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.     

Complex Communication Dynamics: Exploring the Structure of an Academic Talk

Communication is a multimodal phenomenon. The cognitive mechanisms supporting it are still understudied. We explored a natural dataset of academic lectures to determine how communication modalities are used and coordinated during the presentation of complex information. Using automated and semi‐automated techniques, we extracted and analyzed, from the videos of 30 speakers, measures capturing the dynamics of their body movement, their slide change rate, and various aspects of their speech (speech rate, articulation rate, fundamental frequency, and intensity). There were consistent but statistically subtle patterns in the use of speech rate, articulation rate, intensity, and body motion across the presentation. Principal component analysis also revealed patterns of system‐like covariation among modalities. These findings, although tentative, do suggest that the cognitive system is integrating body, slides, and speech in a coordinated manner during natural language use. Further research is needed to clarify the specific coordination patterns that occur between the different modalities.     

Future‐Bias: A (Qualified) Defense

The preferences of ordinary folks typically display a future‐bias. For instance, we care more about pains and pleasures in our future than pains and pleasures in our past. Indeed, this future‐bias is so pervasive, many have taken it for granted that the preferences of rational agents will, or at least can, display this future‐bias to some degree or other. However, the rationality of future‐biased preferences has recently come in for critique. However, in this article, I offer a defense of future‐biased preferences against three recent attempts – offered by David Brink, Preston Greene and Meghan Sullivan, and Tom Dougherty – to show such preferences irrational.     

Technique and countertransference in Freud's analysis of the Rat Man

Freud's records of his treatment of the Rat Man constitute a unique document in the history of psychoanalysis. Through the years different analysts have used these records to support different theories about analytic technique. Certain non-interpretive interventions of Freud's have especially aroused their interest, and many reasons have been put forward to "explain" Freud's behavior. One reason never yet advanced and documented is that a countertransference tension may have been involved in one of these instances. This is surprising, since countertransference is a necessary part of every analysis. Evidence is presented that Freud's behavior may indeed have been under the sway of countertransference. Some recently discovered details concerning his early life are discussed as constituting a plausible background for ths countertransference enactment.     

A note on accepting the null hypothesis: problems with respect to the mass-spring and pulse-step models of movement control

Models are sometimes developed on the premise that there are no differences between two or more conditions regardless of experimental manipulation. This article argues that unless a very sensitive experiment (or series of experiments) was conducted, such conclusions are often premature. Design and statistical factors such as alpha level, variability, sample size, and treatment effect are all determinants of the sensitivity of the experiment. It is sometimes the case that an experiment produces differences between means and yet the null hypothesis is not rejected because of high variability within experimental conditions or because too few subjects were used. Unless the probability of detecting a difference between groups is known, it would seem unwise to conclude that no difference exists. Judgment on the model should be suspended. Examples are taken from the mass-spring and pulse-step models fro voluntary movement control to illustrate the problem.     

Secobarbital and perceptual processing

An experiment which employed each of 18 subjects in four days of testing was used to examine acute secobarbital dose treatment effects on choice reaction time in a Cooper and Shepard (1973) character recognition task. Manipulations of visual stimulus degradation, character difficulty, 180 degree rotation, and mirror-image reversal were included in order to evaluate the hypothesis that the drug affects performance by disrupting early stimulus input processing. The results indicate significant increases in the effect of secobarbital on reaction time and errors under conditions of visual stimulus degradation. The effects of the drug, however, were not changed by 180 degree rotation of the target character or by the other task variables. The results were interpreted to indicate that secobarbital impairs performance primarily by placing selective stress on hypothetical early encoding activities and that later processing operations (associated with use of an internal representation of the target character) are not affected by the drug. Strengths and weaknesses of the two-stage model of visual stimulus processing are discussed and implications of the model for future drug research are indicated.     

Integrating vocational interest inventory results and expressed choices

Though many studies have examined the predictive power of expressed choices versus that of measured interests, fewer have been concerned with the relationship between the degree to which choices and interests agree and later persistence in an expressed choice. This study explored that relationship, using longitudinal data for 7706 college students and 1372 employed persons. Four levels of congruence between expressed choice and measured interests were identified. Results indicated that persistence in an expressed choice increases systematically as congruence between choice and interests increases. Implications for counselors are noted.     

Information processing abilities in twins reared apart

A battery of information processing measures and psychometric tests of specific and general cognitive abilities was administered to a sample of 105 individuals which included 34 monozygotic and 13 dizygotic reared apart twin pairs or triplets. Correlations between information processing parameters and psychometric abilities as well as twin resemblances for the information processing parameters were examined. In a principal components analysis of the information processing parameters, three components were identified which accounted for 67% of the total variation; Overall Speed of Response (OSR), Speed of Information Processing (SIP), and Speed of Spatial Processing (SSP). OSR was significantly correlated with WAIS IQ, and psychometric measures of verbal reasoning, spatial ability, and perceptual speed and accuracy. SIP was significantly correlated with WAIS IQ, measures of verbal reasoning, and one of the perceptual speed and accuracy measures. SSP was significantly correlated with measures of both spatial ability and perceptual speed and accuracy. Due to the small size of the dizygotic twin sample, no strong conclusions could be drawn regarding the magnitude of their resemblance. The correlation between component scores of reared apart monozygotic twins was significant for OSR, but not for SIP or SSP.     

Arguers as editors

People use editorial criteria to decide whether to say or to suppress potential arguments. These criteria constitute people's standards as to what effective and appropriate arguments are like, and reflect general interaction goals. A series of empirical investigations has indicated that the standards fall into three classes: those having to do with argument effectiveness, those concerned with personal issues for arguer and target, and those centered on discourse quality. The essay also sketches the affinities certain types of people have for the different criteria.