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.     

Guidelines are not enough: The need for written sentencing opinions

Guideline sentencing systems, including the new federal guidelines, have not settled on a clear conception of when and how a trial judge should explain sentences. Indeterminate sentencing systems did not have a tradition of written sentencing decisions and recent sentencing reforms do not focus on the trial judge's role. This article suggests the many advantages of written sentencing opinions. Initial experience under the federal sentencing guidelines bolsters the conclusion that written sentencing opinions in appropriate cases—including both sentences “within” guidelines and guideline “departures”—are the next step in the evolving law of sentencing and the best way to recognize trial judges as an essential engine of principled change.     

Training non-native speech contrasts in adults: Acquisition of the English /ð/-/θ/ contrast by francophones

Attention, Perception, & Psychophysics - Speech perception abilities are modified by linguistic experience to maximize sensitivity to acoustic contrasts that are important for one’s...     

Secobarbital and perceptual processing

An experiment which employed each of 18 subjects in four days of testing was used to examine acute secobarbital dose treatment effects on choice reaction time in a Cooper and Shepard (1973) character recognition task. Manipulations of visual stimulus degradation, character difficulty, 180 degree rotation, and mirror-image reversal were included in order to evaluate the hypothesis that the drug affects performance by disrupting early stimulus input processing. The results indicate significant increases in the effect of secobarbital on reaction time and errors under conditions of visual stimulus degradation. The effects of the drug, however, were not changed by 180 degree rotation of the target character or by the other task variables. The results were interpreted to indicate that secobarbital impairs performance primarily by placing selective stress on hypothetical early encoding activities and that later processing operations (associated with use of an internal representation of the target character) are not affected by the drug. Strengths and weaknesses of the two-stage model of visual stimulus processing are discussed and implications of the model for future drug research are indicated.     

Integrating vocational interest inventory results and expressed choices

Though many studies have examined the predictive power of expressed choices versus that of measured interests, fewer have been concerned with the relationship between the degree to which choices and interests agree and later persistence in an expressed choice. This study explored that relationship, using longitudinal data for 7706 college students and 1372 employed persons. Four levels of congruence between expressed choice and measured interests were identified. Results indicated that persistence in an expressed choice increases systematically as congruence between choice and interests increases. Implications for counselors are noted.