A new high-pressure high-temperature deformation apparatus to study the brittle to ductile transition in rocks.

Understanding the micro-mechanisms underlying the localized-ductile transition (LDT) as well as the brittle-plastic transition (BPT) has become crucial for our wider understanding of crustal processes and seismicity. Given how difficult in situ observations of these transitions are to perform, laboratory experiments might be our only way to investigate the processes active under these conditions (high T and high P). Here, we present Triaxial AppaRatus for GEoThermal energy, a new gas-based triaxial apparatus located at EPFL in Switzerland that was specifically designed to operate under conditions where both the LDT and BPT can occur in geomaterials. We show that the machine is capable of deforming rock samples at confining pressures of up to 400 MPa, temperatures of up to 800 °C, and pore pressures (liquid or gas) of up to 300 MPa while keeping the temperature gradient along samples of 40 mm in length and 20 mm in diameter minimal (less than 30 at 700 °C). Most importantly, the maximum load is 1000 kN (stresses as high as 2.2 GPa on 24 mm samples and 3 GPa on 20 mm samples), allowing for the deformation of very competent rock samples. Moreover, during deformation, the pair of syringe pore pressure pumps allow for continuous permeability or dilatancy recording. We benchmarked our machine against existing data in the literature and show that it accurately and precisely records stress, strain, permeability, pressure, and temperature.

How clinical teachers perceive the doctor-patient relationship and themselves as role models.

PURPOSE: Teachers must be good role models. In order to act the part, however, they must reflect on and articulate the attitudes and behaviors they wish to convey. The aim of this study was to describe how clinicians who teach clerks and residents represent the doctor-patient relationship and how they see themselves as role models for this relationship. METHOD: In the fall of 1997, 28 clinical teachers in family medicine and various medical and surgical specialties at Laval University Faculty of Medicine participated in individual semistructured interviews regarding their perceptions of the doctor-patient relationship and how it is taught. The interviews were conducted by a trained research assistant and the content of the interviews was coded by three independent observers, who then performed a qualitative analysis. RESULTS: The clinical teachers identified competencies associated with the doctor-patient relationship that differed in complexity and specificity. Paramount among these competencies were the ability to conduct interviews effectively and politely, the ability to understand and involve the patient, and, in some cases, the ability to handle emotionally-charged situations. The clinical teachers tended to demand more of their students in doctor-patient relationships than they did of themselves. Lack of time and a negative attitude toward the doctor-patient relationship, on the part of both teachers and students, were obstacles to teaching and learning this essential competency, even to the point of making it difficult for teachers to demonstrate and supervise these competencies during their daily clinical activities. CONCLUSIONS: Most of the teachers had difficulty describing situations or behaviors in which they modeled the doctor-patient relationship. Being a role model requires a fairly precise idea of what one is modeling and accomplishing, and what one wants trainees to understand about the relationship. Efforts must be made to help clinical teachers to integrate the doctor-patient relationship into their clinical supervision and to provide them with tools to demonstrate this relationship effectively.

Learning surgical technical skills.

Training issues raised by the recent introduction of laparoscopic surgical techniques led to this analysis of motor-skill learning principles as they apply specifically to the learning of technical surgical skills. The most accepted theories of motor-skill learning are presented, not as opposing views, but as complementary constructs. The behaviourist school of thought's main contribution is the executive routine or knowledge of the steps of a procedure. Schmidt's schema theory and MacKay's node theory suggest that perceptual information may play an important role in the quality of the performance. The conclusions reached from neuropsychologic testing experiments on surgeons are that visuospatial perceptual skills (the ability to represent mentally the physical environment and the movement to be performed) are the major determinants of surgical technical performance. Learners should make use of learning strategies that improve mental representation of a skill and the corresponding anatomy. Specific strategies discussed include imagery, mental practice and a systematic review of performance that focuses on the perceptual feedback received by the learner.

Taxonomy of difficulties in general practice.

A questionnaire combining qualitative and quantitative methods was used to compile a taxonomy of the difficulties experienced by general practitioners in their practices. Difficulties are grouped in 11 categories, ranging from clinical diagnosis to physicians' personal feelings. The taxonomy can be used as a guide for planning medical education or as a starting point for further research in general practice.

