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.     

How help during pregnancy can undermine self-efficacy and increase postpartum intentions to quit

Pregnancy reflects a common experience for women in today's workforce, yet recent data suggest that some women scale back or leave the workforce following childbirth. Considering these effects on women's careers, researchers have sought to understand the underlying dynamics of these decisions. Here, we explore a paradoxical reason for weakened postpartum career attitudes: help that women receive during pregnancy. We integrate stereotype threat and benevolent sexism theories to explain how the effects of help on postpartum intentions to quit may be transmitted through reductions in work self-efficacy. In doing so, we consider the role of perceived impact—or the extent to which help interferes with versus enables women's perceived ability to continue performing their work role. Results of a weekly diary study of 105 pregnant employees suggest that work-interfering help led to decreased self-efficacy for work during the following week. Furthermore, there was an indirect effect of average help received at work during pregnancy on postpartum intentions to quit the workforce through reductions in work self-efficacy that was stronger insofar as help was work-interfering versus work-enabling. Taken together, our results highlight unintended negative consequences that occur when others provide ineffective support to women at work during pregnancy.     

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.     

Perceptual Categorization: Connectionist Modelling and Decision Rules

Although it is currently popular to model human associative learning using connectionist networks, the mechanism by which their output activations are converted to probabilities of response has received relatively little attention. Several possible models of this decision process are considered here, including a simple ratio rule, a simple difference rule, their exponential versions, and a winner-take-all network. Two categorization experiments that attempt to dissociate these models are reported. Analogues of the experiments were presented to a single-layer, feed-forward, delta-rule network. Only the exponential ratio rule and the winner-take-all architecture, acting on the networks' output activations that corresponded to responses available on test, were capable of fully predicting the mean response results. In addition, unlike the exponential ratio rule, the winner-take-all model has the potential to predict latencies. Further studies will be required to determine whether latencies produced under more stringent conditions conform to the model's predictions.     

Children's perception of certain musical properties: scale and contour

Children's perception of scale and contour in melodies was investigated in five studies. Experimental tasks included judging transposed renditions of melodies (Studies 1 and 3), discriminating between transposed renditions of a melody (Study 2), judging contour-preserving transformations of melodies (Study 4), and judging similarity to a familiar target melody of transformations preserving rhythm or rhythm and contour (Study 5). The first and second studies showed that young children detect key transposition changes even in familiar melodies and they perceive similarity over key transpositions even in unfamiliar melodies. Young children also are sensitive to melodic contour over transformations that preserve it (Study 5), yet they distinguish spontaneously between melodies with the same contour and different intervals (Study 4). The key distance effect reported in the literature did not occur in the tasks of this investigation (Studies 1 and 3), and it may be apparent only for melodies shorter or more impoverished than those used here.