Comparative Effectiveness of Web-Based vs. Educator-Delivered HIV Prevention for Adolescent Substance Users: A Randomized, Controlled Trial.

BACKGROUND: Young people who engage in substance use are at risk for becoming infected with HIV and diseases with similar transmission dynamics. Effective disease prevention programs delivered by prevention specialists exist but are rarely provided in systems of care due to staffing/resource constraints and operational barriers-and are thus of limited reach. Web-based prevention interventions could possibly offer an effective alternative to prevention specialist-delivered interventions and may enable widespread, cost-effective access to evidence-based prevention programming. Previous research has shown the HIV/disease prevention program within the Web-based therapeutic education system (TES) to be an effective adjunct to a prevention specialist-delivered intervention. The present study was the first randomized, clinical trial to evaluate the comparative effectiveness of this Web-based intervention as a standalone intervention relative to a traditional, prevention specialist-delivered intervention. METHODS: Adolescents entering outpatient treatment for substance use participated in this multi-site trial. Participants were randomly assigned to either a traditional intervention delivered by a prevention specialist (n=72) or the Web-delivered TES intervention (n=69). Intervention effectiveness was assessed by evaluating changes in participants' knowledge about HIV, hepatitis, and sexually transmitted infections, intentions to engage in safer sex, sex-related risk behavior, self-efficacy to use condoms, and condom use skills. FINDINGS: Participants in the TES intervention achieved significant and comparable increases in HIV/disease-related knowledge, condom use self-efficacy, and condom use skills and comparable decreases in HIV risk behavior relative to participants who received the intervention delivered by a prevention specialist. Participants rated TES as easier to understand. CONCLUSION: This study indicates that TES is as effective as HIV/disease prevention delivered by a prevention specialist. Because technology-based interventions such as TES have high fidelity, are inexpensive and scalable, and can be implemented in a wide variety of settings, they have the potential to greatly increase access to effective prevention programming.

Effect of concomitant pharmacotherapy on electroconvulsive therapy outcomes: short-term efficacy and adverse effects.

CONTEXT: Medication resistance is the leading indication for use of electroconvulsive therapy (ECT) in major depression. The practice of stopping antidepressant medications prior to ECT derived from studies in the 1960s and 1970s in nonresistant samples. There is also continuing controversy regarding the relative efficacy and adverse effects of right unilateral and bilateral ECT. OBJECTIVE: To test the hypotheses that, compared with placebo, concomitant treatment with nortriptline or venlafaxine during the ECT course enhances short-term efficacy without a meaningful effect on adverse effects and reduces the rate of post-ECT relapse, and to test the hypotheses that high-dose, right-sided, unilateral ECT is equivalent in efficacy to moderate-dosage bilateral ECT and retains advantages with respect to cognitive adverse effects. DESIGN: Prospective, randomized, triple-masked, placebo-controlled study conducted from 2001 through 2005. SETTING: Three university-based hospitals. PATIENTS: Of approximately 750 consecutive patients referred for ECT, 319 with a major depressive episode consented, were randomized to pharmacological or ECT treatment conditions, and received at least 1 ECT treatment. MAIN OUTCOME MEASURES: Scores on the Hamilton Rating Scale for Depression, remission rate following completion of ECT, and selective measures of cognitive adverse effects. RESULTS: Treatment with nortriptyline enhanced the efficacy and reduced the cognitive adverse effects of ECT relative to placebo. Venlafaxine resulted in a weaker degree of improvement and tended to worsen cognitive adverse effects. High-dosage right unilateral ECT did not differ or was superior to bilateral ECT in efficacy and resulted in less severe amnesia. CONCLUSIONS: The efficacy of ECT is substantially increased by the addition of an antidepressant medication, but such medications may differ in whether they reduce or increase cognitive adverse effects. High-dose, right-sided, unilateral ECT is at least equivalent to moderate-dosage bilateral ECT in efficacy, but retains advantages with respect to cognitive adverse effects.

Representation of principled connections: a window onto the formal aspect of common sense conception.

Nominal concepts represent things as tokens of types. Recent research suggests that we represent principled connections between the type of thing something is (e.g., DOG) and some of its properties (k-properties; e.g., having four legs for dogs) but not other properties (t-properties; e.g., being brown for dogs). Principled connections differ from logical, statistical, and causal connections. Principled connections license (i) the expectation that tokens of the type will generally possess their k-properties, (ii) formal explanations (i.e., explanation of the presence of k-properties in tokens of a type by reference to the type of thing it is), and (iii) normative expectations concerning the presence of k-properties in tokens of the type. The present paper investigates the hypothesis that representing principled connections requires representing properties as aspects of being the relevant kind of thing (Aspect Hypothesis). Experiment 1 provides a direct test of the Aspect Hypothesis. Experiments 2 and 3 provide indirect tests of the Aspect Hypothesis. All three experiments provide support for the Aspect Hypothesis. Experiment 4 investigates a prediction of the Aspect Hypothesis concerning the manner in which formal explanations are licensed by principled connections. Finally, Experiment 5 investigates a prediction of the Aspect Hypothesis concerning the nature of the normative expectations licensed by principled connections. Together these results provide strong evidence for the idea that representing principled connections involves representing a property as being an aspect of being a given kind of thing. The results also help clarify the manner in which formal explanation differs from other modes of explanation. Finally, the results of the experiments are used to motivate a proposal concerning the formal structure of the conceptual representations implicated by principled connections. This structure provides a domain-general way of structuring our concepts and embodies the perspective we take when we think and talk of things as being instances of a kind.

Principled and statistical connections in common sense conception.

Nominal concepts represent things as tokens of types. We report six experiments that investigate the nature of the relations we represent between the type of thing something is (e.g. DOG) and its other properties. The experiments provide evidence that we represent principled connections between the type of thing something is (e.g. DOG) and some of its properties (k-properties; e.g. having four legs for dogs), but not other properties (t-properties; e.g. being brown for dogs). Principled connections are different from logical, statistical, and causal connections. Principled connections, (i) license the expectation that tokens of the type will generally possess the k-property, (ii) license explanation of the presence of k-properties in tokens of a type by reference to the type of thing it is, and (iii) license normative expectations concerning the presence of the k-property in tokens of the type. The experiments provide evidence for all three of these aspects of principled connections. The experiments also demonstrate that principled connections must be distinguished from merely strong statistical connections. We suggest that principled connections are one of the fundamental types of relations (in addition to logical, statistical, and causal relations) in terms of which our conceptual knowledge is structured. We argue that principled connections reveal a formal mode of understanding and explanation. This mode of understanding complements other modes of understanding that have been studied within the theory-based approach to conceptual representation. Finally, we suggest that kind representations are distinguished from representations of mere types by the representation of principled connections to k-properties.