Génération cannabis: Paroles de jeunes, paroles dexperts (Éducateurs et Préventions) (French Edition)

Direct Numerical Simulations DNS of turbulent nonpremixed jet flames have revealed that Polycyclic Aromatic Hydrocarbons PAH are confined to spatially intermittent regions of low scalar dissipation rate due to their slow formation chemistry. The length scales of these regions are on the order of the Kolmogorov scale or smaller, where molecular diffusion effects dominate over turbulent transport effects irrespective of the large-scale turbulent Reynolds number.

A strain-sensitive transport model has been developed to identify such species whose slow chemistry, relative to local mixing rates, confines them to these small length scales. A priori analysis indicates that this strain-sensitive transport model significantly affects PAH yield in nonpremixed flames with essentially no impact on temperature and major species. The model is applied with Large Eddy Simulation LES to a series of turbulent nonpremixed sooting jet flames and validated via comparisons with experimental measurements of soot volume fraction.

Multi-dimensional upwinding-based implicit LES for the vorticity transport equations. Complex turbulent flows such as rotorcraft and wind turbine wakes are characterized by the presence of strong coherent structures that can be compactly described by vorticity variables.

The vorticity-velocity formulation of the incompressible Navier-Stokes equations is employed to increase numerical efficiency. Compared to the traditional velocity-pressure formulation, high order numerical methods and sub-grid scale models for the vorticity transport equation VTE have not been fully investigated. Consistent treatment of the convection and stretching terms also needs to be addressed. Our belief is that, by carefully designing sharp gradient-capturing numerical schemes, coherent structures can be more efficiently captured using the vorticity-velocity formulation.

In this work, a multidimensional upwind approach for the VTE is developed using the generalized Riemann problem-based scheme devised by Parish et al. The algorithm obtains high resolution by augmenting the upwind fluxes with transverse and normal direction corrections. The approach is investigated with several canonical vortex-dominated flows including isolated and interacting vortices and turbulent flows.

The capability of the technique to represent sub-grid scale effects is also assessed. Technical Communications in Urban Operations Les communications techniques en operations urbaines. A synergetic approach for estimating the local direct aerosol forcing: A method dedicated to the investigation of direct radiative forcing of the main anthropogenic aerosol species ammonium sulfate, black carbon, particulate organic matter is presented.

The methodology is based on chemical, photometric, and satellite measurements. We first determined the optical properties of the main aerosol species and then computed their direct radiative impact at local scale. Optical computations indicate that the single scattering albedo, for the total aerosol population in the external mixture, is equal to 0.

At the same time the mean asymmetry parameter is equal to 0. Progress in Military Airlift: Etude de l'impact de la valorisation energetique de pneus hors d'usage, dans une cimenterie, sur les emissions gazeuses par modelisation de la dispersion atmospherique. De plus, le mode de fonctionnement des fours est responsable d'un effet de lessivage des gaz acides par le cru alcalin. MTBE transport follows from - phyiscal and chemical properties and hydrology.

North American Container Port Capacity: Transportation Journal, Spring Interrupting a Legacy of Hatred: Inevitably, revenge attacks occurred. Security was heightened with hundreds of police patrolling the area, but residents and city officials alike…. Large-eddy simulations LES combined with the one-dimensional turbulence ODT simulations of a spatially developing turbulent reacting shear layer with heat release and high Reynolds numbers were conducted and compared to results from direct numerical simulations DNS of the same configuration. The shear layer is simulated with a single-step, second-order reaction with an Arrhenius reaction rate.

The transport equations are solved using a low Mach number approximation. Deregulation in the early s allowed the freight rail industry to If so, the transportation Using data collected in a provincial poll and provided by the Ministry of Education of Quebec, this article analyzes the impact of the urban-rural variable on different aspects of the management of school commissions at a time of economic recession and population decrease.

The reduction in school enrollees as much as that of the educational personnel is more considerable in the urban environment than the rural one. When analyzing the consequences of management strategies in all assessments the decrease in enrolments and the urban-rural variable show constant results.

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Although some of these effects are direct, in most cases, however, they tend to be indirect because of the decrease in the number of staff members. In general, the consequences of management are less positive in the urban environment than in the rural one. Finally, according to the respondents the quality of the service linked to teaching has deteriorated more so in the urban environment than compared to the rural one.

LES of propeller crashback. Crashback is an operating condition to quickly stop a propelled vehicle, where the propeller is rotated in the reverse direction to yield a negative thrust. In crashback, the freestream interacts with the strong reverse flow from the propeller leading to massive flow separation and highly unsteady loads. We have used Large-Eddy Simulation LES in recent years to accurately simulate the flowfield in crashback around a stand-alone open propeller, hull-attached posterior alone open propeller and a ducted propeller with stator blades.

This talk will discuss our work towards LES of crashback inclusive of the entire hull. The results will be compared to available experimental data, and the flow physics will be discussed. This work is supported by the Office of Naval Research. D'Eichthal and Urbain 's "Lettres sur la race noire et la race blanche": This article is a close reading of Gustave D'Eichthal and Ishmayl Urbain 's Lettres sur la race noire et la race blanche , written during the decade prior to the "second" French emancipation in The article argues that the hierarchical gendering of race described in the letters is reflective of metropolitan concerns about potential for social disorder accompanying slave emancipation in the French colonies.

In arguing for social reconciliation through interracial marriage and its offspring, the symbolically charged figure of the mulatto, the authors deployed gendered and familial language to describe a stable post-emancipation society. The concentration of these artificial pinning centers with a well characterized morphology is easily controlled. The pinning efficiency of these defects has been often demonstrated, mainly from magnetization measurements. They show the ability of these defects to prevent the thermal fluctuations effects.

The measurements have been performed on the same crystal before and after the heavy ion irradiation. Les brulures electriques chez les voleurs de cuivre. The organization called " Les Impatients" was founded in Using a unique model, Les Impatients welcomes those with mental health issues who would like to express themselves through art. Les Impatients offers free creative workshops and encourages exchanges with the community through the sharing of its participants' creations. The name Les Impatients reinforces the idea that the organization does not consider those attending its workshops as patients, but rather creators who are eager to heal, develop their craft and find their place in society.

The participants contribute to the collective objective of breaking down the stigma that surrounds mental illness. Les Impatients offers more than 48 workshops in eight different locations to around participants each week. Dissemination activities, remarkable events, original projects: Les Impatients stands out through its realizations.

Examples are exhibitions, collections of love letters, comic books, CD, concerts, and reading nights. The organization's originality resides in the exploration of the links between the work of the participants and that of professional artists. An illustration of this interest is the annual Parle-moi d'amour auction-exhibition, which has been one of Les Impatients' major events since As part of its mission, Les Impatients conserves the works of art created by the participants during the workshops.

Its collection includes more than 15, works of art from Les Impatients as well as pieces donated by collectors of unconventional art, commonly known as "art brut" or "outsider art". The dynamic Smagorinsky model is employed to account for the subgrid-scale motions. The LES solver is first validated for the Sandia Flame D using a steady flamelet method in which the chemical compositions, density and temperature fields are parameterized by the mean mixture fraction and its variance. In this approach, the modeled transport equations for the mean mixture fraction and the square of the mixture fraction are solved and the variance is then computed from its definition.

The results are found to be in a good agreement with the experimental data. The dataset can be used for comparison with other LES and computational fluid dynamics model outputs. Engineers charged with making jet aircraft quieter have long dreamed of being able to see exactly how turbulent eddies produce sound and this dream is now coming true with the advent of large eddy simulation LES.

Two obvious challenges remain: This paper primarily addresses the former, the use of advanced experimental techniques such as particle image velocimetry PIV and Raman and Rayleigh scattering, to validate the computer codes and procedures used to create LES solutions. It also addresses the latter problem in discussing what are relevant measures critical for aeroacoustics that should be used in validating LES codes. These new diagnostic techniques deliver measurements and flow statistics of increasing sophistication and capability, but what of their accuracy?

And what are the measures to be used in validation? This paper argues that the issue of accuracy be addressed by cross-facility and cross-disciplinary examination of modern datasets along with increased reporting of internal quality checks in PIV analysis. Further, it is argued that the appropriate validation metrics for aeroacoustic applications are increasingly complicated statistics that have been shown in aeroacoustic theory to be critical to flow-generated sound. This paper addresses the former, the use of advanced experimental techniques such as particle image velocimetry PIV and Raman and Rayleigh scattering, to validate the computer codes and procedures used to create LES solutions.

This paper argues that the issue of accuracy of the experimental measurements be addressed by cross-facility and cross-disciplinary examination of modern datasets along with increased reporting of internal quality checks in PIV analysis. Further, it argues that the appropriate validation metrics for aeroacoustic applications are increasingly complicated statistics that have been shown in aeroacoustic theory to be critical to flow-generated sound, such as two-point space-time velocity correlations.

A brief review of data sources available is presented along with examples illustrating cross-facility and internal quality checks required of the data before it should be accepted for validation of LES. Picard et les satellites de Saturne. A LES -Langevin model for turbulence. However, they fail to reproduce backward energy transfer backscatter from small to large scale, which is an essentiel feature of the turbulence near wall or in boundary layer. Specifically, we first divide the small scale contribution to the Reynolds Stress Tensor in two parts: We use this to model the cross term evolution by a Langevin equation, in which the random force is provided by sub-grid pressure terms.

Our LES model is thus made of a truncated Navier-Stockes equation including the turbulent force and a generalized Langevin equation for the latter, integrated on a twice-finer grid. The backscatter is automatically included in our stochastic model of the pseudo-Lamb vector. We apply this model to the case of homogeneous isotropic turbulence and turbulent channel flow.