Why are clinical problems difficult? General practitioners' opinions concerning 24 clinical problems.

This study was conducted to describe the difficulties perceived by general practitioners concerning 24 common clinical problems and to compare their perceptions with those of faculty members in family medicine. A random sample of 467 general practitioners and all 182 faculty members in family medicine in Quebec were sent one of four open-ended questionnaires, each of which dealt with six clinical problems; 214 general practitioners and 114 faculty members participated. A total of 5111 difficulties were reported; the number reported by each subject varied from 0 to 13 (mean 2.6 [standard deviation 2.09]) per problem. The problems that generated the most difficulties were depression, confusion in the elderly, chronic back pain, loss of autonomy in the elderly and sexually transmitted disease. The most frequent difficulties were with the patient's noncompliance with treatment, clinical diagnosis, failure of a specific treatment, inadequate health care resources and the physician's own emotional reactions. The difficulties for each problem were the same in the two groups 70% of the time. Physician's perceptions of their difficulties can be useful in the planning of initial training and continuing medical education.

[Comparison of the diagnostic performance of students of the old and new medical curriculum at the Laval University]. / Comparaison de la performance diagnostique des étudiants de l'ancien et du nouveau cours de médecine de l'Université Laval.

In the Fall of 1982, the "Université Laval" School of Medicine inaugurated a new undergraduate curriculum consisting primarily in the introduction of problem-based learning to foster the development of clinical reasoning. The purpose of the study was to compare the diagnostic performance of the students of the old (n = 118) and the new (n = 120) program. The measurement instrument consisted of 12 short clinical vignettes. There is no significant difference in the performance of the students from the two programs. In spite of these results, it is advocated to wait before initiating yet another curriculum reform or reversal. Finally and for both classes of students, their performance varied significantly from hospital to hospital. A number of suggestions are made to better standardize the quality of clinical teaching across the different hospital settings.

Patient-management problems as a learning tool for the continuing medical education of general practitioners.

The value of Patient-Management Problems (PMPs as a learning tool for continuing medical education was studied by using two frequently seen cardiovascular problems (angina and high blood pressure) and a province-wide sample of full-time general practitioners. The results indicate that PMPs can be a motivating and effective means of CME for the general practitioner; that knowledge was gained through the successive resolution of three pmps; that corrective feedback enhanced learning; and, that most of the knowledge gained on the paper cases was transferred to practice as reported by the participants on a questionnaire. Furthermore, while cueing may be a confounding factor when PMPs are used for evaluation purposes, it was shown to facilitate learning in the present learning context.

[Not Available]. / Les infections: Un livre de médecine conçu et structure selon la démarche de l'omnipraticien.

A book on infectious diseases based directly on clinical practice has been produced for family physicians. It identifies clear objectives oriented towards resolution of clinical problems. The book is organized on four fundamental principles: 1. to respond to pertinent problems in the practice of general medicine; 2. to respect the process of the family doctor's clinical practice, taking into account the means at his disposal; 3. to integrate the necessary basic science with the understanding of clinical and therapeutic decisions; 4. to limit the extent of basic and clinical knowledge, taking into account the nature and degree of complexity of the family doctor's decisions. Examples of these principles are given.

[Rahnella aquatilis, a new member of the Enterobacteriaceae (author's transl)]. / Rahnella aquatilis, nouveau membre de la famille des Enterobacteriaceae.

A DNA-DNA hybridization study was carried out to determine the taxonomic position of a new group of enterobacteria (group H2) previously studied by numerical taxonomy. All the strains of this group revealed relatively high reassociation binding ratios with the centrotype; 82% of the strains of the group showed more than 69% of reassociation with the centrotype. In spite of numerical taxonomy conclusions, there was no genetic relationship with the species Enterobacter cloacae (higher reassociation binding ratio: 37%). No significant genetic relationship with the other groups of enterobacteria was found. Rahnella aquatilis was defined from phenotypic and genetic data. The strain 133 (CIP 78-65) is proposed as type strain of the species.