Sustained impact of a short small group course with systematic feedback in addition to regular clinical clerkship activities on musculoskeletal examination skills-a controlled study.

BACKGROUND The discrepancy between the extensive impact of musculoskeletal complaints and the common deficiencies in musculoskeletal examination skills lead to increased emphasis on structured teaching and assessment. However, studies of single interventions are scarce and little is known about the time-dependent effect of assisted learning in addition to a standard curriculum. We therefore evaluated the immediate and long-term impact of a small group course on musculoskeletal examination skills. METHODS All 48 Year 4 medical students of a 6 year curriculum, attending their 8 week clerkship of internal medicine at one University department in Berne, participated in this controlled study. Twenty-seven students were assigned to the intervention of a 6×1 h practical course (4-7 students, interactive hands-on examination of real patients; systematic, detailed feedback to each student by teacher, peers and patients). Twenty-one students took part in the regular clerkship activities only and served as controls. In all students clinical skills (CS, 9 items) were assessed in an Objective Structured Clinical Examination (OSCE) station, including specific musculoskeletal examination skills (MSES, 7 items) and interpersonal skills (IPS, 2 items). Two raters assessed the skills on a 4-point Likert scale at the beginning (T0), the end (T1) and 4-12 months after (T2) the clerkship. Statistical analyses included Friedman test, Wilcoxon rank sum test and Mann-Whitney U test. RESULTS At T0 there were no significant differences between the intervention and control group. At T1 and T2 the control group showed no significant changes of CS, MSES and IPS compared to T0. In contrast, the intervention group significantly improved CS, MSES and IPS at T1 (p < 0.001). This enhancement was sustained for CS and MSES (p < 0.05), but not for IPS at T2. CONCLUSIONS Year 4 medical students were incapable of improving their musculoskeletal examination skills during regular clinical clerkship activities. However, an additional small group, interactive clinical skills course with feedback from various sources, improved these essential examination skills immediately after the teaching and several months later. We conclude that supplementary specific teaching activities are needed. Even a single, short-lasting targeted module can have a long lasting effect and is worth the additional effort.

Search for satellites near comet 67P/Churyumov-Gerasimenko using Rosetta/OSIRIS images

Context. The European Space Agency Rosetta mission reached and started escorting its main target, the Jupiter-family comet 67P/Churyumov-Gerasimenko, at the beginning of August 2014. Within the context of solar system small bodies, satellite searches from approaching spacecraft were extensively used in the past to study the nature of the visited bodies and their collisional environment. Aims. During the approaching phase to the comet in July 2014, the OSIRIS instrument onboard Rosetta performed a campaign aimed at detecting objects in the vicinity of the comet nucleus and at measuring these objects' possible bound orbits. In addition to the scientific purpose, the search also focused on spacecraft security to avoid hazardous material in the comet's environment. Methods. Images in the red spectral domain were acquired with the OSIRIS Narrow Angle Camera, when the spacecraft was at a distance between 5785 km and 5463 km to the comet, following an observational strategy tailored to maximize the scientific outcome. From the acquired images, sources were extracted and displayed to search for plausible displacements of all sources from image to image. After stars were identified, the remaining sources were thoroughly analyzed. To place constraints on the expected displacements of a potential satellite, we performed Monte Carlo simulations on the apparent motion of potential satellites within the Hill sphere. Results. We found no unambiguous detections of objects larger than similar to 6 m within similar to 20 km and larger than similar to 1 m between similar to 20 km and similar to 110 km from the nucleus, using images with an exposure time of 0.14 s and 1.36 s, respectively. Our conclusions are consistent with independent works on dust grains in the comet coma and on boulders counting on the nucleus surface. Moreover, our analysis shows that the comet outburst detected at the end of April 2014 was not strong enough to eject large objects and to place them into a stable orbit around the nucleus. Our findings underline that it is highly unlikely that large objects survive for a long time around cometary nuclei.

Health, education and community: Assets and needs of a small urban community in north east Tamaulipas, Mexico: A community based participatory research assessment

This study explored the health, education, social assets, needs, attitudes, and behaviors of residents of Ferrocarril #4, a small urban community in Tamaulipas, Mexico. A collaborative Participatory Action Research approach was used to emphasize community involvement. Using Triangulation to ensure validity, qualitative methods included key informant in depth interviews, participant observation and participatory discussion groups with women and men. A personal interview with a probability sample of women was done. The median age of interviewees was 37 years. The majority was married or had a partner. Over half of respondents completed grades 6-9. Employed women (25%) earned a median weekly salary equivalent to ∼56 USD. Women with health insurance (67.7%) were covered mainly through Social Security and Seguro Popular. One in 5 reported bad health. Barriers to care were primarily money and transportation. To improve health care, women wanted a full service clinic in or close to the community and affordable health care. Socially, 28% of respondents had no close friends in the community and most did not participate in beneficial community activities. Many women did not socialize with others and help from neighbors was situational. Primary school teachers lacked parental support and it interfered with classroom efforts. Healthy community discussion groups focused on personal and environmental hygiene and safety. Valuable assets exist in the community. To date, collaborative efforts resulted in a school First Aid station, a school nurse visit weekly, posting of emergency contact phone numbers in the school and community center, and development of a student health information form. ^