Fluctuations quantiques et instabilites structurales dans les conducteurs a basse dimensionalite. Un engouement particulier s'est manifeste ces dernieres annees pour les systemes electroniques fortement correles, ce en rapport avec l'immense richesse de leurs proprietes physiques. En general, ces proprietes sont induites par la presence d'interactions entre electrons qui, combinees a la structure du reseau moleculaire, donnent parfois lieu a une tres grande variete de phases electroniques et structurales ayant des incidences directes sur les phenomenes de transport dans ces materiaux.

Les systemes electroniques couples a un reseau moleculaire et designes systemes electron-phonon font partie de cette classe de materiaux qui ont recemment capte l'attention, en raison notamment de la competition entre plusieurs echelles d'energie dans un environnement caracterise par une forte anisotropie cristalline et une dynamique moleculaire assez importante.

En effet, en plus des proprietes electroniques et structurales particulieres la dimensionalite de ces systemes contribue egalement a leur richesse. Ainsi, une tres forte anisotropie structurale peut rehausser de facon considerable l'importance des interactions entre electrons et entre molecules constituant le reseau au point ou la physique du systeme soit regie par de tres fortes fluctuations.

Ce dernier contexte est devenu un domaine a part de la physique des systemes fortement correles, a savoir celui des les phenomenes critiques quantiques. Parmi les systemes electron-phonon, on retrouve les composes inorganique KCP et organique TTF-TCNQ decouverts durant les annees 70, et explores en profondeur a cause de leur tendance vers une instabilite du type onde de densite de charge a basse temperature. Ces composes, en general designes systemes de Peierls en reference a l'instabilite de leurs structures electroniques regie par le reseau moleculaire, ont recemment connu un regain d'interet a la lumiere des nouveaux developpements dans les techniques de caracterisation des structures electroniques ainsi que sur le plan de.

Les supraconducteurs en courant alternatif. Since , when the very first AC wire became available, the comprehension of electromagnetic phenomenas ruling over stability and losses of multifilamentary superconductors in AC use, has much improved. Improvements of manufacturing process has opened up the possibility of industrial scale manufacturing of up to one million, nm in diameter, filaments. The AC loss performances and stability remains at the best level up to date. Les premiers brins supraconducteurs utilisables en courants alternatifs sont apparus en Les fluctuations supraconductrices dans le compose praseodyme-cerium-oxyde de cuivre.

La technique utilisee pour sonder ces fluctuations est le transport electrique DC dans le plan ab. Les echantillons etudies sont des couches minces d'epaisseur plus grande que nm crues par ablation laser. Les mesures electriques DC effectuees dans ce travail sont la resistance en reponse lineaire et les courbes IV en reponse non lineaire en fonction de la temperature.

La mise en oeuvre experimentale de ces mesures a necessite une grande attention au filtrage et aux effets de chauffage a haut courant. Nous montrons que, sans cette attention, les donnees experimentales sont toujours erronees dans le regime pertinent pour nos echantillons. D'abord, le regime des fluctuations gaussiennes est tres bien decrit par le modele d'Aslamazov-Larkin en deux dimensions. Ensuite, le regime de fluctuations critiques, se trouvant a plus basse temperature que le regime gaussien, est tres bien decrit par la physique 2D de Kosterlitz-Thouless.

Dans cette analyse, les deux regimes ont des temperatures critiques coherentes entre elles, ce qui semble confirmer ce scenario 2D. Une analyse des donnees dans le cadre de fluctuations 3D est exploree mais donne des conclusions incoherentes. Les resultats pour les autres dopages sont qualitativement equivalents avec le dopage optimal et permettent donc une explication purement 2D.

Par contre, contrairement au dopage optimal. Douleurs induites par les soins: Regard sur les lazarets en terre canadienne. A consistent method for the evolution of the joint-scalar probability density function PDF transport equation is proposed for application to large eddy simulation LES of turbulent reacting flows containing evaporating spray droplets. PDF transport equations provide the benefit of including the chemical source term in closed form, however, additional terms describing LES subfilter mixing must be modeled.

The recent availability of detailed experimental measurements provide model validation data for a wide range of evaporation rates and combustion regimes, as is well-known to occur in spray flames. In this work, the experimental data will used to investigate the impact of droplet mass loading and evaporation rates on the subfilter scalar PDF shape in comparison with conventional flamelet models. In addition, existing model term closures in the PDF transport equations are evaluated with a focus on their validity in the presence of regime changes. Effets Seebeck et Nernst dans les cuprates: Etude de la reconstruction de la surface de Fermi sous champ magnetique intense.

Ce memoire presente des mesures de transport thermoelectrique, les effets Seebeck et Nernst, dans une serie d'echantillons de supraconducteurs a haute temperature critique. Une attention particuliere est accordee aux equations de la theorie semi-classique du transport et leur validite est verifiee.

La procedure experimentale et les materiaux utilises pour concevoir les montages de mesures sont expliques en detail. Les donnees d'effet Seebeck dans les echantillons de La 1. Les donnees d'effet Nernst recueillies indiquent que la contribution des fluctuations supraconductrices est limitee a un modeste intervalle de temperature au-dessus de la temperature critique. Investigating the scale-adaptivity of a shallow cumulus parameterization scheme with LES. In this study we investigate the scale-adaptivity of a new parameterization scheme for shallow cumulus clouds in the gray zone.

The Eddy-Diffusivity Multiple Mass-Flux or ED MF n scheme is a bin-macrophysics scheme, in which subgrid transport is formulated in terms of discretized size densities. While scale-adaptivity in the ED-component is achieved using a pragmatic blending approach, the MF-component is filtered such that only the transport by plumes smaller than the grid size is maintained. For testing, ED MF n is implemented in a large-eddy simulation LES model, replacing the original subgrid-scheme for turbulent transport. LES thus plays the role of a non-hydrostatic testing ground, which can be run at different resolutions to study the behavior of the parameterization scheme in the boundary-layer gray zone.

In this range convective cumulus clouds are partially resolved. We find that at high resolutions the clouds and the turbulent transport are predominantly resolved by the LES , and the transport represented by ED MF n is small. This partitioning changes towards coarser resolutions, with the representation of shallow cumulus clouds becoming exclusively carried by the ED MF n. The way the partitioning changes with grid-spacing matches the results of previous LES studies, suggesting some scale-adaptivity is captured.

Sensitivity studies show that a scale-inadaptive ED component stays too active at high resolutions, and that the results are fairly insensitive to the number of transporting updrafts in the ED MF n scheme.

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Other assumptions in the scheme, such as the distribution of updrafts across sizes and the value of the area fraction covered by updrafts, are found to affect the location of the gray zone. We present results for the transfer spectra, the skewness and flatness factors of the velocity components, the PDF's of the angle between the vorticity and the eigenvectors of the rate of strain, and that between the vorticity and the vorticity stretching tensor. We further observe that in all the numerical measurements, the trend was for the LES field to be more gaussian than the fDNS field. Future research on this point is planned.

Implicit LES using adaptive filtering. In implicit large eddy simulations ILES numerical dissipation prevents buildup of small scale energy in a manner similar to the explicit subgrid scale SGS models. If spectral methods are used the numerical dissipation is negligible but it can be introduced by applying a low-pass filter in the physical space, resulting in an effective ILES.

In the present work we provide a comprehensive analysis of the numerical dissipation produced by different filtering operations in a turbulent channel flow simulated using a non-dissipative, pseudo-spectral Navier-Stokes solver. The amount of numerical dissipation imparted by filtering can be easily adjusted by changing how often a filter is applied. We show that when the additional numerical dissipation is close to the subgrid-scale SGS dissipation of an explicit LES the overall accuracy of ILES is also comparable, indicating that periodic filtering can replace explicit SGS models.

A new method is proposed, which does not require any prior knowledge of a flow, to determine the filtering period adaptively. Once an optimal filtering period is found, the accuracy of ILES is significantly improved at low implementation complexity and computational cost. The method is general, performing well for different Reynolds numbers, grid resolutions, and filter shapes.

A multivariate quadrature based moment method for LES based modeling of supersonic combustion. The transported probability density function PDF approach is a powerful technique for large eddy simulation LES based modeling of scramjet combustors. In this approach, a high-dimensional transport equation for the joint composition-enthalpy PDF needs to be solved.

Quadrature based approaches provide deterministic Eulerian methods for solving the joint-PDF transport equation. In this work, it is first demonstrated that the numerical errors associated with LES require special care in the development of PDF solution algorithms. The direct quadrature method of moments DQMOM is one quadrature-based approach developed for supersonic combustion modeling. This approach is shown to generate inconsistent evolution of the scalar moments. Further, gradient-based source terms that appear in the DQMOM transport equations are severely underpredicted in LES leading to artificial mixing of fuel and oxidizer.

To overcome these numerical issues, a semi-discrete quadrature method of moments SeQMOM is formulated. The performance of the new technique is compared with the DQMOM approach in canonical flow configurations as well as a three-dimensional supersonic cavity stabilized flame configuration. Uncertainty quantification in LES of channel flow. Here, in this paper, we present a Bayesian framework for estimating joint densities for large eddy simulation LES sub-grid scale model parameters based on canonical forced isotropic turbulence direct numerical simulation DNS data. The framework accounts for noise in the independent variables, and we present alternative formulations for accounting for discrepancies between model and data.

