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.     

The valuing process: A study of favorite songs and the inner experience of persons diagnosed with schizophrenia

Since valuing is a process grounded in the organizational tendency of human behavior, the characteristics of a highly valued object should reflect the experience of the individual who selects it. This research compared the favorite songs of fourteen individuals diagnosed with schizophrenia to their inner experience as assessed in a standard interview. Many relationships were revealed between the two, often pertaining to important issues identified in theories of schizophrenia. Results may have therapeutic applications and shed light on processes through which psychological difficulties persist.     

As If Your Life Depended on It: Promoting Cognitive Development to Promote Wellness

In this article the authors discuss key elements of the cognitive-developmental perspective and the need to integrate it as an important component of the wellness model. Each speaks to the personal empowerment of every person to live a rewarding and responsible life. Each also emphasizes the ongoing promotion of growth rather than secondary prevention or remediation.     

Rate of processing and judgment of response speed: comparing the effects of alcohol and practice

Both alcohol and practice affect choice reaction time. The present study was conducted to investigate the possibility that impairment from alcohol and improvement with practice could be attributed to changes in the efficiency of control mechanisms (Rabbitt, 1979a), some of which depend upon the ability to judge response speed accurately. Twenty subjects participated in a four-choice reaction time experiment in which they received no alcohol (NA) in Session 1 and either no alcohol (10 subjects) or 0.8 ml alcohol (A) per kilogram of body weight (10 subjects) in Session 2. The task was to respond as fast and as accurately as possible to each stimulus. In addition, subjects were required to press a fifth key after any response that they considered to be both fast and accurate. Subjects had no difficulty in performing this task: (1) there was a significant difference of 122 msec between the mean response time for correct responses indicated as fast and that for correct responses not indicated as fast, and (2) subjects indicated 1 in 4 correct responses but only 1 in 64 errors. Alcohol increased all response times by approximately 40 msec. In contrast, practice decreased response times less for correct responses not indicated as fast than for correct responses indicated as fast. The ability to distinguish between fast and slow responses was thus unaffected by alcohol, but was improved by practice. Responses indicated as "fast" were significantly faster than errors, and appeared to occur without warning (unlike errors, which tended to end a sequence of increasingly fast correct responses). The results suggest that alcohol and practice influence choice reaction time in qualitatively different ways: Alcohol impairs overall response speed but has no effect on the ability to judge response speed, whereas practice improves both.     

Predecisional information acquisition: Effects of task variables on suboptimal search strategies

Effective overall performance in judgment tasks generally involves both acquisition of information and integration of the information acquired. When information is costly the decision maker must balance acquisition costs against improved decisional accuracy, a complex balancing problem in which, laboratory evidence suggests, humans often do poorly. The three experiments reported here extend this earlier evidence to different task structures, subject pools, incentive systems, information volumes, decision aids, and kind of data sources. Though each of these factors was found to affect performance, the general finding was of persistent underpurchase (buying less information overall than is optimal) and mispurchase (buying poor sources when better sources are available at the same cost), with significant inflation of overall costs. It is proposed that unaided human judgment is unequal to the complexity of the cost/benefit trade-offs involved in acquiring costly information, and that formal decision analysis should be preferred whenever the stakes justify.     

Locus of control,choice, and satisfaction with an assigned task

P. E. Spector's (1982, Psychological Bulletin, 91, 482–497) hypothesis that under conditions of freedom of choice persons characterized by an internal locus of control will experience greater satisfaction with an undesirable task than persons characterized by an external locus of control is considered in light of distinctions between perceived control and perceived choice. Perceived choice is proposed as an intervening variable implicit in Spector's argument. This reasoning was tested with 46 male and female college student participants in a 2 (Choice) × 2 (Locus of Control) factorial design experiment. An interaction of Choice × Locus of Control on task satisfaction was obtained such that internals tended to be more satisfied when given a choice while externals experienced greater satisfaction when not given a choice. The implications of this result for Spector' hypothesis and for the manner in which undesirable work is assigned are discussed.     

Fictional Characters and Characterisations

Realists about fictional characters posit a certain theoretical role and a candidate to fill this role. I will delineate the role realists take fictional characters like Emma Woodhouse to fill, and I will argue that it is better filled by what I will call ‘characterisations’. In explaining what I mean by ‘characterisations’, I will show that the existence of these entities is comparatively uncontroversial. Realists should acknowledge their existence, but doing so, I will argue, obviates the need to acknowledge the existence of Emma and other fictional individuals.     

Susceptibility to prosocial and antisocial influence in adolescence following mindfulness training

Mindfulness training programmes have shown to encourage prosocial behaviours and reduce antisocial tendencies in adolescents. However, less is known about whether training affects susceptibility to prosocial and antisocial influence. The current study investigated the effect of mindfulness training (compared with an active control) on self-reported prosocial and antisocial tendencies and susceptibility to prosocial and antisocial influence. 465 adolescents aged 11–16 years were randomly allocated to one of two training programmes. Pre- and post-training, participants completed a social influence task. Self-reported likelihood of engaging in prosocial and antisocial behaviours did not change post-training, and regardless of training group, participants showed a higher propensity for prosocial influence than for antisocial influence. Finally, participants were less influenced by antisocial ratings following both training programmes.     

Drawing conclusions: Instructing witnesses to draw what happened to them

We reviewed the child and the adult literature on the impact of witnesses drawing what happened on the number of details recalled and the accuracy of the reported details. Most experiments reported a beneficial effect of drawing what happened (or drawing the scene) on the number of details reported primarily in free recall and sometimes also in cued recall. The consensus across studies was that drawing protocols did not negatively impact the accuracy of reported details (when accuracy was attainable) unless suggestive details were drawn. These results were largely consistent regardless of interviewer expertise or protocol used. Draw-and-tell instructions should be considered by forensic investigators for the following reasons: (1) the beneficial effect on number of details recalled with no detriment to accuracy, (2) the added benefit for children who need additional interviewer support, and (3) the ease at which the instruction can be implemented with minimal expertise or training. However, more ecologically valid research is needed to establish the efficacy of drawing (1) in forensic interviews, (2) in the presence of misinformation, (3) across instances of repeated event memory, and (4) across sequential interviews.