi and Magister: Overlapping intellectual models of the twelfth-century renaissance

Elka Klein’s writings have illuminated reciprocal and distinctive characteristics of the social and intellectual lives of Jewry in Iberia and by comparison Northern Europe during the High Middle Ages. This article honors her insights, by comparing the development of biblical hermeneutics at the Abbey of St. Victor in Paris and in the writings of Abraham ibn Ezra. Hugh of St. Victor’s introduction to the study of Scripture, Didascalicon, provides a program for the individual student to integrate all branches of human knowledge into the search for Divine Wisdom that may be found only in Scripture. The innovation in Hugh’s program is the emphasis on the “literal” or “historical” sense of Scripture as the solid basis for the development of theological study. Grammar and rhetoric were stepping stones that led the young theologians to higher levels of Divine Wisdom. The introduction to Abraham ibn Ezra’s commentary on the Pentateuch constitutes a parallel point of orientation for twelfth-century Jewish readers. A close reading of ibn Ezra’s prologue maps the hermeneutical approaches that different communities – Christian, rabbinic Jewish, and Karaite – utilized in their expositions of the Pentateuch. After critiquing each community, ibn Ezra offers his own approach that builds an overall framework for correct interpretation on the foundation of grammar and the rabbinic oral tradition. From this perspective, the article demonstrates that during this period Jews and Christians, both in Iberia and Northern Europe, focused on harmonizing reason and revelation. Both communities used grammar as the primary criterion for evaluating the accumulation of traditional sources. Both approaches intended to develop students, who were capable of understanding that “reason is the angel that mediates between God and humanity.”     

Syntactic context and lexical access

Recent studies demonstrating that multiple meanings of an ambiguous word are initially accessed even when only one reading is syntactically appropriate with the preceding context can be criticized on at least two grounds. First, many of the syntactic contexts used were not truly restrictive, and, secondly, subjects may not have had time to integrate the context before processing the ambiguous word. In the present study, subjects listened to a sentence ending in an ambiguous word and then made a lexical decision to a target related to either the appropriate or inappropriate reading. Contexts were completely restrictive, and a pause was introduced between the context and the ambiguous word. Multiple access still obtained, providing further support for the claim that lexical access is not guided by syntactic context.     

Attributions of Responsibility for Obesity: Narrative Communication Reduces Reactive Counterarguing Among Liberals

Informed by theory and research on attributions and narrative persuasion, we compared the effectiveness of narrative and nonnarrative messages in changing attributions of responsibility for causes and solutions related to obesity in the United States. We randomly assigned 500 adults to view one of three messages (narrative, evidence, and a hybrid of the two) emphasizing environmental causes of obesity, or a no‐exposure control condition. The narrative condition increased the belief that societal actors (government, employers) are responsible for addressing obesity, but only among liberals. This pattern of results was partially explained by the success of the narrative condition in reducing reactive counterarguing, relative to the evidence condition, among liberals. We conclude with theoretical and practical implications.