Impacts of studying in a regional medical campus on practice location

Background: New Brunswick, a bilingual Canadian province without a medical school, negotiated an agreement in 1967 in which places were reserved for francophone medical students in the province of Quebec. In 2006, the Centre de Formation Médicale du Nouveau-Brunswick (CFMNB), a regional medical campus (RMC) of Université de Sherbrooke for its provincial francophone medical students, was established to increase the likelihood of graduates setting up practice in the region. Practice locations of the initial 5 cohorts of CFMNB were analysed to compare data with francophone students trained in Quebec.Methods: Practice locations were determined through Scott’s Medical Database and provincial public registries.  Chi-square and relative risk probability were used to examine the relationship between training location and practice location.Results: Doctors trained at CFMNB were 1.4 times more likely to be practicing in Atlantic Canada compared to those trained at Université de Sherbrooke (main campus) before 2006. Those trained at CFMNB were 1.3 times more likely to go on to practice in the region compared to those trained at Université Laval or Université de Montréal. Conclusion: This study supports the hypothesis that individuals completing a medical program in a Francophone RMC in New Brunswick increases the likelihood of them later practicing in the province or in the wider Atlantic Canada region._______Contexte: Le Nouveau-Brunswick, une province canadienne bilingue ne possédant pas de Faculté de médecine, a négocié en 1967 une entente avec le Québec afin de réserver des places pour ses étudiants francophones souhaitant étudier la médecine.  En 2006, le Centre de formation médicale du Nouveau-Brunswick (CFMNB), un campus médical régional (CMR) de l’Université de Sherbrooke, a été créé afin de permettre aux Néo-Brunswickois d’étudier la médecine en français dans leur province.  L’un des objectifs principaux du CFMNB était d’augmenter les probabilités que les diplômés en médecine s’établissent dans la région.  Les lieux de pratique des médecins issus des 5 premières cohortes du CFMNB ont été analysés afin de les comparer avec ceux des médecins francophones d’origine néo-brunswickoise formés au Québec.Méthodes: Les lieux de pratique ont été déterminés via le répertoire des médecins Scott’s et les registres publics provinciaux.  Des tests de Chi carré et des analyses de risque ont été conduits afin d’étudier la relation entre le lieu de formation et le lieu de pratique.Résultats: Les médecins formés au CFMNB étaient 1.4 fois plus enclins à travailler au Canada atlantique comparativement à ceux formés au campus principal de l’Université de Sherbrooke avant 2006.  Les médecins formés au CFMNB étaient également 1.3 fois plus enclins à travailler dans la région que ceux formés à l’Université Laval ou à l’Université de Montréal.Conclusion: Cette étude supporte l’hypothèse selon laquelle le fait de compléter un programme de médecine francophone dans un CMR francophone au Nouveau-Brunswick augmente les chances de pratiquer au Nouveau-Brunswick ou dans la grande région du Canada atlantique.

Les décisions spontanées d’élèves de sixième année dans le contexte d’un projet de développement durable

Les individus influencent la qualité de l’environnement dans leurs rôles de citoyens, d’investisseurs et de membres d’organisations effectuant des choix environnementaux. Or, la prise de décision, en environnement et particulièrement chez les jeunes, est encore peu comprise. La recherche présentée avait pour objectif de décrire le processus décisionnel spontané d’élèves de 10-11 ans, dans le contexte d’un développement résidentiel viable. Les chercheuses voulaient comprendre de quelle façon les élèves représentaient spontanément leur processus décisionnel et les raisons qui motivaient leurs choix. L’approche pédagogique choisie pour le projet en classe a été celle de la simulation globale. Les élèves ont été invités à jouer les rôles des futurs citoyens du développement résidentiel et à prendre des décisions concernant les aménagements à prévoir sur leur propriété. Les outils de collecte de données ont été le journal réflexif des élèves et le journal de la chercheuse. Dans les résultats, on observe que les élèves représentent leur processus décisionnel de façon variée (textes, schémas, listes, tableaux, dessins et plans) et qu’ils ont recours à divers modes décisionnels : la compilation des avantages semblables, le choix par élimination, la liste de comparaison des avantages et inconvénients, le choix par compatibilité des options, le choix basé sur l’argumentation, celui basé sur la description et le choix par visualisation du résultat anticipé. La volonté d’être entouré d’un environnement esthétiquement agréable et aménagé selon ses préférences personnelles sont les principales sources de motivation des élèves dans leurs choix d’aménagement.Individuals influence the quality of the environment through their roles as citizens, investors, and members of organizations making choices that impact the environment. Yet, decision making regarding the environment, especially among young people, is not well understood. This study sought to describe the spontaneous decision-making process of 10-11 years old students, in the context of a sustainable residential neighborhood. The researchers aimed to understand how the students would spontaneously represent their decision-making process and the reasons that motivated their choices. Through their participation in a global simulation, the students were given fictitious identity, representing the future citizens of the residential neighborhood, and had to make decisions concerning the landscaping of their properties. The students’ reflexive journals and the researcher’s journal were the tools used to collect the data. In our results, we observed that the students used a variety of representations of their decision process (texts, schemata, lists, tables, drawings and plans) and a variety of decision modes : the compilation of similar advantages, the choice by elimination, the list of comparison of advantages and disadvantages, the choice based on compatibility of the options, the choice based on argumentation, the choice base on description, and the choice by visualization of the anticipated result. The students’ will of being surrounded by an environment that is visually pleasant and corresponds to their personal preferences are the main motivations behind their choices