To generate probability densities for flow characteristics, posterior densities for sub-grid scale model parameters are propagated forward through LES of channel flow and compared with DNS data. Discrepancies between DNS and calibrated LES results point to additional model form inadequacies that need to be accounted for. Sand Waves in Environmental Flows: Insights gained by LES. In fluvial and coastal environments, sediment transport processes induced by near-bed coherent structures in the turbulent boundary layer developing over a mobile sediment bed result in the formation of dynamically rich sand waves, or bed forms, which grow and migrate continuously.

Bed form migration alters streambed roughness and provides the primary mechanism for transporting large amounts of sediment through riverine systems impacting the morphology, streambank stability, and ecology of waterways. I will present recent computational advances, which have enabled coupled, hydro-morphodynamic large-eddy simulation LES of turbulent flow in mobile-bed open channels.

Furthermore, in agreement with recent experimental observations, the computed spectra of the resolved velocity fluctuations above the bed exhibit a distinct spectral gap whose width increases with distance from the bed. The spectral gap delineates the spectrum of turbulence from that of slowly evolving coherent structures associated with sand wave migration. The talk will also present computational results demonstrating the feasibility of carrying out coupled, hydro-morphodynamic LES of large dunes migrating in meandering streams and rivers with embedded hydraulic structures and discuss future challenges and opportunities.

Analyse de plomb dans les peintures. The analysis of lead in paints was previously used for the characterisation of pigments. In this way, the analysis is able to specify the century of the painting of a work of art. Recently this technique was also used to determine the toxicity of lead paints in building. A hybrid computation is formulated here to allow greater control over the placement of LES and RANS regions and the transitions between them.

The concept of model invariance is introduced, which provides a basis for interpreting hybrid results within an LES -RANS transition zone. Consequences of imposing model invariance include the addition of terms to the governing equations that compensate for unphysical gradients created as the model changes between RANS and LES. Computational results illustrate the increased accuracy of the approach and its insensitivity to the location of the transition and to the blending function employed.

Unstrained and strained flamelets for LES of premixed combustion. The unstrained and strained flamelet closures for filtered reaction rate in large eddy simulation LES of premixed flames are studied. The relative performances of these closures are assessed by comparing numerical results from large eddy simulations of piloted Bunsen flames of stoichiometric methane-air mixture with experimental measurements. The strained flamelets closure is observed to underestimate the burn rate and thus the reactive scalars mass fractions are under-predicted with an over-prediction of fuel mass fraction compared with the unstrained flamelet closure.

The physical reasons for this relative behaviour are discussed. The results of unstrained flamelet closure compare well with experimental data. The SGS variance of the progress variable required for the presumed PDF is obtained by solving its transport equation. An order of magnitude analysis of this equation suggests that the commonly used algebraic model obtained by balancing source and sink in this transport equation does not hold.

This algebraic model is shown to underestimate the SGS variance substantially and the implications of this variance model for the filtered reaction rate closures are highlighted. Many chemical and environmental processes involve the formation of a polydispersed particulate phase in a turbulent carrier flow. Frequently, the immersed particles are characterized by an intrinsic property such as the particle size, and the distribution of this property across a sample population is taken as an indicator for the quality of the particulate product or its environmental impact.

In the present article, we propose a comprehensive model and an efficient numerical solution scheme for predicting the evolution of the property distribution associated with a polydispersed particulate phase forming in a turbulent reacting flow. Here, the particulate phase is described in terms of the particle number density whose evolution in both physical and particle property space is governed by the population balance equation PBE. Based on the concept of large eddy simulation LES , we augment the existing LES-transported probability density function PDF approach for fluid phase scalars by the particle number density and obtain a modeled evolution equation for the filtered PDF associated with the instantaneous fluid composition and particle property distribution.

This LES -PBE-PDF approach allows us to predict the LES -filtered fluid composition and particle property distribution at each spatial location and point in time without any restriction on the chemical or particle formation kinetics. In view of a numerical solution, we apply the method of Eulerian stochastic fields, invoking an explicit adaptive grid technique in order to discretize the stochastic field equation for the number density in particle property space.

In this way, sharp moving features of the particle property distribution can be accurately resolved at a significantly reduced computational cost. As a test case, we consider the condensation of an aerosol in a developed turbulent mixing layer. Le point sur les amas de galaxies.

Consequently, clusters of galaxies play a key role in any cosmological study and thus, are essential for our global understanding of the universe. In the general introduction, we shall outline this fundamental aspect, showing how the study of clusters can help to constrain the various cosmological scenarios. Once this cosmological framework is set, the next chapters will present a detailed analysis of cluster properties and of their cosmic evolution as observed in different wavebands mainly in the optical galaxies , X-ray gas and radio gas and particles ranges.

We shall see that the detailed study of a cluster is conditioned by the study of the interactions between its different components; this is the necessary step to ultimately derive the fundamental quantity which is the cluster mass. This will be the occasion to undertake an excursion into extremely varied physical processes such as the multi-phase nature of the intra-cluster medium, lensing phenomena, starbursts and morphology evolution in cluster galaxies or the interaction between the intra-cluster plasma and relativistic particles which are accelerated during cluster merging.

For each waveband, we shall outline simply the dedicated observing and analysis techniques, which are of special interest in the case of space observations. Finally, we present several ambitious projects for the next observatory generation as well as their expected impact on the study of clusters of galaxies.

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A comprehensive joint-scalar probability density function PDF approach is proposed for large eddy simulation LES of turbulent spray combustion and tests are conducted to analyze the validity and modeling requirements. The PDF method has the advantage that the chemical source term appears closed but requires models for the small scale mixing process.

To understand the modeling issues in the PDF method, direct numerical simulation of a spray flame at three different fuel droplet Stokes numbers and an equivalent gaseous flame are carried out. Assumptions in closing the subfilter conditional diffusion term in the filtered PDF transport equation are evaluated for various model forms. In addition, the validity of evaporation rate models in high Stokes number flows is analyzed. LES of flow in the street canyon. Results of computer simulation of flow over a series of street canyons are presented in this paper.

The setup is adapted from an experimental study by [4] with two different shapes of buildings. The results in the channel layout from the experiment are compared with results with a free top boundary. Newly designed launch and entry suit LES modeled by technician. Space shuttle orange launch and entry suit LES , a partial pressure suit, is modeled by a technician. A report presents a study addressing the question of which large-eddy simulation LES equations are appropriate for modeling the flow of evaporating drops of a multicomponent liquid in a gas e. The LES equations are obtained from the direct numerical simulation DNS equations in which the solution is computed at all flow length scales, by applying a spatial low-pass filter.

Thus, in LES the small scales are removed and replaced by terms that cannot be computed from the LES solution and instead must be modeled to retain the effect of the small scales into the equations. The mathematical form of these models is a subject of contemporary research. For a single-component liquid, there is only one LES formulation, but this study revealed that for a multicomponent liquid, there are two non-equivalent LES formulations for the conservation equations describing the composition of the vapor.

Criteria were proposed for selecting the multicomponent LES formulation that gives the best accuracy and increased computational efficiency. The DNS databases are from mixing layers of diesel and kerosene fuels. The comparisons resulted in the selection of one of the multicomponent LES formulations as the most promising with respect to all criteria.

The different types of accelerators are recalled with emphasis on the most powerful: The use of superconductors in accelerator magnets as well as in RF cavities is discussed. The characteristics of the large accelerators, existing and planned, are given together with the level of industry involvement in their construction. Details concerning superconducting magnets and cryogenic plants are investigated.

Finally, detectors, the most important tool for physics, are mentionned. As pointed out by Rodi standard integral solutions for jets and plumes developed for discharge into infinite, quiescent ambient are difficult to extend to complex situations, particularly in the presence of boundaries such as the sea floor or ocean surface. In such cases the assumption of similarity breaks down and it is impossible to find a suitable entrainment coefficient. The models are also incapable of describing any but the most slowly varying unsteady motions.

There is therefore a need for full time-dependent modeling of the flow field for which there are three main approaches: Rodi applied RANS modeling to both jets and plumes with considerable success, the test being a match with experimental data for time-averaged velocity and temperature profiles as well as turbulent kinetic energy and rms axial turbulent velocity fluctuations. This model still relies on empirical constants, some eleven in the case of the buoyant jet, and so would not be applicable to a partly laminar plume, may have limited use in the presence of boundaries, and would also be unsuitable if one is after details of the unsteady component of the flow the turbulent eddies.

At the other end of the scale DNS modeling includes all motions down to the viscous scales. The model demonstrates its versatility by application to a laminar flow case. Two new datasets have been added to the transport statistics database: This report compiles definitions of transportation terms used throughout the Department of Transportation and other US government agencies. This is the first edition of Transportation Expressions; future editions will be expanded in scope to include An integrated modeling approach for soot evolution in turbulent reacting flows is validated against three-dimensional Direct Numerical Simulation DNS data in a set of n-heptane nonpremixed temporal jet flames.

In addition, the small-scale interactions between soot, chemistry, and turbulence are described with a presumed subfilter PDF approach that accounts for the very large spatial intermittency characterizing soot in turbulent reacting flows. These deficiencies often stem from overly simplistic blending strategies based on scalar measures of turbulence length scale and grid resolution and from use of isotropic subgrid models in LES regions.

A recently developed hybrid modeling approach has shown promise in overcoming these deficiencies in incompressible flows [Haering, ]. Further, the model uses an tensor eddy viscosity that is formulated to represent the effects of anisotropic grid resolution on subgrid quantities. In this work, this modeling approach is extended to compressible flows and implemented in the compressible flow solver SU2 http: We discuss both modeling and implementation challenges and show preliminary results for compressible flow test cases with smooth wall separation.

