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.     

The universality of a contempt expression: A replication

Two experiments replicated Ekman and Friesen's finding of an expression that signals contempt across cultures. The subjects, from West Sumatra, Indonesia, were members of a culture that differs in a number of ways from Western cultures. In one experiment the subjects judged photographs of Japanese and American faces, both males and females, which showed many different emotions. There was very high agreement about which expressions signaled contempt in preference to anger, disgust, happiness, sadness, fear, or surprise. In a second experiment the Indonesian subjects judged expressions shown by members of their own culture, and again there was very high agreement about which expression signals contempt.This study was supported by a grant from the National Institute of Mental Health (MH 41100). Paul Ekman's work is also supported by a Research Scientist Award from the National Institute of Mental Health (MH 06092). Karl G. Heider's work was supported by a grant from the National Institute of Mental Health (MH 38221). We are grateful to Maureen O'Sullivan for her many helpful comments on this report.     

Family therapy without the family: a framework for systemic practice

This paper contrasts the basic tenets of systemic thinking with some guiding principles of the psychodynamic approach, and outlines specific techniques which family therapists can use when seeing individuals. It is argued that a useful systemic framework can be maintained if the therapist aims to keep the therapy system 'open' for relevant others to join at any time.     

Ein Protokoll aus Husserls Logikseminar vom Winter 1925

Ohne Zusammenfassung     

HUMANITY IN NATURE: CONSERVING YET CREATING

Abstract. Developing a scientifically grounded philosophy of cosmic evolution, and using the moral norm of completeness as dynamic harmony, this paper argues that humans are a part of nature in both its conserving and emergent aspects. Humans are both material and cultural, instinctual-emotional and rational, creatures and creators, and carriers of stability and change. To ignore any of the multifaceted aspects of humanity in relation to the rest of nature is to commit one of a number of fallacies that are grounded in a dualistic-conquest mentality. Examples of some new developments in philosophy and theology, metaphorical images, and ritual show how to overcome dualism in favor of a dynamic harmony of humanity within nature.     

Perceived informativeness of verbal information

When people are asked to rate verbal material (texts, statements, and statements forming part of a text) according to informativeness, their judgments will to a large extent depend upon how much they already know about the subject, and how novel the communication is to them. This will in some cases make them stress novelty and in other cases familiarity as the most important determinants for expected or perceived informativeness. It is argued that these apparently contradictory trends are reconcilable by a propositional (subject-predicate) model of information, which presupposes an identifiablesubject of the communication (“what it is all about”), as well as something to be predicated about this subject, topic, or theme. This kind of information structure allows the communication to contain both novel and familiar elements at the same time, with informativeness being at a peak when something quite new and unexpected is told about a familiar subject, or when a new subject is made familiar (i.e., satisfactorily explained) to the person. This article was written when the author was on sabbatical leave at the University of Leicester. The study was supported by a grant from the Norwegian Research Council for Science and the Humanities.     

Spiritual issues in mental health care

Religious and spiritual issues in mental health are explored in the context of four conceptual models: the medical, the nursing, the humanistic, and the pastoral. This is done by looking at each model in terms of content, diagnostic focus, language and treatment goals, and primary qualities in the health provider.The models are illustrated by case studies gathered from a multidisciplinary setting. The discovery that each model can incorporate the religious and spiritual dimension in mental health care, but that each model does this in distinctive ways, is a key point.     

Stomatologic studies in schizophrenic patients--contributions to the problem of medical and social integration of psychiatric patients

Stomatological examination was carried out on 173 patients with schizophrenia (IKK-Nr. 295). It was observed that this group of patients showed a diminished dental and oral care in comparison to the average population of the same region. The close cooperation of dentists with the institutions for chronic patients will be as prophylactic measure in favour of the patients encouraged.