A clinical performance exercise for medicine--pediatrics residents emphasizing complex psychosocial skills.

PURPOSE: To assess the skills of internal medicine-pediatrics (med-peds) residents in evaluating and counseling patients with complex psychosocial problems using a clinical performance exercise (CPE). METHOD: The authors designed a 13-station CPE [nine standardized-patient (SP) stations and four non-SP stations]. Eight of the SP stations focused on counseling or assessing complex psychosocial needs, and three were videotaped and analyzed for specific verbal and nonverbal communication skills. Residents completed a written task for each station and SPs completed a checklist on interviewing and communication skills and a 52-item patient's-satisfaction survey. All first- and third-year residents (n = 25) from two academic years participated. RESULTS: The range of the average scores on the nine SP stations was 43-75%. The residents performed better with common problems (newborn hospital discharge instructions and cardiac risk-factor counseling) than with more complex problems that are less often encountered in the institution (HIV counseling), or problems less often recognized (adult survivor of childhood sexual abuse). As expected, third-year residents scored better than did first-year residents on the written "plan" part of the SP stations and on the non-SP stations. Third-year and first-year residents had similar scores, however, on measures of verbal and nonverbal communication and patient's satisfaction, and for gathering data and providing information. CONCLUSION: This is the first performance-based evaluation of residents in a combined med-peds residency program. The stations addressed more complex clinical skills than those reported for objective structured clinical evaluations of residents.

Comparison of quantitative polymerase chain reaction, acid fast bacilli smear, and culture results in patients receiving therapy for pulmonary tuberculosis.

Quantitative-competitive polymerase chain reaction (QPCR) was performed on serial sputum samples from 22 consecutive cases of acid fast bacilli (AFB) smear-positive pulmonary tuberculosis. Of 94 specimens, 55, 72, and 83% were positive by culture, AFB smear, and QPCR, respectively. Of 52 culture-positive specimens, 6% were negative by PCR, and 13% were negative by AFB smear. Of 42 culture-negative specimens, AFB smear and QPCR were positive in 55 and 61%, respectively. AFB smear and QPCR results were strongly correlated (r = 0.75, p < 0.001), but each correlated less strongly with culture (r = 0.54, p < 0.005 for smear and r = 0.52, p < 0.005 for QPCR). When patients were classified by microbiologic response, responders tended to have less DNA in their sputum and shorter time to a negative PCR result compared to nonresponders. These data do not suggest a great advantage of QPCR over AFB smear for predicting culture results in patients with pulmonary tuberculosis.

Scientific investigations at a lunar base.

Scientific investigations to be carried out at a lunar base can have significant impact on the location, extent, and complexity of lunar surface facilities. Among the potential research activities to be carried out are: (1) Lunar Science: Studies of the origin and history of the Moon and early solar system, based on lunar field investigations, operation of networks of seismic and other instruments, and collection and analysis of materials; (2) Space Plasma Physics: Studies of the time variation of the charged particles of the solar wind, solar flares and cosmic rays that impact the Moon as it moves in and out of the magnetotail of the Earth; (3) Astronomy: Utilizing the lunar environment and stability of the surface to emplace arrays of astronomical instruments across the electromagnetic spectrum to improve spectral and spatial resolution by several orders of magnitude beyond the Hubble Space Telescope and other space observatories; (4) Fundamental physics and chemistry: Research that takes advantage of the lunar environment, such as high vacuum, low magnetic field, and thermal properties to carry out new investigations in chemistry and physics. This includes material sciences and applications; (5) Life Sciences: Experiments, such as those that require extreme isolation, highly sterile conditions, or very low natural background of organic materials may be possible; and (6) Lunar environmental science: Because many of the experiments proposed for the lunar surface depend on the special environment of the Moon, it will be necessary to understand the mechanisms that are active and which determine the major aspects of that environment, particularly the maintenance of high-vacuum conditions. From a large range of experiments, investigations and facilities that have been suggested, three specific classes of investigations are described in greater detail to show how site selection and base complexity may be affected: (1) Extended geological investigation of a complex region up to 250 kilometers from the base requires long range mobility, with transportable life support systems and laboratory facilities for the analysis of rocks and soil. Selection of an optimum base site would depend heavily on an evaluation of the degree to which science objectives could be met. These objectives could include lunar cratering, volcanism, resource surveys or other investigations; (2) An astronomical observatory initially instrumented with a VLF radio telescope, but later expanding to include other instruments, requires site preparation capability, "line shack" life support systems, instrument maintenance and storage facilities, and sortie mode transportation. A site perpetually shielded from Earth is optimum for the advanced stages of a lunar observatory; (3) an experimental physics laboratory conducting studies requiring high vacuum facilities and heavily instrumented experiments, is not highly dependent on lunar location, but will require much more flexibility in experiment operation and EVA capability, and more sophisticated instrument maintenance and fabrication facilities.

Lunar soil: size distribution and mineralogical constituents.

The lunar soil collected by Apollo 11 consists primarily of submillimeter material and is finer in grain size than soil previously recorded photographically by Surveyor experiments. The main constituents are fine-grained to glassy rocks of basaltic affinity and coherent breccia of undetermined origin. Dark glass, containing abundant nickel-iron spheres, coats many rocks, mineral, and breccia fragments. Several types of homogeneous glass occur as fragments and spheres. Colorless spheres, probably an exotic component, are abundant in the fraction finer than 20 microns.