Turbulent Jet Ignition TJI is an efficient method for initiating and controlling combustion in combustion systems, e. It enables combustion in ultra-lean mixtures by utilizing hot product turbulent jets emerging from a pre-chamber combustor as the ignition source for the main combustion chamber. The results show the very complex behavior of the reacting flow and the flame structure in the pre-chamber and RCM. The ignition and combustion of lean fuel-air mixtures by a turbulent jet flow of hot combustion products injected into various geometries are studied by high fidelity numerical models.

Turbulent jet ignition TJI is an efficient method for starting and controlling the combustion in complex propulsion systems and engines. The results show the very complex and different behavior of the turbulence and the flame structure at different jet equivalence ratios. Analysis of rotor noise using LES. The flow field of a five-bladed marine propeller operating at design condition, obtained using large eddy simulation LES , is used to calculate far-field sound.

Three acoustic formulations are used: Each formulation is derived from the Navier-Stokes equations and the effects of the underlying assumptions are examined. The acoustic surface for the Curle and Ffowcs-Williams and Hawkings acoustic analogies is chosen to be the propeller; the propeller is split into a collection of acoustically compact radial strips.

The computed sound is analyzed and the physics of sound generation is inspected. Results including far-field sound spectra and directivity will be discussed. La caracterisation des proprietes mecaniques de l'os cortical est un domaine d'interet pour la recherche orthopedique. En effet, cette caracterisation peut apporter des informations primordiales pour determiner le risque de fracture, la presence de microfractures ou encore depister l'osteoporose.

Ces techniques ne sont pas optimales et presentent certaines limites, ainsi l'efficacite du DXA est questionnee dans le milieu orthopedique tandis que le QCT necessite des niveaux de radiations problematiques pour en faire un outil de depistage. Les ondes guidees ultrasonores sont utilisees depuis de nombreuses annees pour detecter les fissures, la geometrie et les proprietes mecaniques de cylindres, tuyaux et autres structures dans des milieux industriels.

De plus, leur utilisation est plus abordable que celle du DXA et n'engendrent pas de radiation ce qui les rendent prometteuses pour detecter les proprietes mecaniques des os. Depuis moins de dix ans, de nombreux laboratoires de recherche tentent de transposer ces techniques au monde medical, en propageant les ondes guidees ultrasonores dans les os. Le travail presente ici a pour but de demontrer le potentiel des ondes guidees ultrasonores pour determiner l'evolution des proprietes mecaniques de l'os cortical. Il commence par une introduction generale sur les ondes guidees ultrasonores et une revue de la litterature des differentes techniques relatives a l'utilisation des ondes guidees ultrasonores sur les os.

L'article redige lors de ma maitrise est ensuite presente. L'objectif de cet article est d'exciter et de detecter certains modes des ondes guides presentant une sensibilite a la deterioration des proprietes mecaniques de l'os cortical. Ce travail est realise en modelisant par elements finis la propagation de ces ondes dans deux modeles osseux. Space transportation requirements for the NASA baseline scenario for future space missions are discussed. Alan; Rind, David H.

www.newyorkethnicfood.com: Cécile Hayez: Books, Biography, Blogs, Audiobooks, Kindle

MM II defined a series of experiments to better understand and characterize model transport and to assess the realism of this transport by comparison to observations. Measurements from aircraft, balloon, and satellite, not yet available at the time of MM I [Prather and Remsberg, ], provide new and stringent constraints on model transport , and address the limits of our transport modeling abilities. Simulations of the idealized tracers the age spectrum, and propagating boundary conditions, and conserved HSCT-like emissions probe the relative roles of different model transport mechanisms, while simulations of SF6 and C02 make the connection to observations.

Some of the tracers are related, and transport diagnostics such as the mean age can be derived from more than one of the experiments for comparison to observations. The goals of the transport experiments are: The following section are included: Les soins aux enfants et aux adolescents des familles des militaires canadiens: The present study evaluates the effectiveness of current RANS and LES models in simulating natural convection in high-aspect ratio parallel plate channels. The geometry under consideration is based on a simplification of the coolant and bypass channels in the very high-temperature gas reactor VHTR.

Two thermal conditions are considered, asymmetric and symmetric wall heating with an applied heat flux to match Rayleigh numbers experienced in the VHTR during a loss of flow accident LOFA. The occlusion of xylem elements and interference with water transport by Xf and its associated biofilm have been posited as the main cause of PD symptom development; however, Xf virulence mechanisms have not been described.

Les A was secreted by Xf and associated with a biofilm filamentous network. Additional proteomic analysis revealed its abundant presence in outer membrane vesicles OMVs. Accumulation of Les A in leaf regions associated positively with PD symptoms and inversely with bacterial titer. Xf les A mutants were significantly deficient for virulence when mechanically inoculated into grapevines.

We propose that Xf pathogenesis is caused by Les A secretion mediated by OMV cargos and that its release and accumulation in leaf margins leads to early stages of observed PD symptoms. Pierce's disease PD of grapevines is caused by Xylella fastidiosa Xf , a xylem-limited gamma-proteobacterium that is responsible for several economically important crop diseases.

Impedance de surface dans les supraconducteurs quasi-bidimensionnels. Ce travail a caractere experimental et theorique vise l'etude de l'etat supraconducteur de trois familles de composes: Pour ce faire, nous avons utilise une technique hyperfrequence, a savoir la mesure d'impedance de surface en fonction de la temperature et du champ magnetique. Dans les supraconducteurs conventionnels, nous avons mesure pour la premiere fois le pic de "coherence" dans la partie reelle de la conductivite.

Bien que predit par la theorie BCS, ce pic n'avait pas ete clairement observe en raison de difficultes techniques liees a ce type d'experience. D'autre part, la theorie d'Eliashberg appliquee a la partie reelle de la conductivite du niobium nous a revele l'importance des mesures hyperfrequences pour mieux extraire la partie basse frequence de la densite spectrale alphasp2F omega. Cette possibilite est attrayante puisque c'est precisement la region de frequences de alphasp2F omega ou les donnees d'effet tunnel sont imprecises.

Les resultats obtenus sur la longueur de penetration dans les organiques et les cuprates ont permis de montrer que le gap presente des lignes de zeros au niveau de Fermi ou qu'il est, a tout le moins, fortement anisotrope. En effet, la dependance en temperature de la longueur de penetration dans les cristaux purs est lineaire a basse temperature et elle devient quadratique dans les cristaux dopes. Pour le cas des supraconducteurs organiques quasi-bidimensionnels Et sb2X, nous avons aussi observe un maximum sur la partie reelle de la conductivite qui n'a rien a voir avec un pic de coherence.

Pour ces composes, nous avons effectue une des toutes premieres etudes des fluctuations supraconductrices en temperature et en champ magnetique. Nous montrons que la paraconductivite sigmasp' due aux fluctuations presente un comportement de type Aslamazov-Larkin de nature tridimensionnelle. Ces mesures sont appuyees par les resultats theoriques d'un modele Ginzburg. Premier lien, quand il est accessible, peut faciliter le contact avec les services. LES tests on airfoil trailing edge serration.

In the present study, a large number of acoustic simulations are carried out for a low noise airfoil with different Trailing Edge Serrations TES. The acoustic solver is running on the platform of our in-house incompressible flow solver EllipSys3D. The flow solution is first obtained from the Large Eddy Simulation LES , the acoustic part is then carried out based on the instantaneous hydrodynamic pressure and velocity field.

To obtain the time history data of sound pressure, the flow quantities are integrated around the airfoil surface through the FWH approach. For all the simulations, the chord based Reynolds number is around 1. Even though the airfoil under investigation is already optimized for low noise emission, most numerical simulations and wind tunnel experiments show that the noise level is further decreased by adding the TES device.

A finite volume large eddy simulation-conditional moment closure LES -CMC numerical framework for premixed combustion developed in a previous studyhas been extended to account for differential diffusion. The non-unity Lewis number CMC transport equation has an additional convective term in sample space proportional to the conditional diffusion of the progress variable, that in turn accounts for diffusion normal to the flame front and curvature-induced effects.

Planar laminar simulations are first performed using a spatially homogeneous non-unity Lewis number CMC formulation and validated against physical-space fully resolved reference solutions. The same CMC formulation is subsequently used to numerically investigate the effects of curvature for laminar flames having different effective Lewis numbers: Results suggest that curvature does not affect the conditional heat release if the effective Lewis number tends to unity, so that curvature-induced transport may be neglected. Finally, the effect of turbulence on the flame structure is qualitatively analysed using LES -CMC simulations with and without differential diffusion for a turbulent premixed bluff body methane-air flame exhibiting local extinction behaviour.

Overall, both the unity and the non-unity computations predict the characteristic M-shaped flame observed experimentally, although some minor differences are identified. The findings suggest that for the high Karlovitz number from 1 to 10 flame considered, turbulent mixing within the flame weakens the differential transport contribution by reducing the conditional scalar dissipation rate and accordingly the conditional diffusion of the progress variable.

De nombreux travaux theoriques et experimentaux ont ete publies sur les excitations topologiques de gaz electroniques bidimensionnels GE2D , appellees skyrmions, dans le regime de l'effet Hall quantique a remplissage unitaire. On attend des excitations semblables appellees bimerons dans les systemes formes de deux GE2D couples.

Contrairement au cas des GE2D simples, aucune experience n'a, a notre connaissance, presente la mesure d'une propriete specifique aux bimerons. Nous presentons dans cette these des travaux experimentaux ayant pour objectif l'etude d'excitations topologiques dans les heterostructures a double puits quantique. Une manifestation attendue les bimerons est la presence d'une anisotropie dans la conductivite a travers une constriction.

