Serial pattern learning by event observation.

Serial pattern learning was investigated in a variation of the task introduced by Nissen and Bullemer (1987). We presented an asterisk at 1 of 4 spatial locations on each trial, and Ss either responded with a keypress or observed the event. The first 4 blocks contained 10 repetitions of a 10- or 16-element pattern, and the 5th block contained a random sequence. The difference in response time on the 5th random block and the previous patterned block served as an indirect measure of pattern learning. A direct measure was obtained in a final test block in which Ss predicted the next asterisk position. Equivalent learning occurred for responding and observing with indirect measures, but observation was superior with direct measures. These findings indicate that knowledge of serial order can develop through simple perceptual experience, and this is more available to deliberate recall than is knowledge acquired while responding.     

Cognitive Neuropsychology and Developmental Disorders: Uncomfortable Bedfellows

Cognitive neuropsychology provides a theoretical framework and methods that can be of value in the study of developmental disorders, but the "dissociation" logic at the centre of this approach is not well suited to the developmental context. This is illustrated with examples from specific language impairment. Within the developing language system there is ample evidence for interaction between levels of representation, with modularity emerging in the course of development. This means that one typically is seeking to explain a complex pattern of associated impairments, rather than highly selective deficits. For instance, a selective impairment in auditory processing can have repercussions through the language system and may lead to distinctive syntactic deficits that are seen in written as well as spoken language. Changes in the nature of representations and in the relationships between components of a developing system mean that cross-sectional data at a single point in development may be misleading indicators of the primary deficit. Furthermore, traditional cognitive neuropsychology places a disproportionate emphasis on representational (competence) deficits, with processing (performance) deficits being relatively neglected. Methods for distinguishing these two kinds of impairment are discussed, as well as other approaches for elucidating the underlying nature of developmental disorders.     

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.     

Identifying subgroups that succeed or fail with three levels of physical activity intervention: the Activity Counseling Trial.

The authors used recursive partitioning methods to identify combinations of baseline characteristics that predict 2-year physical activity success in each of 3 physical activity interventions delivered in the multisite Activity Counseling Trial. The sample consisted of 874 initially sedentary primary care patients, ages 35-75 years, who were at risk for cardiovascular disease. Predictors of 2-year success were specific to each intervention and represented a range of domains, including physiological, demographic, psychosocial, health-related, and environmental variables. The results indicate how specific patient subgroups (e.g., obese, unfit individuals; high-income individuals in stable health) may respond differently to varying levels and amounts of professional assistance and support. The methods used provide a practical first step toward identifying clinically meaningful patient subgroups for further systematic investigation.     

A quantitative analysis of the relationship between the Cook-Medley Hostility Scale and traditional coronary artery disease risk factors.

One possible explanation for the association between Cook-Medley Hostility Scale (Ho Scale; W. W. Cook & D. M. Medley, 1954) scores and premature coronary artery disease (CAD) morbidity and mortality is that hostile persons also have elevations on CAD risk factors. Meta-analyses with fixed and random-effects models were used to evaluate the relationship between Ho Scale scores and CAD risk factors in the empirical literature. Ho Scale scores were significantly related to body mass index, waist-to-hip ratio, insulin resistance, lipid ratio, triglycerides, glucose, socioeconomic status (SES), alcohol consumption, and smoking. Although there was also heterogeneity among study outcomes, the results of conservative random effects models provide confidence in the obtained relationships. On the basis of available evidence, researchers might give attention to obesity, insulin resistance, damaging health behaviors, and SES as potential contributing factors in understanding the association between Ho Scale scores and CAD.