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OBJECTIVES Students often express uncertainty regarding changing their answers on multiple choice tests despite multiple studies quantitatively showing the benefits of changing answers. METHODS Data was collected from 86 first-year podiatric medical students over one semester for the course of Biochemistry, as shown in electronic testing data collected via ExamSoft's® Snapshot Viewer. Quantitative analysis was performed comparing frequency of changing answers and whether students changed their answers from incorrect-to-correct, correct-to-incorrect, or incorrect-to-incorrect. A correlation analysis was performed to assess the relationship between the frequency of each type of answer change and class rank. Independent-sample t-tests were used to assess differences in the pattern of changing answers amongst the top and bottom performing students in the class. RESULTS The correlation between total changes made from correct-to-incorrect per total answer changes and class rank yielded a positive correlation of r = 0.218 (P = .048). There was also a positive correlation of r = 0.502 (P < .000) observed in the number of incorrect-to-incorrect answer changes per total changes made compared to class rank. A negative correlation of r = −0.382 (P < .000) was observed when comparing class rank and the number of changed answers from incorrect-to-correct. While most of the class benefited from changing answers, a significant positive correlation of r = 0.467 (P < .000) for percent ultimately incorrect (regardless of number of changes) and class rank was observed. CONCLUSION Analysis revealed that class rank correlated to likelihood of a positive gain from changing answers. Higher ranking students were more likely to gain points from changing their answer compared to lower ranking. Top students changed answers less frequently and changed answers to an ultimately correct answer more often, while bottom students changed answers from an incorrect answer to another incorrect answer more frequently than top students.

ABSTRACT Background Many lesbian and bisexual (LB) women veterans may have been targets of victimization in the military based on their gender and presumed sexual orientation, and yet little is known regarding the health or mental health of LB veterans, nor the degree to which they feel comfortable receiving care in the VA. Objective The purpose of this study was to examine the prevalence of mental health and gender-specific conditions, VA healthcare satisfaction and trauma exposure among LB veterans receiving VA care compared with heterosexually-identified women veterans receiving. Design Prospective cohort study of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) women veterans at two large VA facilities. Participants Three hundred and sixty five women veterans that completed a baseline survey. Thirty-five veterans (9.6 %) identified as gay or lesbian (4.7 %), or bisexual (4.9 %). Main Measures Measures included sexual orientation, military sexual trauma, mental and gender-specific health diagnoses, and VA healthcare utilization and satisfaction. Key Results LB OEF/OIF veterans were significantly more likely to have experienced both military and childhood sexual trauma than heterosexual women (MST: 31 % vs. 13 %, p  < .001; childhood sexual trauma: 60 % vs. 36 %, p  = .01), to be hazardous drinkers (32 % vs. 16 %, p  = .03) and rate their current mental health as worse than before deployment (35 % vs. 16 %, p  < .001). Conclusions Many LB veterans have experienced sexual victimization, both within the military and as children, and struggle with substance abuse and poor mental health. Health care providers working with female Veterans should be aware of high rates of military sexual trauma and childhood abuse and refer women to appropriate VA treatment and support groups for sequelae of these experiences. Future research should focus on expanding this study to include a larger and more diverse sample of lesbian, gay, bisexual, and transgender veterans receiving care at VA facilities across the country.

The human immunodeficiency virus (HIV), hepatitis C virus (HCV), and the treatment of HCV with pegylated interferon and ribavirin (IFN/RBV) have been associated with neurocognitive and psychiatric abnormalities. The goal of this research was to prospectively evaluate neurocognitive functioning among a group of HCV mono-infected and HIV/HCV co-infected patients during the first 24 weeks of IFN/RBV treatment while accounting for practice effects, normal variations in change over time, and variations in IFN/RBV treatment exposure. Forty-four HCV mono-infected and 30 HIV/HCV co-infected patients were enrolled in a prospective study of patients beginning on IFN/RBV for chronic HCV infection. Patients were administered a depression inventory, a measure of fatigue, a structured psychiatric interview, and a neurocognitive battery at baseline and 24 weeks after initiation of treatment. Analyses were conducted to explore possible associations between neurocognitive functioning and the following: HIV/HCV co-infection vs. HCV mono-infection, IFN and RBV treatment exposure, psychiatric status, liver disease stage, and other medical characteristics. At baseline, there were no significant differences between the two groups’ neuropsychiatric or neurocognitive function other than the mono-infected group had significantly higher reports of fatigue ( p  = 0.033). Over the course of 24 weeks of treatment after controlling for practice effects, the HIV/HCV co-infected patients experienced significantly greater declines in memory ( t (56) = 2.14, p  = 0.037) and global neurocognitive functioning ( t (53) = 2.28, p  = 0.027). In a well-characterized sample of mono-infected and co-infected patients, it appears that persons with HIV/HCV co-infection are potentially more vulnerable to neurocognitive sequalae during HCV treatment.

