PURPOSE:To investigate the impact of an adjuvant Web-based teaching program on medical students' learning during clinical rotations.METHOD:From April 2003 to May 2004, 351 students completing clinical rotations in surgery-urology at four U.S. medical schools were invited to volunteer for the study. Web-based teaching cases were developed covering four core urologic topics. Students were block randomized to receive Web-based teaching on two of the four topics. Before and after a designated duration at each institution (ranging one to three weeks), students completed a validated 28-item Web-based test (Cronbach's alpha = .76) covering all four topics. The test was also administered to a subset of students at one school at the conclusion of their third-year to measure long-term learning.RESULTS:Eighty-one percent of all eligible students (286/351) volunteered to participate in the study, 73% of whom (210/286) completed the Web-based program. Compared to controls, Web-based teaching significantly increased test scores in the four topics at each medical school (p < .001, mixed analysis of variance), corresponding to a Cohen's d effect size of 1.52 (95% confidence interval [CI], 1.23-1.80). Learning efficiency was increased three-fold by Web-based teaching (Cohen's d effect size 1.16; 95% CI 1.13-1.19). Students who were tested a median of 4.8 months later demonstrated significantly higher scores for Web-based teaching compared to non-Web-based teaching (p = .007, paired t-test). Limited learning was noted in the absence of Web-based teaching.CONCLUSIONS:This randomized controlled trial provides Class I evidence that Web-based teaching as an adjunct to clinical experiences can significantly and durably improve medical students' learning.

This study investigated the association of recent risk-taking behaviors (i.e., substance use and risky, sexual behaviors) and lifetime interpersonal victimization in a sample of 310 female university students. Specifically, type of victimization (sexual or physical), number of experiences (single vs. multiple), and characteristics of assault (e.g., relationship to the perpetrator) were examined. Univariate analyses indicated that experiencing single and multiple incidents of sexual assault, multiple incidents of physical assault, and both sexual and physical assaults were associated with greater involvement in risk-taking behaviors, In addition, regression analyses revealed that Younger age and experiencing sexual assault were uniquely associated with involvement in risky behaviors, Examination of specific characteristics associated with risk taking among victims of sexual assault revealed that experiencing sexual assault in both childhood and adulthood, assault by a friend or acquaintance, and assault by multiple perpetrators were associated with increased involvement in risky behaviors. Implications for future research endeavors are discussed.

This article presents a sexual and physical violence prevention program designed for college student athletes. The program has been in place for approximately 10 years and has demonstrated several uniquely positive results. Implications for prevention programs designed for high-risk groups and athletes in particular are presented as are the components and philosophy felt necessary for such program;. (C) 2000 John & Wiley & Sons, Inc.

Traditionally, general or regional anesthesia has been employed during endourologic procedures. The success of sedative-analgesic sedation during SWL prompted an investigation into its use in minor endourologic procedures. We compared intravenous alfentanil-midazolam anesthesia (n = 30) with spinal anesthesia (n = 35) during procedures such as ureteroscopy and stent placement using physiologic measures and patient and anesthetist ratings. The former series was prospective; the latter was retrospective. Physiologic measures remained stable and oxygen saturation was above 90% in all patients in both groups during the procedures. The average anesthesia and recovery room times were significantly shorter for patients given alfentanilmidazolam: 23.3 v 36.1 minutes and 85.5 v 179.6 minutes, respectively (P < 0.001; t-test), and this difference reduced the anesthesia cost an average of 46%. The anesthetists rated the intravenous regimen satisfactory in 92% of the patients, and 94% of the patients rated the procedure as comfortable. All 18 of the patients who had previously had spinal anesthesia considered alfentanil-midazolam superior. Intravenous alfentanil-midazolam sedation anesthesia can provide adequate analgesia for many minor endourologic procedures while shortening the anesthesia recovery time.

