Far-ultraviolet photography of orion: interstellar dust.

Wide-angle photography of Barnard's Loop Nebula suggests that the nebular emission is much less intense in the 1230- to 2100-angstrom spectral region than in the 2200- to 3200-angstrom near-ultraviolet region. This contrast may be due to differences in the absorption or scattering properties of the interstellar grains in these two wavelength regions.

X-ray Pulsar in the Crab Nebula.

X-ray pulsations have been observed in the Crab Nebula at a frequency closely matching the radio and optical pulsations. About 5 percent of the total x-ray power of the nebula appears in the pulsed component. The x-ray pulsations have the form of a main pulse and an interpulse separated by about 12 milliseconds.

A search for far-ultraviolet emissions from the lunar atmosphere.

An ultraviolet spectrometer aboard the Apollo 17 orbiting spacecraft attempted to measure ultraviolet emissions from the lunar atmosphere. The only emissions observed were from a transient atmosphere introduced by the lunar landing engine. The absence of atomic hydrogen implies that solar wind protons are converted to hydrogen molecules at the lunar surface.

Food supply and bioenergy production within the global cropland planetary boundary.

Supplying food for the anticipated global population of over 9 billion in 2050 under changing climate conditions is one of the major challenges of the 21st century. Agricultural expansion and intensification contributes to global environmental change and risks the long-term sustainability of the planet. It has been proposed that no more than 15% of the global ice-free land surface should be converted to cropland. Bioenergy production for land-based climate mitigation places additional pressure on limited land resources. Here we test normative targets of food supply and bioenergy production within the cropland planetary boundary using a global land-use model. The results suggest supplying the global population with adequate food is possible without cropland expansion exceeding the planetary boundary. Yet this requires an increase in food production, especially in developing countries, as well as a decrease in global crop yield gaps. However, under current assumptions of future food requirements, it was not possible to also produce significant amounts of first generation bioenergy without cropland expansion. These results suggest that meeting food and bioenergy demands within the planetary boundaries would need a shift away from current trends, for example, requiring major change in the demand-side of the food system or advancing biotechnologies.

Breast and testicular self-examination in primary care.

Among a random sample of Michigan family physicians, attitudes about encouraging patients to perform breast and testicular self-examination were very positive. The physicians' self-reported incorporation of such encouragement into their practices was much lower for testicular than breast self-examination. Two hundred seventy-eight randomly selected family physicians in Michigan were surveyed about their beliefs about and professional practices regarding encouraging patients to perform breast self-examination (BSE) and testicular self-examination (TSE). Attitudes were very positive about both techniques. Self-reported incorporation of patient encouragement into professional practice was much lower for TSE than for BSE. The physicians' own personal practices were similarly skewed: female physicians performed BSE for themselves far more regularly than young male physicians did TSE. The barriers they identified to incorporating encouragement into their practices were similar for testicular and breast self-examination, with lack of patient motivation the leading barrier seen.

Community partnerships: educational linkages to increase the number of primary care practitioners.

The Community Partnerships initiative is focused on the creation of academic, non-hospital community health centers shaped by people and institutions at the local level. In our view, public policy-makers need such positive ideas and programs to support--things to be for rather than against. Incessant lamenting about the problems of the health care system will change the system less than will positive programs shaped and supported by the people whose needs they serve. All of us in medical education recognize the need for change in medical education. The Community Partnerships program represents one strategy for change that brings communities directly into the sphere of influence and enables them to enhance the relevance of the educational experience for health professions students.

When do medical students become human subjects of research? The case of program evaluation.

Intense national dialogue exists around federal requirements protecting the rights of human subjects in clinical research. There is much less discussion surrounding protections for human subjects in such areas as evaluation research when the subjects are also students. Differential interpretation of 45 CFR 46 (the standing regulation on research involving human subjects) by institutional review boards (IRBs) leaves many confused about whether research using student data requires IRB review. At the heart of the uncertainty are "dual purpose activities," for example, when student data from program evaluation or routine assessments subsequently become the basis for faculty scholarship that is disseminated as "generalizable knowledge" to the community of medical educators. The authors identify two factors that should be considered as institutions develop applications and interpretations of 45 CFR 46. First, medical educators should enter into dialogues with their IRBs to become more familiar with these regulations and their application in evaluation or assessment studies. Second, for reasons of professionalism, faculty should seek opportunities to model in their role as researchers those ethical behaviors that are central to an honest relationship between physician and patient. In the educational context this means faculty disclosure of how student data may be used by faculty in their own scholarship and determination of when student consent is needed. The authors also describe how one medical school addressed this thorny challenge with assistance from the university IRB and offer suggestions to improve institutional procedures.

Multidisciplinary education outcomes of the W.K. Kellogg Community Partnerships and Health Professions Education initiative.