Nous avons concu un dispositif original a point de contact a trois grilles non-coplanaires. Ce dispositif a trois grilles a la particularite de permettre la creation d'une constriction etroite dans le double GE2D tout en permettant l'equilibrage de la densite electronique entre les deux puits dans l'etroit canal de conduction. Nous avons fabrique ce dispositif de taille submicronique par electrolithographie sur des heterostructures a double puits. Les dispositifs ainsi fabriques ont ete etudies a basse temperature 0. Les travaux n'ont pas permis de mettre en evidence une anisotropie de transport revelatrice de l'existence de bimerons.

Cette these est a notre connaissance la premiere etude experimentale visant la realisation de l'experience d'anisotropie de transport et est ainsi une contribution significative a l'avancement des connaissances dans ce domaine. Les travaux theoriques que nous presentons ont permis de montrer l'effet des excitations topologiques sur la capacite grille-GE2D du systeme. Ces travaux ouvrent la voie de la detection des bimerons par l'intermediaire de la mesure de la capacite grille-GE2D ou encore de la susceptibilite electrique du.

Discusses the problems created in graduate chemical engineering programs when students enter with a wide diversity of understandings of transport phenomena. Describes a two-semester graduate transport course sequence at the University of Notre Dame which focuses on fluid mechanics and heat and mass transfer. Understanding the impact of wind turbine wake dynamics on downstream turbines is particularly important for the design of efficient wind farms. High-order numerical methods can be computationally efficient and provide increased accuracy in simulating complex flows.

In the context of LES , high-order numerical methods have shown some success in predictions of turbulent flows. However, the specifics of hybrid RANS- LES models, including the transition region between both modeling frameworks, pose unique challenges for high-order numerical methods. We describe the interactions between filtering, model transition, and order of accuracy and their effect on turbulence quantities such as kinetic energy spectra, boundary layer evolution, and dissipation rate.

This work was funded by the U. In most previous work, the filter size is usually set to be proportional to the grid spacing. The resulting hybrid scheme is particularly attractive because a larger portion of the resolved energy is captured as the order of spectral approximation increases. Different cases for LES of a three-dimensional temporally developing mixing layer are appraised and a systematic parametric study is conducted to investigate the effects of grid resolution, the filter width size, and the order of spectral discretization.

Comparative assessments are also made via the use of high resolution direct numerical simulation DNS data. Eulerian time-domain filtering seems to be appropriate for LES large eddy simulation of flows whose large coherent structures convect approximately at a common characteristic velocity; e. For these flows, we develop an approach to LES based on an explicit second-order digital Butterworth filter, which is applied in,the time domain in an Eulerian context.

The approach is validated through a priori and a posteriori analyses of the simulated flow of a heated, subsonic, axisymmetric jet. NREL research supports development of electric, hybrid, hydrogen. Detailed characteristics of drop-laden mixing layers: Methodes de calcul des forces aerodynamiques pour les etudes des interactions aeroservoelastiques.

L'aeroservoelasticite est un domaine ou interagissent la structure flexible d'un avion, l'aerodynamique et la commande de vol. De son cote, la commande du vol considere l'avion comme une structure rigide et etudie l'influence du systeme de commande sur la dynamique de vol. Dans cette these, nous avons code trois nouvelles methodes d'approximation de forces aerodynamiques: We used a sum-of-squares F test to assess for statistically significant different in fit between the models.

Peak searches occurred in mid-June mid-summer and troughs occurred in mid-December mid-winter. Internet searches for ankle swelling and related terms are highly seasonal, with interest peaking in mid-summer. To estimate the cost savings that could result from implementation of a rational prescribing model for drug classes that are equivalent in terms of efficacy, toxicity, and convenience. The top 10 drug classes based on annual spending were gathered from the Canadian Institute for Health Information.

They were reviewed for potential inclusion in the study based on the ability to compare intraclass medications. When equivalence in efficacy, toxicity, and convenience was determined from a literature review, annual prescribing data were gathered from the National Prescription Drug Utilization Information Systems Database. The potential cost savings were then calculated by comparing current market shares with potential future market shares.

Estimated differences in spending produced by a rational prescribing model. Statins, proton pump inhibitors, angiotensin-converting enzyme inhibitors, and selective serotonin reuptake inhibitors were determined to have class equivalence for efficacy, toxicity, and convenience. Most of the potential savings are derived from deprescribing the newest patentprotected medications in each class.

Avoiding prescribing the newest intraclass drug, particularly in the absence of research to support its superiority in relevant clinical outcomes, could lead to considerable savings in health care expenditures and might push the pharmaceutical industry to innovate rather than imitate. Can Fam Physician ; Routine collection of sociodemographic data in primary care Andrew D. Detailed data on social determinants of health can facilitate the identification of inequities in access to health care. We report on a sociodemographic data collection tool used in a family medicine clinic.

Four major health organizations in Toronto collaborated to identify a set of 14 questions that covered a range of social determinants of health. These were translated into 13 languages. This survey was self-administered using an electronic tablet to a convenience sample of patients in the waiting room of a primary care clinic. Data were uploaded directly to the electronic medical record.

Patients reported finding the process acceptable. In subsequent implementation across 5 clinics, 10, patients have been surveyed; only 6. A modified survey is now administered to all patients. Such data are now being used to identify health inequities, develop novel interventions and evaluate their impact on health outcomes. For clinicians and patients, the Internet constitutes a common source of information.

This presentation will outline few key aspects and results of a year research program on information outcomes in a primary care context. This program is based on a theoretical model and the Information Assessment Method IAM that were developed and validated by our research group integrating information studies and health sciences. We commonly use participatory research in partnership with governmental, professional and philanthropic organizations synergy with existing interventions. Considering the complexity of human information interactions, we usually conduct systematic mixed studies reviews and mixed methods research.

First, results of observational studies may encourage family physicians to search information more often. For example, they suggest the number of patients for whom medical information has to be retrieved by family physicians in order for one patient to benefit might be 14 Number Needed to Benefit from Information: Second, more than 15, Canadian pharmacists and physicians use the IAM to rate and comment educational emails reflective learning activity , and earn continuing education credits. In turn, their feedback comments can contribute to improve informational content two-way knowledge translation.

Implications of these results will be outlined. The goal of this initiative is for every family practice in each community across Canada to be able to offer comprehensive, coordinated, and continuing care to their populations through family physicians working with health care teams. Teams may involve, physically or virtually, several allied health care providers and specialists, depending on the needs of the patient community. The PMH is where patients can present and discuss their personal and family health concerns and receive a full spectrum of care.

Relationships between patients and family physicians and other health care professionals are developed and strengthened over time, enabling the best possible health outcomes for each person, the practice population, and the community being served. The presenters will demonstrate that this model aligns very well with the pillars of the PMH.

Barriers to implementing such a model in the CAF will also be shared. This interactive session will explore the usefulness of the PMH model in the context of managing occupational medicine issues, particularly in challenging scenarios, and will be aimed at sharing best practices in addressing these challenges. Areas for future development will also be proposed for discussion by and feedback from participants. Explore approaches to initiation of early palliative care in long-term care practice 2. Describe appropriate screening practices in long-term care practice 3.

Apply practising wisely principles to practice in long-term care Description: This workshop will focus on the principles of practising wisely in long-term care LTC. Care for individuals in LTC is becoming increasingly complex as patients are being admitted later in life and with more comorbidities. Prevalence of dementia in this clinical population is upwards of 70 per cent and, increasingly, people are admitted with a shortened life expectancy. It is estimated that average length of stay for new admissions to LTC is close to 18 months with a wide variation across this spectrum.

That being said, residents and families are often unaware of this and far too often discussions about prognosis and clinical expectations have not been had. The workshop will start with an exploration of attitudes and awareness of the benefits of initiating of conversations about end-of-life care. Case scenarios that focus on communicating with residents and families will be used to facilitate interactive discussions highlighting key issues challenging our approach to LTC.

The second part of this workshop will focus on discussions around appropriate prescribing and use of investigations in the LTC setting. This will build upon the newly released Choosing Wisely Canada LTC recommendations developed by the Long Term Care Medical Directors Association of Canada, as well as recommendations and adaptation of materials developed for the popular workshops of Practising Wisely. We will present this in a case-based format to stimulate interactive discussion and practical challenges faced by clinicians in this setting. We hope to have education on a national stage by introducing this workshop at FMF, as LTC practices are not standard amongst the provinces.

What are family physicians doing and why? Describe differences between physicians in the documentation of chaperone use 2. How family physicians are applying this guidance in their daily practice is unknown. Data on documentation practices and awareness of provincial recommendations were collected by cross-sectional survey, with analysis using SPSS statistical software. Data on influencing factors were collected through individual interviews that underwent thematic analysis by constant comparison method.

Survey participants included family physicians in Calgary. Interview participants included 17 family physicians in three academic, community-based Calgary teaching clinics. There were surveys used for analysis 30 per cent response rate and 17 individual interviews were completed. Interview findings suggested physician reasoning around documentation was variable and included individual physician standard of practice, anticipation of concern, patient choice, and other patient factors.

Survey results demonstrated that only 25 per cent of respondents were aware of provincial recommendations. This was supported by interview findings, which also showed that while many did not use the recommendations in determining chaperone use, others used them as a way to counsel patients that a chaperone was required. Documentation of chaperone use and application of provincial guidance are variable. Most physicians do not document chaperone use and physician gender may affect documentation practices. To determine the range of services and procedures offered by family physicians who define themselves as comprehensive practitioners and compare their responses across three generations of alumni of one family practice program.