Background Primary care is an important yet underutilized resource in addressing the overdose crisis. Previous studies have identified important aspects of primary care for people who use drugs (PWUD) and have found patient involvement in healthcare decisions and goal-setting to be especially critical. However, there has been limited research describing the primary care goals of PWUD. In harm reduction settings, where it is imperative that PWUD set their own goals, this research gap becomes especially relevant. Objective To explore how PWUD navigate primary care with a focus on understanding their primary care goals. Design A qualitative study using semi-structured interviews. Participants PWUD currently engaged in primary care at the Respectful and Equitable Access to Comprehensive Healthcare (REACH) Program, a harm reduction–based primary care program in New York City. Approach Between June 2022 and August 2022, we conducted 17 semi-structured interviews. Informed by phenomenology, transcripts were coded using both inductive and deductive codes and themes were developed using thematic analysis approaches. Key Results Phenomenological analysis identified four core components that, together, created an experience that participants described as “a partnership” between patient and provider: (1) patient-provider collaboration around patient-defined healthcare goals; (2) support provided by harm reduction–based approaches to primary care anchored in incrementalism and flexibility; (3) care teams’ ability to address healthcare system fragmentation; and (4) the creation of social connections through primary care. This holistic partnership fostered positive primary care experiences and supported participants’ self-defined care goals, thereby facilitating meaningful care outcomes. Conclusions To best meet the primary care goals of PWUD, these findings underscore the importance of primary care providers and programs facilitating such partnerships through organizational-level support anchored in harm reduction. Future research should explore how these experiences in primary care affect patient health outcomes, ultimately shaping best practices in the provision of high-quality primary care for PWUD.

Although many HIV-positive individuals use alternative medicine, little is known about user characteristics. In this study, the prevalence of alternative medicine use in a sample of 70 HIV-positive gay men is assessed and characteristics of alternative medicine users are identified. Seventy-one per cent (50/70) of the sample used at least one alternative therapy since HIV serostatus notification, alone or in combination with traditional medicine. A logistic regression was used to identify those measures which are characteristic of alternative users. It revealed that the typical user is a person with symptomatic HIV disease (Wald = 6.18, p = 0.01), who reports little or no pain (Wald = 10.01, p < 0.01) and actively tries to cope with disease-specific problems (Wald = 7.35, p = 0.01) while expressing his feelings about them (Wald = 7.66, p = 0.01). In the sub-set of subjects using antiretroviral medication, those also using alternative medicine reported using more antiretrovirals and better adherence to them, than those not using alternative medicine.

Background: This study compared the effects of a supportive-expressive group intervention (GI) with an educational control condition (EC) on long-term psychosocial adjustment in gay men with HIV infection. Method: Subjects (n = 85) were randomized after stratification for disease stage and use of antiretroviral medication. GI consisted of 4 months of weekly group sessions followed by 5 monthly maintenance sessions plus written educational material, whereas the EC subjects received educational material only. Results: There were no between-group differences in effects on distress, coping or social support in analyses examining 4 time points over 15 months. Both conditions decreased in distress over time on the Hopkins Symptom Checklist and Beck Depression Inventory. Conclusions: Several explanations are offered for the reason why no additional benefit of the GI was found on outcome measures studied when compared with the EC condition and recommendations are made for future psychosocial intervention research with HIV-infected persons.

This paper examines psychotherapy with HIV-positive gay men from a psychodynamic perspective. Adjustment to being HIV-positive is conceptualized as an ongoing process of confrontation with loss and uncertainty. Interventions offered to HIV-positive gay men range from counseling, indicated in response to an \"uncomplicated\" adjustment process; to dynamically oriented psychotherapy, indicated when the functioning of the self has been thrown off balance by HIV illness. The client's process of accepting his HIV illness is shaped and colored by the degree to, and manner in, which he has accepted being gay and integrated this into his identity. Sexuality is a core theme in psychotherapy with this population. It often plays a prominent role in the past unresolved conflicts (feelings about having become HIV-infected) as well as present concerns (feelings about living with HIV illness) which the client has come to therapy to address. The process of addressing the meanings being HIV-positive holds for the client in therapy can promote acceptance of the illness and cohesiveness of the self. Cultural and subcultural differences in how life stress is experienced must also be taken into account by the therapist in order to fully appreciate the client's concerns.

The lower court held that a \"school district's simple failure to provide a reasonable accommodation is not enough to trigger liability\" under Section 504. The Supreme Court found it was not equitable to impose a higher standard for students alleging discrimination under Section 504 when compared with general discrimination claims under the ADA and Rehabilitation Act. [...]this ruling from the Supreme Court has made it easier for students with disabilities to obtain compensatory damages from their schools when such schools are found to have disregarded a strong likelihood that their actions violated a student's federal rights.