A Comprehensive Analysis of Neurocognition in Young Psychosis Patients with Current Cannabis Use

The aim of this thesis is to examine the neuropsychological profiles of psychosis patients, with and without current cannabis use. Specifically, to determine how age may moderate the effects of cannabis use on neurocognition. In normal populations, cannabis use has been shown to provoke deficiencies across a range of cognitive domains. However, patients diagnosed with a psychotic disorder, who have a history of, but then abstain from cannabis use, demonstrate cognition that is seemingly superior to their cannabis-naïve peers. In some cases, comorbid patients exhibit neurocognition similar to control subjects. The first study of this thesis (i.e. Chapter 2) is a meta-analysis that investigates neuropsychological data reporting on current cannabis-using and cannabis-naive psychosis patients. It was hypothesized that comorbid patients would demonstrate significant deficits across a range of neurocognitive tests, compared to non-using patients. It was found that current cannabis-using patients underperformed across 6 of the 11 cognitive domains compared to cannabis-naïve patients. Meta-regressions showed older age in cannabis-using patients was predictive of worse performance in processing speed, sustained attention, verbal memory, and better performance in verbal learning and verbal fluency. Importantly, it appears this is exacerbated with increasing age. In the second study (i.e. Chapter 3), psychosis patients were exclusively between 16 and 25 years of age. The patients underwent neurocognitive assessments to compare cognition between drug-naïve patients and comorbid patients. It was expected comorbid psychosis patients and cannabis-naïve patients would demonstrate no significant neurocognitive differences. Patients were administered a neurocognitive battery, indexing estimated several cognitive domains. The findings indicated no significant neurocognitive differences between the two clinical psychosis groups. Ultimately, previous studies reporting superior cognition in patients with a history of cannabis use, and the current thesis demonstrating no cognitive differences between patients regardless of concurrent cannabis use, taken together suggest the notion of psychosis-onset, and subsequent schizophrenia, initiated by early cannabis onset

Love as an organizational norm: an exploration at a values-centered organization

This study investigated to what extent, if any, developing a norm of love might be accepted, incorporated, sustained, and beneficial to an organization. Participants included 18 directors, manager, and supervisors of a 24-year-old telecommunications company located in Puerto Rico. Data were collected through individual interviews where interviewees shared their perspectives on the possibility of adopting the norm of love, their acceptance of it, and how they would implement it. Findings indicated that a majority (83.33%) of the participants acknowledged that love is part of the human essence and whole selves, and that such a norm would be beneficial to employees and the organization. Findings additionally suggested that the norm could be sustained when supported by a thorough implementation strategy, including all stakeholders int eh effort, and preparing the organization to face challenges that emerge before, during, and after implementing the norm. Based on these findings, it may be concluded that love could become an organizational norm

Le référential CanMEDS en médecine de laboratoire : une étude phénoménographique explorant la manière dont les rôles professionnels sont appliqués en dehors de l'environnement clinique