One family medicine program in the province of Ontario. All graduates of one family medicine program between and Self-reported provision of care in office, care in-hospital, intrapartum obstetrics, house calls, palliative care, after hours care, nursing home care, minor surgery, emergency room, sport medicine, walk-in care. In addition, gender, training stream urban or rural , size of community of practice, practice model, and satisfaction with practice were considered.

Participants practised in eight provinces across Canada, but principally in Ontario. A small number were located in the United States. There was a decline in the number of services across three generations of graduates, with newer graduates providing fewer services than the older graduates. Significant declines across the three groups were observed in the provision of house calls, palliative care, and nursing home care. Non-significant changes were seen in the provision of intrapartum obstetrics across the three alumni groups with an initial decline then an increase in reported activity.

The average number of types of procedures offered declined from the oldest to the newest graduates. Most respondents were in a patient-enrolment practice model and those in such models reported offering significantly more services than those in either fee for service, Family Health Group, or salary models Conclusion: The normative definition of comprehensive care varies across three generations of graduates of this family medicine program, with newer physicians reporting fewer overall services and procedures than older graduates.

A greater understanding of the forces that determine the meaning of comprehensive primary care is necessary if this foundational element of family medicine is to be preserved. Identify and define Choosing Wisely Recommendations applicable to primary care 2. Recognize factors associated with adherence to the Choosing Wisely recommendations 3. To assess factors associated with adherence to four Choosing Wisely CW recommendations during patient encounters with a primary care clinician.

Data from clinicians in 46 clinics representing , patients. All patients with at least one encounter to from a participating MaPCReN primary care clinician. Data relating to the following CW recommendations: Adherence to each of the four CW recommendations. Descriptive statistics and multivariable logic models with generalized estimating equations assessed adherence to the CW recommendations and association with patient, provider, and practice characteristics.

There were , primary care encounters related to one of the four CW recommendations evaluated. The most common non-adherent CW encounter related to an antibiotic prescription for viral infection Female patients had an increased odds of an encounter with an antibiotic prescription for viral infections OR 1.

Salaried physicians, older patients, patients with more frequent office visits, and patients residing in rural areas had increased odds of non-adherence. There are patient-, provider-, and practice-related factors that affect adherence to CW recommendations. Understanding factors associated with adherence is essential to designing strategies to reduce unnecessary investigations and treatments. Describe to patients what their experience with medical assistance in dying might be like 2.

To explore the experiences and perspectives of Canadians who requested and were eligible for MAID as well as the experiences of people supporting them. This was a qualitative study using semi-structured interviews and thematic analysis. Patients who had a consultation about MAID in a clinic in British Columbia and were found eligible were recruited for the study. Basic demographics were recorded for context. Twenty-three patient experiences were explored in interviews with 11 patients and 18 support people.

Most patients had a malignancy, neurological disorder, or organ failure. The major reason for requesting assisted death was a self-perceived unacceptable quality of life, most commonly due to the loss of autonomy, independence, physical function, and ability to communicate.

Some patients expressed fear of future suffering and future disability. The support people included spouses, sons, daughters, and friends. All 11 support people who were interviewed after the MAID death said the death was peaceful. They valued that they could be present, prepared, and able to say some final words. The reasons patients in our study requested assisted death were similar to the findings in other countries, namely loss of autonomy and the ability to do the things they enjoyed.

Their loved ones supported their decisions and valued the chance to be prepared and present. Evidence-based assesment and treament Enhanced Clinical Session Learn to assess the severity of alcohol withdrawal 2. Learn best practices for the medical management of alcohol withdrawal in the emergency department 3.

Learn how and when to discharge patients in alcohol withdrawal safely Description: Alcohol withdrawal is a common and potentially life-threatening condition encountered in emergency departments across the country. There is a high degree of variability in the assessment and treatment of such patients. During this seminar participants will learn the current best practices involved in the safe assessment, treatment, and discharge of this vulnerable population.

The treatment protocols discussed will stress a simple, non-invasive approach that can be used for the majority of patients in most emergency department settings. Supporting Family Medicine Resident Research: Understand feasibility in resident research and identify common pitfalls impeding the success of research projects 2. Appraise a resident research proposal for scientific rigour and originality 3.

Develop a comprehensive plan to support a family medicine resident in completing a research project Description: Many Canadian family medicine residency programs require the completion of a scholarly project. In some programs this takes the form of a research project. Designing and completing a high-quality research project can be challenging in the course of a residency program.

Time constraints and the process of learning research methods and study design are barriers in the context of busy clinical training programs. One of the most significant barriers residents encounter is the Research Ethics Board REB application process, which can be difficult particularly for those without prior research experience.

Our team of family physicians at North York General Hospital, an academic community hospital in Toronto, Ontario, has instituted various initiatives and processes to support residents in doing research. Our process for assisting residents in completing projects includes staff physician review, resident peer review, and deliberate engagement with the local REB to facilitate successful, expeditious reviews. We support residents in planning for a presentation or publication, rather than merely the completion of a rote requirement of the residency program.

Our strategies have been successful and well received by residents and we think they are of value to the greater academic family medicine community. This session will provide family physicians in both academic and community settings involved with supporting resident research projects with practical strategies for success. Building on what we have learned we will discuss suggestions and tips for incorporating them into your setting for this purpose. Become familiar with the coaching model as it applies to the family medicine clinical preceptor 2. Learn how coaching techniques can be incorporated in the evaluation portfolio of our learners 3.

Have you ever had the experience of working with a really good sports coach or music teacher? If so, you will probably remember how amazing it felt to have someone working with you to help you achieve at a level that was just not possible for you to do on your own. Research suggests that learning medicine is no different. We all know that a good coach needs to observe your performance in order to help, but that does not occur often enough in medicine. As medical education moves toward a more competency-based structure, direct observation, feedback, and the facilitation of deliberate practice are becoming essential teaching competencies for faculty and learners.

The Doctor as Coach framework intentionally supports the implementation of contemporary concepts in medical education. Through this workshop attendees will learn practical techniques from the coaching model to apply to the learner in the family medicine setting. Describe the elements needed for managing the data associated with competency-based assessment 2. List advantages and disadvantages of paper versus online systems for competency-based assessment 3. Evaluate using a system like eCBAS 2. Competency-based medical education became an undeniable fact of curriculum and assessment in family medicine residency programs across Canada in , when the College of Family Physicians of Canada implemented the Triple C Competency-Based Curriculum.

While individual programs across Canada have approached competencybased medical education in different ways, there have been some common challenges for many programs. One of those challenges has been how best to assess and track competence. Individual programs have had to decide which actual tools and processes to use for assessment. Some programs have workable systems, but many are still struggling with how and what to do for competency-based assessment.

Our program addressed the challenge of managing assessment information by developing an electronic portfolio, called the Electronic Competency-Based Achievement System eCBAS. Regularly evaluating and monitoring eCBAS has proven to be an integral part of our change management strategy, allowing us to learn within the system, evolve, and continuously improve. In this session, we present the newest version, eCBAS 2. We will share evaluation data about the system. A system demonstration will be followed by the opportunity for participants to practise, using some of the tools in eCBAS.

Table and group discussions will address issues of assessment centred around two case studies about residents—one progressing well and one encountering difficulty. This primarily interactive workshop is excellent for anyone with questions about how to implement workable competency-based assessment, and those who are already carrying out competency-based assessment and would like to share their experiences—positive and negative—with others. Describe how to identify a learner in difficulty and the range of problems this term encompasses 2.

Describe how to deal with these resident learning issues including the institution of learning, remediation, and probation plans 3. Understand the processes involved from remediation to appeal, and recognize the inherent challenges in finding solutions that work Description: As program directors, we are sometimes faced with supporting residents in difficulty.

Having a robust tracking system to identify residents in trouble early is key. Designing an adequate learning program as well as remediation and probation plans are often challenging but should be done using an evidence-based rubric with input from multiple sources including the learner. We will discuss the definition of a problem learner, the confounding issues in making this definition, and potential strategies that can be used to assist these learners in need.

We will also present a tracking system and administrative structure that help identify. Strong ties with the postgraduate medical education office helps in these situations, and having a working knowledge of the appeal process can help you design the plans. We will then present case scenarios that will be discussed in a workshop-based format. Describe essential components of a competency-based assessment framework for an enhanced skills program 2.

Explain the need for cumulative evidence of progress towards competence in the context of Certificates of Added Competence 3. Plan how to incorporate competency-based assessment into your own enhanced skills programs Description: Enhanced skills programs in Canada are currently facing two challenges: CBAS is a competency-based assessment framework, developed by researchers in family medicine at the University of Alberta, that uses formative feedback to inform summative evaluation. CBAS offers a straightforward, learner-driven method to capture and document workplace observations of competency FieldNotes , which provides immediate feedback, tracks learner progress, and allows for early identification of learners who are encountering difficulty.

With CBAS, residents guide their learning using formative feedback. For preceptors and program directors, CBAS offers a way to document workplace observations and feedback, so that summative decisions are evidence-based and defensible.

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In this interactive workshop, an enhanced skills program director will present evidence of proof-of-concept for using CBAS via exploration of findings from a pilot study in the two SEM programs. Case studies will also be reviewed. Participants will gain some experience using CBAS tools through demonstration and group discussion. Participants will be encouraged to share their own experiences. Review feedback from a national survey of residents on current teaching of advance care planning within family medicine residency 2. Review results from a literature review on best practices on teaching advance care planning to medical learners 3.

The theme of the review is advance care planning ACP. The SoR performed an online national survey of current family medicine residents in December The survey had a response rate of , representing approximately 20 per cent of all current Canadian family medicine residents. Eighteen per cent of responses were submitted in French. Responses were received from each of the 17 family medicine residency programs, and there was a proportional representation of residents at different stages of residency training.

