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.     

II—Véronique Munoz-Dardé

ABSTRACT Are there distinctively political values? Certain egalitarians seem to think that equality is one such value. Scheffler's contribution to the symposium seeks to articulate a division of moral labour between norms of personal morality and the principles of justice that regulate social institutions, and using this suggests that the egalitarian critique of Rawls can be deflected. In this paper, instead, I question the status of equality as an intrinsic value. I argue that an egalitarianism which focuses on the status of equality as valuable in itself embraces a theory of value with the worst elements of utilitarianism (in particular its consequentialism) while leaving behind any of the intuitive appeal that utilitarianism has. In its place I press that we need a political conception of egalitarianism which stresses the role of equality as a political ideal without presupposing any values with which we engage beyond those found in the norms of personal morality.     

A longitudinal study of pain sensitivity and blood pressure in adolescent boys: results from a 5-year follow-up.

A growing literature has observed a significant reduction in pain sensitivity among hypertensive animals and humans. It is uncertain whether a reduced sensitivity to pain can be observed in nonnotensive individuals who go on to develop high blood pressure. Blood pressure (BP) was reassessed in one hundred fifteen 19-year-old boys initially tested at age 14, when they were also presented with a pain stimulus (mechanical finger pressure). Hierarchical regression analyses indicated that information regarding pain tolerance improved prediction of changes in systolic and diastolic blood pressure beyond that afforded by differences in BP at age 14, parental history of hypertension, and body mass index. These analyses suggest that pain sensitivity may be associated with physiological processes involved in the development of sustained high blood pressure.