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.     

Line bisecting as a predictor of personal optimism and desirability of risky behaviors.

Our goal was to test whether current hemisphere predominance is a predictor of scores on standardized measures of personal optimism and preference for risk. In two between-subject experiments, current hemisphere predominance was measured by the direction and extent of line bisecting errors. Pearson correlations and median splits of the line bisecting errors showed significantly greater personal optimism and preference for risk with left hemisphere predominance. These results support previous research in which manipulation of hemisphere predominance produced similar effects on personal optimism in normal individuals and on risk taking in lesioned and normal samples. We conclude that the association of optimism and risk with left hemisphere predominance can be observed in resting as well as in manipulated situations.     

The role of inhibition in a spreading-activation model of language production. II. The simulational perspective

This is the second part of a project aimed at establishing the role of lateral inhibition in spreading-activation models of language production. While the first part (Berg &; Schade, 1992) reviewed the psycholinguistic evidence for inhibition and established that indeed inhibition takes place, this paper addresses the issue from the implementational perspective. A series of computer simulations are reported in which spreading-activation models with or without inhibition are directly contrasted. The performance of the competing models is evaluated against two sets of criteria. On the more technical side, the “heat death” and the selection problems have to be solved. That is, the target must have a high and the nontarget units a low level of activation. Additionally, there are certain empirical effects from the production literature which may serve as test cases for deciding between the rival models. The results of the simulations indicate that only the inhibition-based model proves capable of meeting all challenges. All inhibitionless variants fail in one or more respects. It is further shown that the need for the inhibitory component increases with the size of the processing network and that one well-known production model can do without lateral inhibition only at the expense of introducing a concept which resembles inhibition in its effect but cannot replace it.     

Development of stepping patterns in human infants: a dynamical systems perspective

Upright locomotion has been, perhaps, the most studied of all human motor behaviors. The acquisition of this motor milestone has been of major interest to developmentalists from the motor as well as the cognitive domains. Until recently, developmentalists have chosen a nonexperimental approach, opting instead to describe the motor behaviors that precede walking, assigning them precursor status, and attributing the sequence solely to maturation of the nervous system. In this paper, I will discuss evidence that suggests that we may better understand this and other aspects of motor development by viewing them from the theoretical perspective of nonlinear and complex dynamical systems. Focus will be on the availability of a coordinated and alternating stepping pattern throughout much of the first year of life. Factors that influence the expression of and variability in this movement pattern will also be discussed. In addition, I will address the need to understand the development of control of pattern formations as well as their coordination, and I will discuss one approach that may provide some insight; that is, to study the modulations and patterns of muscle and other forces underlying limb movements.     

A new quantitative approach to the assessment of stages of vigilance as defined by spatiotemporal EEG patterning

Electroencephalographically oriented research on vigilance needs valid measures for assessing the level of vigilance between wakefulness and sleep. When studying different psychologically, psychopathologically, and pharmacologically induced states, special attention has to be paid to minor alterations of the level of vigilance which are reflected, essentially, in topographical changes of alpha-activity (Stage A). Since vigilance is a dynamic process, brief fluctuations in the range of a few seconds must also be recorded. In our opinion existing methods of quantification do not fully meet these demands. We have, therefore, developed a relatively simple procedure which can be characterized as an attempt quantitatively to reconstruct visually, i.e., spatiotemporally defined patterns of vigilance. The usefulness of this method, which also has certain limitations, has been demonstrated in psychopharmacological studies.     

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.     

Information processing abilities in twins reared apart

A battery of information processing measures and psychometric tests of specific and general cognitive abilities was administered to a sample of 105 individuals which included 34 monozygotic and 13 dizygotic reared apart twin pairs or triplets. Correlations between information processing parameters and psychometric abilities as well as twin resemblances for the information processing parameters were examined. In a principal components analysis of the information processing parameters, three components were identified which accounted for 67% of the total variation; Overall Speed of Response (OSR), Speed of Information Processing (SIP), and Speed of Spatial Processing (SSP). OSR was significantly correlated with WAIS IQ, and psychometric measures of verbal reasoning, spatial ability, and perceptual speed and accuracy. SIP was significantly correlated with WAIS IQ, measures of verbal reasoning, and one of the perceptual speed and accuracy measures. SSP was significantly correlated with measures of both spatial ability and perceptual speed and accuracy. Due to the small size of the dizygotic twin sample, no strong conclusions could be drawn regarding the magnitude of their resemblance. The correlation between component scores of reared apart monozygotic twins was significant for OSR, but not for SIP or SSP.