Two-thirds of respondents had not received didactic or clinical instruction about ACP in their residency training. Most respondents who were taught ACP rated the quality of the teaching they received as satisfactory or excellent. More than 77 per cent of respondents would like to see more ACP instruction in their residency training. Detailed results from this national survey, as well as the findings from literature searches on the topics of best practices in teaching ACP to medical learners and resources in teaching and performing ACP, will be reviewed in the workshop. Review clinical teaching scenarios to identify opportunities to integrate the collaborator role and reflect on these examples in their contexts 3.

Globally, health systems are transitioning to integrated team-based care models. As such, collaborative practice education and assessment are now accreditation requirements for family medicine and most health professional programs. However, without common teaching and assessment tools, ensuring the acquisition of integrated person-centred practice competencies in training remains challenging.

Family medicine preceptors need easily accessible tools to support them in their day-to-day roles of teaching and assessing the collaborative practice competencies of their learners. To address this need, the CFPC engaged an interprofessional group of educators to develop a how-to guide for teaching and assessing collaborator competencies. The guide has been purposefully designed to align with the CFPC Fundamental Teaching Activities Framework, and provides strategies applicable across a variety of educational settings—clinical preceptor, outside of the clinical setting, and educational leaders e.

This interactive workshop is geared to family medicine educators e. The workshop will present the current state of teaching and assessment of the collaborator role in Canada, review some of the best practices identified, and give participants an opportunity to familiarize themselves with the how-to guide for teaching and assessing collaborative practice competencies. Through interactive scenarios, participants will be able to practice identifying teaching and assessment opportunities and applying some of the teaching and assessment strategies contained within the guide.

Participants will be encouraged to reflect on the strategies and how they would apply in their own teaching contexts. Examine the myths about family medicine within the medical student population 2. Contemplate the information medical students are seeking about family medicine 3. Develop a message for medical students reflective of our changing discipline Description: Following , when the number of students matching to family medicine was at its lowest, the CFPC undertook a number of strategies to overcome the barriers to students selecting a career in family medicine.

Subsequently, attitudes towards family medicine began to shift. Our discipline has grown. The Undergraduate Medical Education Committee began a process to reconsider our messaging to medical students about our changing discipline. At FMF , we heard new myths and barriers, as well as new ideas in considering this message. Apply key narratives to motivate the patient, caregivers, and family to engage in a behaviour management plan 3.

Develop and implement a management plan to address these behaviours in collaboration with the patient, caregivers, and family Description: Patients with impaired cognition often communicate through behaviour. Historically, the behaviour of people with impaired cognition has been misunderstood to be simply a symptom of the disability or an inappropriate effort to manipulate caregivers. However, these hypotheses can neglect the important information communicated by behaviour. Physicians providing primary care to individuals with impaired cognition frequently identify a need for education regarding challenging behaviours.

This workshop will use a combination of didactic teaching and case-based discussion to introduce concepts and practical assessment tools behavioural specialists use when working with this population. Participants will be provided with a framework for establishing a behaviour management plan that can be implemented in collaboration with the patient, caregivers, family, and allied health professionals. Discussion will include resources for patients and caregivers and how to re-evaluate patients in follow-up. Screen for adverse childhood experiences. Provide trauma-informed care to patients 3.

Build healthy therapeutic boundaries with your patients Description: A large landmark study done by the Centers for Disease Control and Prevention and the HMO Kaiser Permanente confirmed that adverse childhood experiences ACEs , such as exposure to violence, neglect, and abuse, are strongly associated with long-term poor mental health.

In addition, the study revealed that these adverse events are associated with many other deleterious effects on health, such as increased rates of addiction, increased cardiovascular events, increased cancer rates, and earlier death. At the end of this workshop participants will be able to use ACE screening and integrate it into everyday practice. Participants will learn how to use the insight of trauma-informed care to improve the health and well-being of patients.

Participants will learn to use the power of empathy, compassion, and self-care to build resiliency in both patients and themselves. Experiences of current ACE screening pilot projects will be shared with the goal of developing a variety of ways to incorporate this tool into everyday family practice and measure outcomes of ACE screening.

A discussion and simulation for family doctors in disasters Enhanced Clinical Session Identify the various types of disasters and forms of humanitarian response and discuss ethical considerations for disaster response 2.

Cécile Hayez

Access resources that will help develop next steps for active contribution in their community for disaster preparedness 3. Define specific next steps and actions in the approach to disaster preparedness and response in their own Canadian community Description: This workshop is a novel and highly pertinent exercise for Canadian family physicians FPs. As the complexity and diversity of disasters and emergencies continue to increase, FPs need to be prepared and understand our role in these contexts.

This workshop is based on identified needs of family physicians in multiple contexts: Our three-stage workshop will be informed by existing literature and expert input on experiences in disaster contests. The first stage will be a discussion of foundational concepts that FPs should be able to engage in and understand. Participants will be asked to share their working definitions of terms such as disaster, humanitarian emergency, and the phases of disasters.

They will be encouraged to draw on experiences within the Canadian context, including the Fort McMurray wildfire and Maritime ice storms. The second and main stage will be an interactive tabletop simulation. A team of circulating facilitators will introduce various ethical challenges and scenariobased content as the disaster event evolves.

Participants will learn concepts of risk assessment and about the roles of different agencies and organizations involved in the response. Follow-up resources will be provided and may include webinars, evidenced-based ethical tools for disaster response, and appropriate publications. Important decisions and skills in intrapartum care Enhanced Clinical Session Interpret and respond to challenging intrapartum fetal surveillance; review intrauterine resuscitation and indications for emergency delivery 2. Manage intrapartum challenges and delivery complications and use under-utilized techniques for managing pain 3.

Explore evidence-based third stage management and optimize skin-to-skin maternal child care in all environments Description: This clinically based session will focus on the difficult decisions encountered and the skills required in providing intrapartum care. Participants are encouraged to bring their own challenges for discussion. Faculty will facilitate small group discussions and practical, low-fidelity simulations with adequate time for interactive learning.

This workshop will create an environment that allows participants to achieve increased competence and confidence in emergency procedures. All management strategies will involve teamwork and effective communication. Examples of scenarios are: Researchers will provide free-standing oral presentations of new research; the research award recipients are among the list of distinguished presenters.

Discuss the impact of a criterion-based competency assessment tool on the identification and management of residents in difficulty Background: This computerized tool includes a decision support system suggesting educational diagnoses and prescriptions to support resident feedback and guide teachers in their judgment of competency achievement for each milestone. To determine the impact of a CCAT on the identification and management of residents in difficulty. Clinical teachers who had filled out at least one family medicine resident summative assessment in the previous three months participated in this study.

Anonymized data about remediation rotations was obtained from the program promotion committee. A total of clinical teachers completed the questionnaire. Three constructs improved after CCAT implementation: Residents in difficulty were identified earlier after implementation of the CCAT, and remediation rotations were offered earlier to residents pre: This project suggests a criterion-based competency assessment tool that includes a decision support system improves the identification and management of residents in difficulty.

Describe rating behaviour by preceptors when assessing residents 2. Demonstrate the value of data analysis for program evaluation 3. Validate the approach of an action-oriented rating scale for competency attainment Context: To explore how preceptors have completed ITERs since this rating system was implemented. ITER data in one45 were sorted by preceptor with sequenced FM rotations for five communication competencies.

Post hoc tests revealed when the sequential changes in ITER scoring occurred. Supervisors should flag concerns and discern progression so residents can attain competencies required for graduatoin. Residents in a department of FM acquire communication competencies progressively. Analysis of preceptor ITER ratings allows normative feedback to preceptors on their patterns of scoring residents. Describe the feasibility of using the Competency-Based Achievement System to track resident progress to competence Context: Competency-based assessment in medical education incorporates multiple constructs, including: In both cases the provision of continuous formative feedback is paramount for improving both the validity of summative assessments and the quality of coaching that residents receive.

The objective of this study was to examine: Between- and within-resident as well as between- and within-preceptor comparisons were made. No apparent differences in progress level assignment existed between preceptors and academic advisors when controlling for differences between residents. Similarities between advisor- and preceptor-made notes support triangulation in formative assessment.

• Ideen für die Schweiz: 44 Chancen, die Zukunft zu gewinnen (German Edition).
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• You Should Have Been There: A Collection of Stories.
• There Are Only Seven Jokes;

Observed teaching site differences suggest further research is needed to examine reasons behind site discrepancies. Explain the different approaches to implementation of the Triple C curriculum and its impacts across Canadian family medicine residency programs Context: To examine the different approaches to implementation of TC and its impacts across Canadian family medicine residency programs. A realist audit of the different approaches to the implementation of TC and its impacts was conducted. Realist analysis of the results was to identify the different contexts, mechanisms, and outcomes associated with implementing TC.

Data were collected through individual interviews and focus groups that underwent thematic analysis by constant comparison method. Participants included program directors, department chairs, deans, administrators, preceptors, and residents at all 17 schools. Outcomes included the identification of narrative themes related to TC implementation and its impact.

Every family medicine residency program had implemented some part of TC, in some way or form. Implementation was pragmatic, making use of opportunities where they arose. Some challenges in implementing TC were common to all schools, others were more localized.

TC has been broadly successful, with earlier and more specific identification of struggling students being of particular value. Some programs struggled with renegotiating the role and presence of specialist physicians outside of family medicine in the training of family doctors. Implementing TC involved substantial administrative and resource costs. Schools that delayed the adoption of the TC curriculum learned from earlier adopters and many partially attribute their success to concurrent and new assessment programs.