This evaluation highlights several points to be considered by others instituting multidisciplinary approaches to health professions education. Community-based, multidisciplinary experiences appear to reinforce support students' interests in pursuing primary care careers. The multidisciplinary, community-based approach to health professions education did not affect academic learning. Project leaders and students reported no risks in terms of board scores between CPHPE students and others in traditional programs. The multidisciplinary, community-based approach to health professions education created opportunities at some sites for students to see "team medicine" in action. It was practical and helped students to understand how they could be more effective in their roles as opposed to competitive. Students require socialization within their own individual disciplines as well as socialization across disciplines. The differences in the structures of traditional health professions education schools interfered with the development of multidisciplinary contexts for learning at some sites. Campus faculty were not necessarily socialized to engage in multidisciplinary efforts. Their disciplines generally do not recognize and reward this behavior. Early and continuous faculty development may significantly help projects to improve communication and develop a better understanding of the contexts of curricular changes across disciplines. This evaluation was exploratory. Further research is needed to better understand what forms of multidisciplinary curriculum are most effective and economically feasible, what forms survive over time, and whether the intended final outcomes of the CPHPE initiative are achieved, not only with medical students but also with the other health professions students.

The emperor's new clothes: the OSCE reassessed.

In response to increasing concerns about the prevalence of knowledge- based assessments of medical student competency, leaders in medical education have emphasized the importance of methods that quantify student performance. As a result, the use of objective structured clinical examinations (OSCEs) is viewed by many as the newest and most promising technique for assessing students' abilities. In considering the implementation of a fourth-year OSCE, faculty at the College of Human Medicine at Michigan State University became uncomfortable with some of the technical limitations of the method (limited generalizability; weak linkages to the curriculum; little opportunity provided for improvement in examinees' skills; and others), as well as the possible ramifications of such an innovation within their school's specific curricular and organizational contexts. This essay is offered as a reflection of the challenges and possible alternatives that have emerged as the faculty have considered how best to design and implement performance-based assessment within their institution. Rather than using the OSCE as a milestone marker of student performance, they consider the possibility of smaller assessment events, closely tied to the curriculum and consistent with the guiding principles of the medical school.

Evaluation and implementation of public health registries.

A rapid proliferation of registries has occurred during the last 20 years. Given the long-term commitment of resources associated with registries and limited public health funding, proposals for new registries should be carefully considered before being funded. A registry is defined as a data base of identifiable persons containing a clearly defined set of health and demographic data collected for a specific public health purpose. Criteria for evaluating whether a registry is needed, feasible, or the most effective and efficient means of collecting a specific set of health data are presented. They include an evaluation of the stated purpose; a review of the function, duration, and scope of the registry; consideration of existing alternative data sources; an assessment of the practical feasibility of the registry; the likelihood of sufficient start-up and long-term funding; and an evaluation of the cost effectiveness of the registry. Creating a public health registry is a complex process. A range of technical and organizational skills is required for a registry to be successfully implemented. Eight requirements are identified as crucial for the successful development of a new registry. They include an implementation plan, adequate documentation, quality control procedures, case definition and case-finding (ascertainment) procedures, determination of data elements, data collection and processing procedures, data access policy, and a framework for dissemination of registry data and findings.

Preventive medicine: physician practices, beliefs, and perceived barriers for implementation.

Despite increasing recognition of the need for physicians to practice preventive medicine, there is much evidence that performance is well below the ideal recommended by experts. The purpose of this study was to determine what preventive medicine activities physicians practice, whether their personal health practices and beliefs about preventive medicine correlate with professional practices of preventive medicine, and what barriers to practicing preventive medicine physicians identify. Results from a questionnaire mailed to a random sample of 430 family physicians indicated physicians practice health promotion for themselves more than revealed in earlier studies and that physicians frequently incorporate many preventive medicine activities into their professional practices. Several exceptions, however, were noted. When identifying barriers to practicing preventive medicine, respondents overwhelmingly selected lack of patient motivation more than any other factor.

Evaluating the impact on public policy of foundation-sponsored programs in the health professions.

The leaders of national philanthropic foundations have long been active in informing public policy makers about their organizations' accomplishments and lessons learned in health care and other issues. The public policy context also is seen increasingly as an important factor influencing changes in the health care market. This article outlines how public policy was monitored and evaluated in a recent initiative in health care by a prominent national foundation. The markers of policy change in the evaluation of this initiative represented a mixture of the initiative's efforts to inform policy makers, the success the participant projects had in making policy makers aware of the initiative's goals, and actual changes in policy outcomes.

When (not if) evaluation flexibility is desirable. Examples from the CPHPE initiative.

The evaluation literature often debates whether evaluators should be flexible in evaluation design and activities in order to collaborate with program directors and be responsive to programming needs. Two conditions are specified under which evaluation flexibility is not only desirable but essential. Two examples from the cluster evaluation of the W. K. Kellogg Foundation's Community Partnerships for Health Professions Education initiative are provided to illustrate why flexibility under these conditions proved to be essential. One of the examples, related to the "community" involvement in the initiative, illustrates the need for flexibility as programs experience goals clarification. The other example, related to the coincidental national health care reform efforts, illustrates the need for flexibility both to capture programs' efforts to protect their integrity and to ensure against spurious conclusions as a result of external turbulence in policy environments. How the cluster evaluation team addressed these issues is also described.