Cocaine Intoxication and Thyroid Storm: Similarity in Presentation and Implications for Treatment

Introduction: Cocaine, a widely used sympathomimetic drug, causes thermoregulatory and cardiac manifestations that can mimic a life-threatening thyroid storm. Case: A man presented to the emergency department requesting only cocaine detoxification. He reported symptoms over the last few years including weight loss and diarrhea, which he attributed to ongoing cocaine use. On presentation he had an elevated temperature of 39.4°C and a HR up to 130 beats per minute. Examination revealed the presence of an enlarged, non-tender goiter with bilateral continuous bruits. He was found to have thyrotoxicosis by labs and was treated for a thyroid storm and cocaine intoxication concurrently. The patient was ultimately diagnosed with Graves disease and treated with Iodine-131 therapy. Conclusion: Cocaine use should be considered a possible trigger for thyroid storm. Recognition of thyroid storm is critical because of the necessity for targeted therapy and the significant mortality associated with the condition when untreated.\u2

Irdisches Himmelreich. Die 'Stitshütte' (Ex 25–40*)als theologische Metapher

Die biblische Erzählung von der Errichtung des Sinaiheiligtums, der sogenannten Stitshütte, im Buch Exodus Kap 25–40 wird als „ausgeführte Metapher“ im Sinne Paul Ricoeurs sowie als „absolute Metapher“ im Sinne Hans Blumenbergs gedeutet. Das heilige Zelt und seine sakrale Ausstattung, das die Israeliten auf Anweisung Gottes an Mose herzustellen haben, soll Gott als ‚Wohnung‘ bei den Israeliten dienen. Der Raum und die Räume des Heiligtums werden aus unterschiedlichen Perspektiven entwickelt. Der metaphorische Charakter der Erzählung erweist sich dadurch, dass das ‚Wohnen Gottes‘ nur in Spannung zwischen göttlichem und menschlichem Bereich dargestellt werden kann. Der Raum des Heiligtums vereinigt gegensätzliche und zugleich komplementäre Weisen der Präsenz Gottes unter den Menschen.The biblical narrative of the creation of the Sinai sanctuary, called the tabernacle, in the book of Exodus chapters 25-40 is interpreted as “living metaphor” in the sense of Paul Ricoeur as well as “absolute metaphor” in the sense of Hans Blumenberg. The tabernacle and its sacred furniture have to be built by the Israelites on God’s instruction. It serves God as ‘dwelling’ among the Israelites. The space and the rooms of the sanctuary are developed from different perspectives. The metaphorical character of the narrative is proved by the fact that the ‘dwelling of God’ can only be represented in the tension between divine and human realms. The space of the sanctuary unites opposing yet complementary ways of God’s presence among mankind

PMMA Third-Body Wear after Unicondylar Knee Arthroplasty Decuples the UHMWPE Wear Particle Generation In Vitro

Introduction. Overlooked polymethylmethacrylate after unicondylar knee arthroplasty can be a potential problem, since this might influence the generated wear particle size and morphology. The aim of this study was the analysis of polyethylene wear in a knee wear simulator for changes in size, morphology, and particle number after the addition of third-bodies. Material and Methods. Fixed bearing unicondylar knee prostheses (UKA) were tested in a knee simulator for 5.0 million cycles. Following bone particles were added for 1.5million cycles, followed by 1.5million cycles with PMMA particles. A particle analysis by scanning electron microscopy of the lubricant after the cycles was performed. Size and morphology of the generated wear were characterized. Further, the number of particles per 1 million cycles was calculated for each group. Results. The particles of all groups were similar in size and shape. The number of particles in the PMMA group showed 10-fold higher values than in the bone and control group (PMMA: 10.251 x 10(12); bone: 1.145x10(12); control: 1.804x10(12)). Conclusion. The addition of bone or PMMA particles in terms of a third-body wear results in no change of particle size and morphology. PMMA third-bodies generated tenfold elevated particle numbers. This could favor an early aseptic loosening

