Context: Clinical reasoning plays a major role in the ability of doctors to make diagnoses and decisions. It is considered as the physician's most critical competence, and has been widely studied by physicians, educationalists, psychologists and sociologists. Since the 1970s, many theories about clinical reasoning in medicine have been put forward. Purpose: This paper aims at exploring a comprehensive approach: the ''dual-process theory'', a model developed by cognitive psychologists over the last few years. Discussion: After 40 years of sometimes contradictory studies on clinical reasoning, the dual-process theory gives us many answers on how doctors think while making diagnoses and decisions. It highlights the importance of physicians' intuition and the high level of interaction between analytical and non-analytical processes. However, it has not received much attention in the medical education literature. The implications of dual-process models of reasoning in terms of medical education will be discussed.

To address the central question of how climate change influences tree growth within the context of global warming, we used dendroclimatological analysis to understand the reactions of four major boreal tree species -Populus tremuloides, Betula papyrifera, Picea mariana, and Pinus banksiana -to climatic variations along a broad latitudinal gradient from 46 to 541N in the eastern Canadian boreal forest. Tree-ring chronologies from 34 forested stands distributed at a 11 interval were built, transformed into principal components (PCs), and analyzed through bootstrapped correlation analysis over the period 1950-2003 to identify climate factors limiting the radial growth and the detailed radial growthclimate association along the gradient. All species taken together, previous summer temperature (negative influences), and current January and March-April temperatures (positive influences) showed the most consistent relationships with radial growth across the gradient. Combined with the identified species/site-specific climate factors, our study suggested that moisture conditions during the year before radial growth played a dominant role in positively regulating P. tremuloides growth, whereas January temperature and growing season moisture conditions positively impacted growth of B. papyrifera. Both P. mariana and P. banksiana were positively affected by the current-year winter and spring or whole growing season temperatures over the entire range of our corridor. Owing to the impacts of different climate factors on growth, these boreal species showed inconsistent responsiveness to recent warming at the transition zone, where B. papyrifera, P. mariana, and P. banksiana would be the most responsive species, whereas P. tremuloides might be the least. Under continued warming, B. papyrifera stands located north of 491N, P. tremuloides at northern latitudes, and P. mariana and P. banksiana stands located north of 471N might benefit from warming winter and spring temperatures to enhance their radial growth in the coming decades, whereas other southern stands might be decreasing in radial growth.

To understand how tree growth has responded to recent climate warming, an understanding of the tree-climate-site complex is necessary. To achieve this, radial growth variability among 204 trees established before 1850 was studied in relation to both climatic and site factors. Seventeen forest stands were sampled in the Spanish Central Pyrenees. Three species were studied: Pinus uncinata, Abies alba, and Pinus sylvestris. For each tree, a ring-width residual chronology was built. All trees cross-dated well, indicating a common influence of the regional climate. For the 1952-1993 period, the radial growth of all species, especially P. uncinata, was positively correlated with warm Novembers during the year before ring formation and warm Mays of the year the annual ring formed. Differences in species-stand elevation modulated the growth-climate associations. Radial growth in P. uncinata at high elevation sites was reduced when May temperatures were colder and May precipitation more abundant. In the 20th century, two contrasting periods in radial growth were observed: one (1900-1949) with low frequency of narrow and wide rings, low mean annual sensitivity, and low common growth variation; and another (1950-1994) with the reverse characteristics. The increased variability in radial growth since the 1950s was observed for all species and sites, which suggests a climatic cause. The low shared variance among tree chronologies during the first half of the 20th century may result from a ''relaxation'' of the elevation gradient, allowing local site conditions to dominate macroclimatic influence. These temporal trends may be related to the recently reported increase of climatic variability and warmer conditions. This study emphasizes the need to carefully assess the relationships between radial growth and site conditions along ecological gradients to improve dendroclimatic reconstructions.