An exploratory look at hydrocarbon data from the Photochemical Assessment Monitoring Stations network.

This paper describes some characteristics of speciated nonmethane organic compound (NMOC) data collected in 1994 at five Photochemical Assessment Monitoring Stations (PAMS) and archived in the U.S. Environmental Protection Agency's Aerometric Information Retrieval System (AIRS). Topics include data completeness, distribution of individual NMOCs in concentration categories relative to minimum detectable levels, percentage of total NMOC associated with the sum of the 55 PAMS target compounds, and use of scatterplots to diagnose chromatographic misidentification of compounds. This is an early examination of a database that is expanding rapidly, and the insights presented here may be useful to both the producers and future users of the data for establishing consistency and quality control.

The transformation of laryngeal leucoplakia to cancer.

In the transformation of laryngeal keratosis to cancer what one may be witnessing is a progression from normal epithelium to keratosis without cellular atypia, through varying degrees of atypia to the stage of carcinoma-in-situ when the full thickness of the epithelium is occupied by atypical cells until finally, with breaching of the basement membrane, an invasive carcinoma occurs (Fig. 12). Although this is, in theory, an attractive sequence, in practice it seems rare to detect an alteration in the epithelium from keratosis without atypia to keratosis with atypia and furthermore most of the carcinomas which developed were not in-situ but invasive. Therefore the significant pathway is probably a change from normal non-keratinizing stratified squamous epithelium via keratosis with atypia to invasive carcinoma (Fig. 13).

Cerebrospinal fluid otorrhoea and otorhinorrhoea following closed head injury.

A discussion of acute traumatic CSF otorrhoea and otorhinorrhoea is presented. The incidence of meningeal infection is reviewed and the management of these cases is outlined with special emphasis on the indications for surgical intervention and the otological procedures available. Two patients who sustained transverse fractures of the petrous temporal bone are described in whom subsequent attacks of meningitis were prevented by a new, simple yet effective operation.

Community partnership model for health professions education.

Many health professions schools have neglected the US population's health by emphasizing acutely ill patients in hospitals, biomedical research of disease, and high technology. Because most students will eventually fill practitioner roles in primary and secondary care, it is logical that the health professions must shift their curricula's focus to prepare practitioners for the health care needs of the community. The Community Partnership Model is one approach that focuses on public health care needs by educating students in multiprofessional teams in a new organizational structure known as the academic, community-based, primary health care center. This partnership between academic institutions and communities is designed to shift the educational and socializing activities of health professions training outside hospitals to the community setting where research, teaching, and service take place in one structure.

Gender-specific differences in family practice graduates.

In 1979 the American Academy of Family Physicians (AAFP) conducted a study of family practice residency graduates to develop a database of personal and professional characteristics. Questionnaires were sent to 4,295 physicians, and results were based on a total of 3,021 respondents. Female physicians made up 7.1 percent of this sample; however, analysis of the data at that time did not distinguish between men and women. The current study is a reanalysis of the data collected by the AAFP to include comparisons of male and female respondents and to determine whether gender differences that have been reported in the literature continue to persist. Results indicate that gender differences did persist in four of six areas studied; however, these differences were not so large as described in earlier studies. Areas in which differences were found are demographics, family structure, practice arrangements, and salary. Notable differences were not found in the areas of career choice development and professional activities. Now that the number of female physicians approaches 20 percent of all new family physicians, further data collection efforts are needed to determine their impact on family practice as a specialty.

A comparison of two antismoking interventions among pregnant women in eleven private primary care practices.

Despite the dangers of smoking during pregnancy having been widely publicized, few studies have actually examined the effectiveness of antismoking interventions among pregnant women in the private primary care obstetric setting. A randomized experimental study involving 24 private physicians and 109 pregnant smokers was conducted comparing the American Lung Association's Because You Love Your Baby smoking intervention (ALA) to a standard-of-care protocol (non-ALA). The non-ALA protocol was based upon the smoking interventions that study physicians said they commonly used among pregnant women. Self-reported smoking rates were obtained by questionnaire at the first prenatal visit, at 32 to 36 weeks' gestation, and at the six-week postpartum visit. By the time of the first prenatal visit, both groups reduced by half the number of cigarettes smoked. By 32 to 36 weeks, the groups decreased the daily average by an additional 2.3 (ALA) and 1.8 (non-ALA) cigarettes, a nonsignificant difference between the groups. Fifteen (28 percent) of the ALA group compared with 9 (16 percent) of the non-ALA group reported quitting at the 32- to 36-week visit (P = .10). Only 9 percent of the ALA group and 10 percent of the non-ALA were nonsmokers at the postpartum visit. Pregnancy alone is a powerful motivator for women to decrease their smoking. Although the difference between the ALA and non-ALA protocols did not attain statistical significance, the percentage of those who quit was comparable to the results obtained in other controlled trials. The ALA Because You Love Your Baby protocol should be used until more effective methods are available.