Histopathological Analysis of PEEK Wear Particle Effects on the Synovial Tissue of Patients

Introduction. Increasing interest developed in the use of carbon-fiber-reinforced-poly-ether-ether-ketones (CFR-PEEK) as an alternative bearing material in knee arthroplasty. The effects of CFR-PEEK wear in in vitro and animal studies are controversially discussed, as there are no data available concerning human tissue. The aim of this study was to analyze human tissue containing CFR-PEEK as well as UHMWPE wear debris. The authors hypothesized no difference between the used biomaterials. Methods and Materials. In 10 patients during knee revision surgery of a rotating-hinge-knee-implant-design, synovial tissue samples were achieved (tibial inserts: UHMWPE;bushings and flanges: CFR-PEEK). One additional patient received revision surgery without any PEEK components as a control. The tissue was paraffin-embedded, sliced into 2 mu m thick sections, and stained with hematoxylin and eosin in a standard process. A modified panoptical staining was also done. Results. A "wear-type" reaction was seen in the testing and the control group. In all samples, the UHMWPE particles were scattered in the tissue or incorporated in giant cells. CFR-PEEK particles were seen as conglomerates and only could be found next to vessels. CFR-PEEK particles showed no giant-cell reactions. In conclusion, the hypothesis has to be rejected. UHMWPE and PEEK showed a different scatter-behavior in human synovial tissue

Increase in the Tibial Slope Reduces Wear after Medial Unicompartmental Fixed-Bearing Arthroplasty of the Knee

Introduction. Unicompartmental arthroplasty of the knee in patients with isolated medial osteoarthritis gives good results, but survival is inferior to that of total knee prosthesis. Knees may fail because positioning of the prosthesis has been suboptimal. The aim of this study was to investigate the influence of the tibial slope on the rate of wear of amedial fixed-bearing unicompartmental knee arthroplasty. Materials and Methods. We simulated wear on a medial fixed-bearing unicompartmental knee prosthesis (Univation) in vitro with a customised, four-station, and servohydraulic knee wear simulator, which exactly reproduced the walking cycle (International Organisation for Standardisation (ISO) 14243-1: 2002(E)). The medial prostheses were inserted with 3 different posterior tibial slopes: 0 degrees, 4 degrees, and 8 degrees (n = 3 in each group). Results. The wear rate decreased significantly between 0 degrees and 4 degrees slope from 10.4 (SD 0.62) mg/million cycles to 3.22 (SD 1.71) mg/million cycles. Increasing the tibial slope to 8 degrees did not significantly change the wear rate. Discussion. As an increase in the tibial slope reduced the wear rate in a fixed-bearing prosthesis, a higher tibial slope should be recommended. However, other factors that are influenced by the tibial slope (e.g.,the tension of the ligament) must also be considered

Increase in the Tibial Slope Reduces Wear after Medial Unicompartmental Fixed-Bearing Arthroplasty of the Knee

Introduction. Unicompartmental arthroplasty of the knee in patients with isolated medial osteoarthritis gives good results, but survival is inferior to that of total knee prosthesis. Knees may fail because positioning of the prosthesis has been suboptimal. The aim of this study was to investigate the influence of the tibial slope on the rate of wear of amedial fixed-bearing unicompartmental knee arthroplasty. Materials and Methods. We simulated wear on a medial fixed-bearing unicompartmental knee prosthesis (Univation) in vitro with a customised, four-station, and servohydraulic knee wear simulator, which exactly reproduced the walking cycle (International Organisation for Standardisation (ISO) 14243-1: 2002(E)). The medial prostheses were inserted with 3 different posterior tibial slopes: 0 degrees, 4 degrees, and 8 degrees (n = 3 in each group). Results. The wear rate decreased significantly between 0 degrees and 4 degrees slope from 10.4 (SD 0.62) mg/million cycles to 3.22 (SD 1.71) mg/million cycles. Increasing the tibial slope to 8 degrees did not significantly change the wear rate. Discussion. As an increase in the tibial slope reduced the wear rate in a fixed-bearing prosthesis, a higher tibial slope should be recommended. However, other factors that are influenced by the tibial slope (e.g.,the tension of the ligament) must also be considered