Our results with the combination anesthetic technique of midazolam-alfentanil during elective outpatient extracorporeal shock wave lithotripsy on the Dornier HM3 (N = 79) were compared with those of epidural anesthesia in the same setting (N = 81). The mean anesthesia time and recovery room time were significantly shorter (72.85 v 113.58 minutes and 115.0 v 159.20 minutes, respectively) with the combination technique. No procedures in the alfentanil group had to be discontinued because of patient discomfort. Side effects with alfentanil were minimal, and oxygen saturation remained above 90% for all patients. Combination midazolam-alfentanil anesthesia is safe and allows the urologist to treat renal and ureteral calculi effectively and efficiently without using general or regional anesthesia.

Obsidian prismatic blades first appeared in the Pacific coast of Guatemala at the beginning of the Middle Preclassic, ca. 900 b.c., at the site of La Blanca. Blades were imported in finished form and supplemented an existing technology based on hard-hammer percussion. This indicates that by the Middle Preclassic obsidian was being traded in at least two forms: raw material and finished products. The beginnings of blade use coincide with a number of important social and political changes on the Pacific coast. Most important of these are the emergence of La Blanca as a regional center and the formation of a settlement hierarchy that includes over 50 sites. X-ray fluorescence reveals that the material used to make the blades comes from three geological sources: El Chayal, Ixtepeque, and San Martín Jilotepque. An analysis of the source frequencies through time reveals that El Chayal obsidian dominates the assemblage throughout the Conchas phase, with Ixtepeque being a minor source in all subphases. San Martín Jilotepeque obsidian is absent in the Conchas A and B subphases, but is present in Conchas C and D. This latter occurrence may signal a shift in trade relationships, but the overall pattern suggests that exchange connections established in the Early Preclassic were continued during the Middle Preclassic.

The present study investigated how rural attorneys and judges attributed blame in incest cases. It was found that incest blame was multidimensional; distributed across offender, societal, situational and victim factors. In addition, male attorneys blamed the victim significantly more than female attorneys. Finally as incest blame varied, so did offender sentencing. This study has important implications regarding the treatment of incest offenders and victims within the legal system. It also calls into question the objectivity of incest offender sentencing. In light of the heinous nature of the crime of incest and the devastating long-term consequences imposed on the victim, these findings are most disturbing.

A dichotic color-naming VRT task and a dichotic digits recognition task were administered. The first required the naming of five colors paired with their backward pronunciation: the second of five nonsimilar digits. Forty-eight right-handed male and female subjects were used, controlling for the factors of sex, handedness, and familial sinistrality. A highly significant left-ear advantage was obtained, suggesting that previous results of dichotic studies may only pertain to a limited class of phenomic stimuli. Results implicate different cerebral processes in the analysis of familiar and novel auditory and phenomic stimuli.

This study was designed to identify the empirical structure of attitudes relating to attribution of blame in incest. A second purpose was to determine how variables such as gender, physically abused status, and sexually abused status influence the attribution of blame in incest. A sample of 201 male and 211 female college students was administered the Jackson Incest Blame Scale. Four factors emerged from the factor analysis of the total sample supporting the hypothesis that attribution of blame in incest is a multidimensional construct including victim, offender, situational, and societal factors. A difference in the level of victim blame was found between male and female samples. Results are discussed with regard to their implications for further research and training. Other potential uses of the Jackson Incest Blame Scale are suggested.

This study examined the attribution of blame in rape among mental health professionals from one state. Thirty-eight professionals (76% of the total population) completed the Attribution of Rape Blame Scale, a 20-item questionnaire reflecting different ways people account for rape. The responses were factor analyzed yielding four clear factors: Societal Blame, Victim Blame, Assailant Blame, and Sociological Status Blame. Analyses of variance were then performed on the participants' four factor scores to determine if there were differences in blame attribution across age or gender of respondents. The only significant finding was a gender difference on the societal blame factor. Results of the factor analysis, ANOVAs as well as implications for training of professionals are discussed.