Background: The CanMEDS Competency Framework is an internationally recognized model used to outline the proficiencies of a physician. It has predominantly been studied in clinical environments but not all medical specialties take part in direct patient contact. In laboratory medicine, the role of the physician is to promote and enhance patient diagnostics by managing and overseeing the functions of a diagnostic laboratory. Methods: This phenomenographic study explores the lived experiences of biochemistry, microbiology, and pathology residency program directors to better understand how they utilize the CanMEDS competencies. Eight laboratory medicine program directors from across Canada were individually interviewed using a semi-structured interview, and the data was analysed using inductive thematic analysis. Results: The findings show that the current framework is disconnected from the unique context of laboratory medicine with some competencies appearing unrelatable using the current standardized definitions and expectations. Nevertheless, participants considered the framework to be an appropriate blueprint of the competencies necessary for their professional environment, but to make it accessible more autonomy is required to adapt the framework to their needs. Conclusion: Newer renditions of the CanMEDS Competency Framework should better consider the realities of non-clinical disciplines.Contexte : Le référentiel CanMEDS est un modèle reconnu à l'échelle internationale qui décrit les compétences nécessaires d'un médecin. Cependant, il a été principalement étudié dans des environnements cliniques, mais ce ne sont pas toutes les spécialités médicales qui ont des contacts directs avec les patients. En médecine de laboratoire, le rôle du médecin est de promouvoir et d'améliorer les analyses diagnostiques des patients en supervisant les fonctions d'un laboratoire diagnostic. Méthodes : Cette étude phénoménographique explore les expériences vécues de directeurs de programmes de résidence en biochimie, microbiologie et pathologie afin de mieux comprendre comment leurs programmes de formation utilisent les compétences CanMEDS. Huit directeurs de programme Canadiens en médecine de laboratoire ont participé à une entrevue semi-structurée individuelle et les données recueillies ont été analysées par une analyse thématique inductive. Résultats : Les résultats démontrent que le référentiel actuel est déconnecté de la médecine de laboratoire et que certaines compétences semblent incompatibles en utilisant les définitions normalisées en vigueur. Néanmoins, les participants considèrent que le référentiel est un schéma approprié des compétences nécessaires dans leur environnement professionnel, mais une plus grande autonomie est nécessaire pour l’adapter à leurs besoins. Conclusion : Les prochaines révisions du référentiel de compétences CanMEDS devraient mieux tenir compte des réalités des disciplines non cliniques

Acute ischemic heart disease and interventional cardiology: a time for pause

BACKGROUND: A major change has occurred in the last few years in the therapeutic approach to patients presenting with all forms of acute coronary syndromes. Whether or not these patients present initially to tertiary cardiac care centers, they are now routinely referred for early coronary angiography and increasingly undergo percutaneous revascularization. This practice is driven primarily by the angiographic image and technical feasibility. Concomitantly, there has been a decline in expectant or ischemia-guided medical management based on specific clinical presentation, response to initial treatment, and results of noninvasive stratification. This 'tertiarization' of acute coronary care has been fuelled by the increasing sophistication of the cardiac armamentarium, the peer-reviewed publication of clinical studies purporting to show the superiority of invasive cardiac interventions, and predominantly supporting (non-peer-reviewed) editorials, newsletters, and opinion pieces. DISCUSSION: This review presents another perspective, based on a critical reexamination of the evidence. The topics addressed are: reperfusion treatment of ST-elevation myocardial infarction; the indications for invasive intervention following thrombolysis; the role of invasive management in non-ST-elevation myocardial infarction and unstable angina; and cost-effectiveness and real world considerations. A few cases encountered in recent practice in community and tertiary hospitals are presented for illustrative purposes The numerous and far-reaching scientific, economic, and philosophical implications that are a consequence of this marked change in clinical practice as well as healthcare, decisional and conflict of interest issues are explored. SUMMARY: The weight of evidence does not support the contemporary unfocused broad use of invasive interventional procedures across the spectrum of acute coronary clinical presentations. Excessive and unselective recourse to these procedures has deleterious implications for the organization of cardiac health care and undesirable economic, scientific and intellectual consequences. It is suggested that there is need for a new equilibrium based on more refined clinical risk stratification in the treatment of patients who present with acute coronary syndromes

“Patient-time”, “doctor-time”, and “institution-time”: Perceptions and definitions of time among doctors who become patients

Objective: To examine views and experiences of conflicts concerning time in healthcare, from the perspective of physicians who have become patients. Methods: We conducted two in-depth semi-structured 2-h interviews concerning experiences of being health care workers, and becoming a patient, with each of 50 doctors who had serious illnesses. Results: These doctor–patients often came to realize as they had not before how patients experience time differently, and how “patient-time”, “doctor-time”, and “institution-time” exist and can conflict. Differences arose in both the long and short term, regarding historical time (prior eras/decades in medicine), prognosis (months/years), scheduling delays (days/weeks), daily medical events and tasks (hours), and periods in waiting rooms (minutes/hours). Definitions of periods of time (e.g., “fast”, “slow”, “plenty”, and “soon”) also varied widely, and could clash. Professional socialization had heretofore impeded awareness of these differences. Physicians tried to address these conflicts in several ways (e.g., trying to provide test results more promptly), though full resolution remained difficult. Conclusions: Doctors who became patients often now realized how physicians and patients differ in subjective experiences of time. Medical education and research have not adequately considered these issues, which can affect patient satisfaction, doctor–patient relationships and communication, and care. Practice implications: Physicians need to be more sensitive to how their definitions, perceptions, and experiences concerning time can differ from those of patients