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Rising atmospheric [CO2 ], ca , is expected to affect stomatal regulation of leaf gas-exchange of woody plants, thus influencing energy fluxes as well as carbon (C), water, and nutrient cycling of forests. Researchers have proposed various strategies for stomatal regulation of leaf gas-exchange that include maintaining a constant leaf internal [CO2 ], ci , a constant drawdown in CO2 (ca  - ci ), and a constant ci /ca . These strategies can result in drastically different consequences for leaf gas-exchange. The accuracy of Earth systems models depends in part on assumptions about generalizable patterns in leaf gas-exchange responses to varying ca . The concept of optimal stomatal behavior, exemplified by woody plants shifting along a continuum of these strategies, provides a unifying framework for understanding leaf gas-exchange responses to ca . To assess leaf gas-exchange regulation strategies, we analyzed patterns in ci inferred from studies reporting C stable isotope ratios (δ(13) C) or photosynthetic discrimination (∆) in woody angiosperms and gymnosperms that grew across a range of ca spanning at least 100 ppm. Our results suggest that much of the ca -induced changes in ci /ca occurred across ca spanning 200 to 400 ppm. These patterns imply that ca  - ci will eventually approach a constant level at high ca because assimilation rates will reach a maximum and stomatal conductance of each species should be constrained to some minimum level. These analyses are not consistent with canalization toward any single strategy, particularly maintaining a constant ci . Rather, the results are consistent with the existence of a broadly conserved pattern of stomatal optimization in woody angiosperms and gymnosperms. This results in trees being profligate water users at low ca , when additional water loss is small for each unit of C gain, and increasingly water-conservative at high ca , when photosystems are saturated and water loss is large for each unit C gain.

To decipher spatial and temporal tree-growth responses to climate change we used tree-ring data from Picea mariana (Mill.) BSP and Pinus banksiana Lamb. along a latitudinal transect in western Quebec. The transect encompassed the distinct transition between mixed and coniferous forests at approximately 49°N. Correlation analyses and principal component analyses were used to identify common spatiotemporal growth patterns, and site- and species-specific patterns since 1825. A moist summer in the year t - 1 and an early start of the current growing season favored growth of both species. A prolongation of the growing season into fall was the most distinguishing factor between the species. A long and gradual climatic gradient shifted to a short gradient with a clear segregation between the southern and northern parts of the transect. This shift, around 1875, was abrupt and characterized by a turbulent climatic period. The observed pattern was likely related to a large-scale shift in the mean position of the Arctic Front that occurred at the end of the 1800s. No discrete climatic setting explained the present switch from mixedwoods to conifers at 49°N. Awareness of such nonequilibrial relations between climate and species distribution is essential when assessing vegetation responses to future climate change.

Medical diagnosis is a categorization task that allows physicians to make predictions about features of clinical situations and to determine appropriate course of action. The script concept, which first arose in cognitive psychology, provides a theoretical framework to explain how medical diagnostic knowledge can be structured for diagnostic problem solving. The main characteristics of the script concept are pre-stored knowledge, values acceptable or not acceptable for each illness attribute, and default values. Scripts are networks of knowledge adapted to goals of clinical tasks. The authors describe how scripts are used in diagnostic tasks, how the script concept fits within the clinical reasoning literature, how it contrasts with competing theories of clinical reasoning, how educators can help students build and refine scripts, and how scripts can be used to assess clinical competence.

Five independent multicentury reconstructions of the July Canadian Drought Code and one reconstruction of the mean July–August temperature were developed using a network of 120 well-replicated tree-ring chronologies covering the area of the eastern Boreal Plains to the eastern Boreal Shield of Canada. The reconstructions were performed using 54 time-varying reconstruction submodels that explained up to 50% of the regional drought variance during the period of 1919–84. Spatial correlation fields on the six reconstructions revealed that the meridional component of the climate system from central to eastern Canada increased since the mid–nineteenth century. The most obvious change was observed in the decadal scale of variability. Using 500-hPa geopotential height and wind composites, this zonal to meridional transition was interpreted as a response to an amplification of long waves flowing over the eastern North Pacific into boreal Canada, from approximately 1851 to 1940. Composites with NOAA Extended Reconstructed SSTs indicated a coupling between the meridional component and tropical and North Pacific SST for a period covering at least the past 150 yr, supporting previous findings of a summertime global ocean–atmosphere–land surface coupling. This change in the global atmospheric circulation could be a key element toward understanding the observed temporal changes in the Canadian boreal forest fire regimes over the past 150 yr.