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.     

Religion and the Human Rights Idea

Three recent books focus, in different ways, on the idea of human rights and its relation to religion and religious ethics. All three books discussed here address criticisms of the human rights idea and seek to establish the relationship of religion and human rights with regard to the field of policy. The present discussion begins with an overview that places these three books in the larger context of the development of the human rights idea and its historical relationship with religion. It then turns to Little's book, next to the collection of essays edited by Twiss, Simion, and Petersen, which is described internally as a Festschrift for Little, and then to Hogan's book, and in the final section it explores comparisons among the books.     

Context-dependent variation in social stereotyping 1: The effects of intergroup relations as mediated by social change and frame of reference

During the 1990-1991 Persian Gulf conflict an experiment was conducted with Australian university students (N = 200) to investigate whether the social stereotyping of Americans varied with social contextual manipulations related to the hostilities. The study, conducted in two phases at the start and end of the conflict, examined how the assignment of standard stereotypical traits to Americans was affected (a) by the large-scale social change constituted by the war and (b) by variation in the frame of reference provided by relevant comparison groups. The elicited stereotypes were sensitive to both of these contextual variables, demonstrating significant variation and fluidity. Overall, stereotypes of Americans were relatively negative. They were significantly more negative (a) at the end of the war than at the beginning in the restricted frame (when Australia and Britain were comparison groups) and (b) in the first phase of the conflict when the frame was extended to include Iraq as a comparison group. The findings were in line with expectations derived from self-categorization theory (Turner, 1985) that the social categorization of self and other into ingroup and outgroup is inherently variable, comparative and context-dependent. They question the long-held view of stereotypes as fixed, rigid and resistant to change.     

Context-dependent variation in social stereotyping 2: The relationship between frame of reference,self-categorization and accentuation

This paper examines the hypothesis that patterns of stereotypic accentuation reflect the degree to which judged stimuli share the same social category membership as the stereotyper, Following self-categorization theory, the degree of this shared identity is operationalized in terms of the meta-contrast ratio as a function of the positions of (a) stereotyper and (b) stereotyped target relative to (c) the stereotyper's frame of reference. Three experiments are reported which sought to manipulate shared category membership either by extension of subjects' frame of reference or by extremitization of target and subject with respect to that frame. As predicted, greater shared identity was associated with stronger assimilation of the target to subjects' own position and with change in stereotype content. Findings are discussed in relation to theories of personality, social judgement and social cognition. Like the accentuation processes which underpin them, it is proposed that stereotypes are sensitive to comparative context and that they reflect veridically the social self-categorical properties of stimuli.     

The social phobia and anxiety inventory: Construct validity

The Social Phobia and Anxiety Inventory (SPAI) is a new instrument composed of social phobia and agoraphobia subscales. The latter scale is used to detect social anxiety that may result from agoraphobia. The SPAI's construct validity was assessed through several procedures. First, confirmatory factor analyses were conducted to validate the existence of the two subscales. Second, exploratory factor analyses examined the underlying structure of the social phobia subscale. Third, a Q factor procedure determined if different anxiety diagnostic groups could be differentiated by their SPAI response pattern. The results confirmed the utility of the two SPAI subscales and identified a number of dimensions contained within the social phobia subscale which differed depending upon the specific subject sample. In addition, the complaints of social phobies appeared more homogeneous than those of an agoraphobic comparison group. The results are discussed in terms of construct validity and the sensitivity of the SPAI to various dimensions of social phobia fears.This study was supported in part by NIMH Grants 41852, 30915, 18269, and 16884.     

The Social Phobia and Anxiety Inventory: concurrent validity with a clinic sample

The Social Phobia and Anxiety Inventory (SPAI) is an empirically derived self-report inventory developed as a specific measure of social phobia. The current investigation included two studies. The first examined the correlation of the SPAI with daily social behavior of a clinic sample of social phobics. The results indicated that the SPAI provides a reasonable indication of the distress experienced during daily social encounters in three dimensions: behavior, cognitions, and overall distress. The second study examined the validity of the SPAI with reference to the somatic response and avoidance behavior of social phobics. The results indicated that the somatic items of the SPAI are related to the somatic response of social phobics and that performance on the SPAI is associated with avoidance behavior in an anxiety-producing task.