Cocaine and HIV are independently associated with neural activation in response to gain and loss valuation during economic risky choice.

Stimulant abuse is disproportionately common in HIV-positive persons. Both HIV and stimulants are independently associated with deficits in reward-based decision making, but their interactive and/or additive effects are poorly understood despite their prevalent co-morbidity. Here, we examined the effects of cocaine dependence and HIV infection in 69 adults who underwent functional magnetic resonance imaging while completing an economic loss aversion task. We identified two neural networks that correlated with the evaluation of the favorable characteristics of the gamble (i.e. higher gains/lower losses: ventromedial prefrontal cortex, anterior cingulate, anterior and posterior precuneus and visual cortex) versus unfavorable characteristics of the gamble (i.e. lower gains/higher losses: dorsal prefrontal, lateral orbitofrontal, posterior parietal cortex, anterior insula and dorsal caudate). Behaviorally, cocaine and HIV had additive effects on loss aversion scores, with HIV-positive cocaine users being the least loss averse. Cocaine users had greater activation in brain regions that tracked the favorability of gamble characteristics (i.e. increased activation to gains, but decreased activation to losses). In contrast, HIV infection was independently associated with lesser activation in regions that tracked the unfavorability of gamble characteristics. These results suggest that cocaine is associated with an overactive reward-seeking system, while HIV is associated with an underactive cognitive control system. Together, these alterations may leave HIV-positive cocaine users particularly vulnerable to making unfavorable decisions when outcomes are uncertain.

Impact of the Radiology Scholars Certificate Program: Does It Persist Years After Program Completion?

RATIONALE AND OBJECTIVE: The Radiology Scholars Certificate Program (RSCP) is an elective course for preclinical medical students which aims to improve radiology knowledge, dispel misconceptions regarding the field, and train future clinicians who have a greater understanding of the scope of the field. Previously, we have shown that students demonstrate improved knowledge of radiological topics as well as improved perception of radiology as a field after completing the program. In this study we attempt to determine whether these effects persist up to two years following program completion. MATERIAL AND METHODS: A two-part questionnaire was sent to all third- and fourth-year medical students at our institution in order to assess their objective ability to select appropriate imaging studies and interpret basic imaging findings, as well as evaluate their subjective attitudes and comfort level with radiology topics. Statistical analysis compared students who completed the RSCP to non-RSCP controls. RESULTS: A total of 54 students responded to the survey (34 had previously completed the RSCP). RSCP participants were significantly more likely to select appropriate imaging workups and correctly interpret imaging findings compared to controls (p < 0.001). Furthermore, RSCP participants reported significantly higher confidence in their ability to order imaging (p < 0.001) and significantly higher satisfaction with their radiology education (p < 0.001). RSCP participants were less likely to agree with negative stereotypes regarding radiology and reported more favorable perceptions of the field. CONCLUSION: Preclinical radiology-driven medical student education programs like the RSCP offer the potential for lasting improvements in students' understanding of and attitudes toward radiology as a field. We believe that such programs will help address challenges facing the field of radiology regarding recruitment, diversity, and interdisciplinary understanding.