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.     

Smoking and pain--a method of limits and sensory decision theory analysis

The effects of tobacco smoking on responses to electrical stimulation were studied according to a Method of Limits (ML) threshold analysis and a Sensory Decision Theory (SDT) analysis. For the ML procedure, Detection Threshold (DT), Pain Threshold (PT) and Tolerance Level (TL) measures were obtained. For the SDT procedure, nonparametric estimates of capacity to discriminate between stimulus intensities (P(A)) and response criterion (B) were calculated. There was no main effect of tobacco smoking on responses to electrical stimulation. Males had consistently higher ML thresholds than females in both the NS and S condition. Males also tended to increase in DT and PT after smoking. From a comparison between the effects of smoking on ML and SDT measures it was suggested that PT is related mainly to sensory factors and TL to response factors.     

Effects of pentobarbital on fixed-ratio reinforcement,

Certain doses of pentobarbital consistently increased the rate of pecking engendered by a fixed-ratio schedule of 30 responses in a group of 13 pigeons, and still higher doses produced decrements in rate of responding. For individual subjects, the dose-effect functions were qualitatively similar, but differed with respect to the doses producing the maximum increase and subsequent decrease in rate. In general, the maximum occurred at lower doses and the decrement was greater at the highest dose in the birds with the highest control rates. It was also possible to distinguish between the effects of pentobarbital and several other drugs on the behavior maintained by FR 30. The results indicate that changes in rate of responding on FR 30 after drug administration are dose-dependent, drug-specific effects.     

The effects of unavoidable shocks on a multiple schedule having an avoidance component

Two dogs were maintained on a multiple schedule having both a food reinforced and an avoidance component (Mult VI 1′ S^Δ Avoid_{SS20 RS20} S^Δ). The effects of superimposing an Estes-Skinner procedure for delivering unavoidable shocks on all components of the multiple schedule were observed. The buzzer-shock pairing of the Estes-Skinner procedure produced an increased rate of responding on the avoidance component of the schedule and also on the S^Δ components. No persistent change in rate was observed on the food component during the pre-shock stimulus. Control performances on all components could be regained by either extinguishing or eliminating the buzzer-shock pairing. Extinction of the avoidance responding had little effect on the increased rates of responding produced by the Estes-Skinner procedure on the S^Δ and avoidance extinction components and did not lead to a conditioned suppression of the food reinforced responding. Rate of responding during the pre-shock stimulus was observed to be relatively independent of changes in the maintaining schedules. Responding during the pre-shock stimulus could be conditioned and maintained after an extensive history of avoidance extinction.     

Musical notation for the keyboard: An examination of stimulus-response compatibility

A recent stimulus-response compatibility model was used to provide a performance evaluation of an experimental notation for the keyboard in which pitch varies horizontally in visual space. One hundred and twenty subjects performed a choice reaction time task using either the horizontal notation or a more traditional vertical notation. Half the subjects in each notation group received white noise and half received pitch-varying feedback with responses. A horizontal display advantage was revealed when rules of the model were applied to data analyses. Further, the horizontal display advantage was not dependent on the nature of the feedback. In a second experiment, performance of musicians and non-musicians was compared using the horizontal and vertical notations. Musicians' performance was uniformly better than that of non-musicians, and did not differ with notation orientation. The findings support the use of non-traditional horizontal notations for novice performance on a keyboard instrument.     

Nonsuicidal physically self-damaging acts in adolescents

To determine the frequency and correlates of nonsuicidal physically self-damaging acts in 12–14 year olds, a two stage epidemiologic survey with a self-administered questionnaire (N=3283) followed by a psychiatric interview of a subsample of the adolescents and their parents (N=444) was used. Prevalence estimates of interview validated nonsuicidal physically self-damaging acts were 2.46% in males and 2.79% in females. Significant relationships were found between nonsuicidal physically self-damaging acts and suicidal ideation, major depression and undesirable life events. Data suggest that physically self-damaging acts occur at substantial rates during early adolescence. The strong correlation between nonsuicidal self-destructive acts and both suicidal ideation and major depression clarifies prior conflicting reports in the literature and suggests that a history of self-damaging acts should be taken into consideration when evaluating for possible depression and suicide risk.     

THE IMPORTANCE OF NONGENETIC INFLUENCES ON ROMANTIC LOVE STYLES: A Twin-Family Study

Research in several disciplines reveals large individual differences in orientations to romantic love, yet the origins of the differences have been unclear In this first behavior genetic study of romantic love, biometric model fitting reveals that in contrast to other personality and attitude domains, where genetic factors account for approximately 50% of the reliable variance and shared environment has little effect, individual differences in romantic love are due almost exclusively to environment Moreover, the common family environment plays a sizable role in determining love styles, a finding compatible with theories stressing the importance of family interactions in personality development     

The path analysis controversy: a new statistical approach to strong appraisal of verisimilitude

A new approach for using path analysis to appraise the verisimilitude of theories is described. Rather than trying to test a model's truth (correctness), this method corroborates a class of path diagrams by determining how well they predict intradata relations in comparison with other diagrams. The observed correlation matrix is partitioned into disjoint sets. One set is used to estimate the model parameters, and a nonoverlapping set is used to assess the model's verisimilitude. Computer code was written to generate competing models and to test the conjectured model's superiority (relative to the generated set) using diagram combinatorics and is available on the Web (http://www.vanderbilt.edu/quantmetheval/downloads.htm).