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.     

Development of physical ability tests for police officers: a construct validation approach.

A construct validation approach was followed to affirm that 8 physical ability test events were significantly related to two important constructs underlying the job performance of police officers: strength and endurance. A sample of 115 incumbent police officers took 8 physical ability tests and were rated by supervisors on their physical performances in their job. LISREL methods were used to test the model specified, and a reasonable fit was achieved. Portions of the model were tested on an independent sample of 161 applicants; the fit of the model was again acceptable. A nomological network of relationships, in which strength and endurance factors correlated in expected directions with other physiological and demographic variables, was hypothesized and tested. Finally, the data were examined for potential gender differences and bias. Considerable differences were shown between men and women on both test and performance variables, and women would be overpredicted if a common regression line were used for selection purposes.     

MORAL INERTIA

Abstract. The phenomenon of moral inertia is often explained by reference to all-encompassing features of human nature, such as laziness and cowardice, but in fact it has many causes. A modern person may fail to "stand up" to social evil because he has difficulty seeing it-perhaps because it is deliberately hidden or because she and her neighbors cannot find ways to recognize and discuss it as a soluble problem. Fourteen factors contributing to moral inertia will be listed here under the headings of cognitive and linguistic factors. Further, a consideration of ideology's role (both liberal and Marxist) in inhibiting action against social evil will be presented.     

The evolution of a therapy group for vietnam veterans on a general psychiatry unit

The evolution of a therapy group for hospitalized Vietnam veterans with post-traumatic stress disorder (PTSD) and related symptomatology is described. The literature on group treatment for this population is briefly reviewed and discussed in relation to an inpatient psychiatry setting. The prevailing conditions at the time of group inception are recalled along with the initial goals of the therapeutic intervention. Problems encountered are also discussed, along with the changes made in response to these identified difficulties. The results of three and one-half years of experience with this group are described in detail.The authors would like to thank Cynthia Sturm, Ph.D. for her helpful editorial assistance.     

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.     

Avowal under oppression

Leading expressivist proposals characterize the mental state expressed in the making of a normative judgment solely in terms of intrinsic, psychological dispositions. As a result, they fail to capture a subset of the normative judgments that agents can and do make; they miss the way that external factors can influence what the making of a normative judgment looks like. This problem can be seen most plainly in the context of systemic oppression. Intuitively, one can make a normative judgment that conflicts with the oppressive ideas one has previously been conditioned to endorse, but expressivism seems to deny that this is possible. The expressivist's inability to count these avowals made under oppression as genuine normative judgments makes expressivism deficient as a metaethical theory.