Despite many challenges, TC has been a driver for much quality improvement in programs and it has catalyzed the Canadian family medicine community to be much more engaged in and attentive to educational matters. Explore the effectiveness of the R2C2 feedback model in promoting feedback acceptance and use for improvement across varied disciplines and sites 2. Determine and explain factors that appeared to moderate the use and effectiveness of the model across sites 3.

An evidence-based model R2C2 was tested in residency education. The model focuses on: This was an international study of five residency programs using case study methodology and realist evaluation. Dyads of residents and their supervisors were recruited. Supervisors were trained and then asked to use the R2C2 model in two feedback sessions, three to six months apart. Feedback sessions and subsequent debrief interviews were recorded and transcribed. Content and template analysis were used within and across cases.

Synthesis consisted of case and comparative analysis to identify the usefulness of each component and suggest revisions required to strengthen the R2C2 model. Forty resident-preceptor dyads were recruited. The R2C2 model was effective in engaging residents in a reflective feedback conversation, although variability was noted across sites. The process appeared to enhance resident engagement and reflection, guided self-assessment, and encouraged active collaboration in the development of goals and outcomes. The model appeared to be useful with both excelling and struggling residents.

Coaching for change was the most useful feature of the model, with the learning change plan an integral component to the coaching discussion. Factors influencing the use of the R2C2 model included supervisor and resident factors, such as the resident-supervisor relationship, and programmatic assessment approaches and contextual factors.

The model can be effective in engaging residents in reviewing their performance assessment data, in reflecting and identifying opportunities for improvement, and in working with their supervisors to plan and implement improvements. Identify barriers to acquiring procedural skills perceived by residents at the University of Toronto 2. Identify barriers to teaching procedural skills perceived by staff at the University of Toronto Objective: To evaluate current barriers to minor procedural skills training in postgraduate family medicine at the University of Toronto in Toronto, Ontario.

This is a qualitative study that employed a grounded theory methodology. The data set is multi-sourced, including accreditation documents, one-on-one interviews, and surveys. Interviews were audio-recorded and transcribed verbatim. Documents, transcripts and survey responses were coded and categorized for common themes. The identification of barriers in teaching and acquiring minor procedural skills facilitates further inquiry to improve current standards of training in postgraduate family medicine. Family medicine sites employ a variety of approaches to deliver procedural skills training.

Three are identified in family medicine: Each has its own barriers. Despite various strategies employed by sites, nearly all residents surveyed feel their current curricula are insufficient to develop procedural competence and confidence. Significant barriers identified include: Residents have difficulty obtaining procedure-rich electives within family medicine and experience tends to come disproportionately and inconsistently from external rotations.

Teachers also identify underlying influences on training. In addition to an insufficient case mix, these include a perception of insufficient initiative among residents, an insufficient pool of experienced supervisors, and easy access to other specialists for procedural referrals in urban settings.

Challenges to minor procedural training are multi-faceted; strategies to address this must also be multi-faceted. This study identifies minor procedural skills training needs at the University of Toronto with a view to improvement. Training Doctors for Rural Generalist Practice: The pathways to rural practice approach has led to a program made of four components: Of the students classes of to who completed year 3 FM placements, 97 per cent of their placements were spent in a rural location community or town.

Lifelong Learning in Health Professions: Describe the long-term trend in the orientation toward lifelong learning in health professions Objective: Several studies have examined the orientation toward lifelong learning at various stages of the education and career continuum; however, none has looked at changes throughout training and practice. The main objective of the present study was to determine whether there are differences in this orientation between groups defined by their places on the education and career continuum.

Additionally, involvement in scholarly and research activities was considered for the influence on the orientation toward lifelong learning. This was a group-level meta-. In total, 11 studies conducted with post-secondary health professions students, residents, and practising professionals met the inclusion criteria. Means and standard deviations of the total scores on the Jefferson Scale, together with sample sizes, were extracted from each study and used in the analysis. Results of the meta-analysis indicated that the orientation toward lifelong learning in health professions tended to increase gradually further along the career continuum; however, substantial variability was observed within each group of studies with students, residents, and practising professionals.

Significant differences in group means were found between trainees students and residents and practising professionals. Involvement in scholarly and research activities appeared to be associated with a greater orientation toward lifelong learning along the career continuum. The findings offer insights into the long-term trend in the orientation toward lifelong learning in health professions. Although the links between lifelong learning and its behavioural manifestations in health professions have been reported in the literature, much work in this area still needs to be done, including the examination of the impact of lifelong learning on patient care.

Be able to determine whether a longitudinal procedural curriculum could be implemented at their teaching site Objective: To determine whether a biweekly procedure clinic and structured procedural curriculum throughout family medicine FM residency prepares residents to identify and manage skin cancers better than routine opportunistic teaching of skin procedures. A survey and photo quiz. Family medicine training sites at the University of Ottawa. All incoming FM residents were asked to fill out a survey and photo quiz at the beginning of their training to establish their level of experience with and knowledge of skin conditions.

The photo quiz was validated by a dermatologist. FM residents at one site received training in the procedure clinic every two weeks along with a structured procedural curriculum focused on the diagnosis and management of skin cancer during eight months of FM training throughout the two years of residency. The other sites had routine opportunistic teaching on on the diagnosis and management of skin cancer. The procedure clinic is based on hands-on experience with direct supervision by the study authors.

At the end of their first year and at the end of their training, all FM residents were asked to fill out a survey and photo quiz to verify their knowledge. Twenty-five residents participated in the initial survey and photo quiz. The study participants and non-participants obtained a score of 61 per cent and 58 per cent, respectively, at the beginning of residency and 76 per cent and 57 per cent, respectively, at the end of residency.

Our results indicate that a longitudinal curriculum helps FM residents identify and treat skin cancers, whereas opportunistic teaching showed no objective benefit. An exploratory mixed method design was used to help inform the development of an integrated MAID curriculum. A Canadian FM residency program that included four distributed sites: Survey response rates were 45 per cent for faculty and 33 per cent for residents. Developing a MAID curriculum will bridge the competency gap self-identified by participants. From Reactive to Proactive: Identify a mixed methods approach to curriculum mapping 2.

Describe data sources and methods that can be used to map disease prevention and health promotion in an undergraduate curriculum 3.

Apply suggestions for the improvement in curriculum delivery of disease prevention and health promotion content Objective: To evaluate the delivery of health promotion and disease prevention HPDP content in the curriculum at the University of Calgary medical school. Cumming School of Medicine, Calgary, Alberta. Purposive sampling of 18 faculty from seven specialties. Students extracted quantitative and qualitative data on teaching activities. Two focus groups were conducted with year 1 and 2 learners.

Faculty participated in semi-structured interviews. Quantitative data were analyzed using descriptive statistics to give the proportion of learning events with HPDP content and the proportion of content in each of the four key areas identified by the Framework. Qualitative data were analyzed thematically using the aforementioned theoretical framework. Of the learning events identified, The most frequently identified subject was Foundations of Population Health Faculty emphasized a need to address HPDP proactively by focusing on disease before it manifests, rather than concentrating on secondary and tertiary prevention.

Health promotion and disease prevention content is well represented in the curriculum at the University of Calgary, but the experiences of students and faculty suggest the need for a HPDP approach that helps students better integrate and apply HPDP knowledge in clinical practice. Identify the main curricular messages surrounding enhanced skills fellowships from the resident perspective in one postgraduate family medicine program Objective: To understand better the messages family medicine residents are receiving about enhanced skills fellowship programs throughout their training.

Phenomenologic approach using structured qualitative interviews. Postgraduate family medicine program in Ontario. Residents were recruited using both purposive and, subsequently, snowball sampling until data saturation was reached. Interviews were audiotaped and transcribed, and codes were developed by the study investigators. Themes arose from the data via immersion and crystallization techniques.

Themes emerged in three categories: Residents viewed fellowship programs in terms of their personal and professional benefits. Residents learned about fellowship programs through word of mouth and role modelling. The formal curriculum remained neutral about fellowship training. The hidden curriculum highlighted a number of messages: Residents both hear and perceive mixed messages regarding fellowship training.

This may be an isolated phenomenon at a larger urban centre in Ontario. Decision making at the individual level in terms of career path seems to be affected and this may have implications at the larger system level. La question de recherche. Addressing Driving Retirement with Our Clients: A scoping review Julie Lapointe, erg. To review the existing literature on interventions supporting clients in their transition to driving retirement. A scoping review was completed in September Articles strictly focused on the assessment of driving capacities were excluded.

A thematic analysis was conducted to synthesize findings. These articles fell into four themes: Programs and interventions were often delivered in a group format by multidisciplinary teams including occupational therapists, physicians, nurses, and peer leaders and addressed both practical and emotional concerns associated with driving retirement. The results of this review will enable family physicians to identify and explore with clients the practical and emotional concerns linked to driving retirement. Family physicians will also be able to provide concrete and evidence-based strategies to their clients who need to transition to driving retirement.

Finally, family physicians will be able to determine situations that would benefit from the input of an occupational therapist. In recent years Kingston, Ontario, has seen an influx of new Canadians with limited English proficiency, most recently with the arrival of Syrian refugees. Patients with limited English proficiency have significant health disparities, which can be improved through access to trained interpreters. To develop and evaluate a sustainable model to provide free interpreter services within primary care to patients with limited English proficiency at the QFHT.

Surveys, program evaluation, qualitative descriptive. Academic family health team in a medium-size city. Forty-four student volunteers from health sciences backgrounds, more than 50 patients with limited English proficiency, and health care providers at the QFHT.