First operational experience with the positive-ion injector of ATLAS

The recently completed positive-ion injector for the heavy-ion accelerator ATLAS was designed as a replacement for the tandem injector of the present tandem-linac system and, unlike the tandem, the positive-ion injector is required to provide ions from the full range of the periodic table. The concept for the new injector, which consists of an ECR ion source on a voltage platform coupled to a very-low-velocity superconducting linac, introduces technical problems and uncertainties that are well beyond those encountered previously for superconducting linacs. The solution to these problems and their relationship to performance are outlined, and initial experience in the acceleration of heavy-ion beams through the entire ATLAS system is discussed. The unusually good longitudinal beam quality of ATLAS with its new injector is emphasized

Relations between lipoprotein(a) concentrations, LPA genetic variants, and the risk of mortality in patients with established coronary heart disease: a molecular and genetic association study

Background: Lipoprotein(a) concentrations in plasma are associated with cardiovascular risk in the general population. Whether lipoprotein(a) concentrations or LPA genetic variants predict long-term mortality in patients with established coronary heart disease remains less clear. Methods: We obtained data from 3313 patients with established coronary heart disease in the Ludwigshafen Risk and Cardiovascular Health (LURIC) study. We tested associations of tertiles of lipoprotein(a) concentration in plasma and two LPA single-nucleotide polymorphisms ([SNPs] rs10455872 and rs3798220) with all-cause mortality and cardiovascular mortality by Cox regression analysis and with severity of disease by generalised linear modelling, with and without adjustment for age, sex, diabetes diagnosis, systolic blood pressure, BMI, smoking status, estimated glomerular filtration rate, LDL-cholesterol concentration, and use of lipid-lowering therapy. Results for plasma lipoprotein(a) concentrations were validated in five independent studies involving 10 195 patients with established coronary heart disease. Results for genetic associations were replicated through large-scale collaborative analysis in the GENIUS-CHD consortium, comprising 106 353 patients with established coronary heart disease and 19 332 deaths in 22 studies or cohorts. Findings: The median follow-up was 9·9 years. Increased severity of coronary heart disease was associated with lipoprotein(a) concentrations in plasma in the highest tertile (adjusted hazard radio [HR] 1·44, 95% CI 1·14–1·83) and the presence of either LPA SNP (1·88, 1·40–2·53). No associations were found in LURIC with all-cause mortality (highest tertile of lipoprotein(a) concentration in plasma 0·95, 0·81–1·11 and either LPA SNP 1·10, 0·92–1·31) or cardiovascular mortality (0·99, 0·81–1·2 and 1·13, 0·90–1·40, respectively) or in the validation studies. Interpretation: In patients with prevalent coronary heart disease, lipoprotein(a) concentrations and genetic variants showed no associations with mortality. We conclude that these variables are not useful risk factors to measure to predict progression to death after coronary heart disease is established. Funding: Seventh Framework Programme for Research and Technical Development (AtheroRemo and RiskyCAD), INTERREG IV Oberrhein Programme, Deutsche Nierenstiftung, Else-Kroener Fresenius Foundation, Deutsche Stiftung für Herzforschung, Deutsche Forschungsgemeinschaft, Saarland University, German Federal Ministry of Education and Research, Willy Robert Pitzer Foundation, and Waldburg-Zeil Clinics Isny

Status report on the ATLAS superconducting linear accelerator

ATLAS, the Argonne Tandem-Linac Accelerator System, is a project to upgrade the existing Argonne superconducting linac heavy-ion booster which began providing beams of heavy-ions for experimental nuclear research in 1979. When completed ATLAS will provide beams of heavy ions up to approximately mass 130 at energies as high as 25 MeV/A. The construction of ATLAS is approximately 60% complete. First beam from the accelerator is expected in spring of 1985