Social rhythm interventions for bipolar disorder: a systematic review and rationale for practice.

INTRODUCTION: Three interconnected pathways to relapse have been identified as stressful life events, medication non-adherence and disruptions in social rhythms (daily activity and routine). The role of medication and stressful life events is generally better understood than the role of social rhythms. There is no previous review of interventions that target social rhythms. AIM: To identify the evidence for the effectiveness of interventions that target social rhythms for improving mood symptoms. METHOD: A quantitative systematic review was conducted. Results Seven studies were included in the review: four reporting interpersonal and social rhythm therapy (IPSRT) interventions and three sleep/light interventions. DISCUSSION: The results suggest that IPSRT may have a potential benefit in improving mood symptoms and relapse, but it is not clear whether this is of greater benefit than an intensive supportive care intervention of similar duration. The sleep/light interventions demonstrated rapid mood improvements; however, it was not clear how long this improvement was sustained. IMPLICATIONS FOR PRACTICE: Attention to social rhythms and the implementation of interventions that target these could be useful for mental health nursing practice may provide people with BD a clinically effective adjunctive intervention to medication.

In vivo characterization of the highly selective monoacylglycerol lipase inhibitor KML29: antinociceptive activity without cannabimimetic side effects.

BACKGROUND AND PURPOSE: Since monoacylglycerol lipase (MAGL) has been firmly established as the predominant catabolic enzyme of the endocannabinoid 2-arachidonoylglycerol (2-AG), a great need has emerged for the development of highly selective MAGL inhibitors. Here, we tested the in vivo effects of one such compound, KML29 (1,1,1,3,3,3-hexafluoropropan-2-yl 4-(bis(benzo[d][1,3]dioxol-5-yl)(hydroxy)methyl)piperidine-1-carboxylate). EXPERIMENTAL APPROACH: In the present study, we tested KML29 in murine inflammatory (i.e. carrageenan) and sciatic nerve injury pain models, as well as the diclofenac-induced gastric haemorrhage model. KML29 was also evaluated for cannabimimetic effects, including measurements of locomotor activity, body temperature, catalepsy, and cannabinoid interoceptive effects in the drug discrimination paradigm. KEY RESULTS: KML29 attenuated carrageenan-induced paw oedema and completely reversed carrageenan-induced mechanical allodynia. These effects underwent tolerance after repeated administration of high-dose KML29, which were accompanied by cannabinoid receptor 1 (CB1 ) receptor desensitization. Acute or repeated KML29 administration increased 2-AG levels and concomitantly reduced arachidonic acid levels, but without elevating anandamide (AEA) levels in the whole brain. Furthermore, KML29 partially reversed allodynia in the sciatic nerve injury model and completely prevented diclofenac-induced gastric haemorrhages. CB1 and CB2 receptors played differential roles in these pharmacological effects of KML29. In contrast, KML29 did not elicit cannabimimetic effects, including catalepsy, hypothermia and hypomotility. Although KML29 did not substitute for Δ(9) -tetrahydrocannabinol (THC) in C57BL/6J mice, it fully and dose-dependantly substituted for AEA in fatty acid amide hydrolase (FAAH) (-/-) mice, consistent with previous work showing that dual FAAH and MAGL inhibition produces THC-like subjective effects. CONCLUSIONS AND IMPLICATIONS: These results indicate that KML29, a highly selective MAGL inhibitor, reduces inflammatory and neuropathic nociceptive behaviour without occurrence of cannabimimetic side effects. LINKED ARTICLES: This article is part of a themed section on Cannabinoids 2013. To view the other articles in this section visit http://dx.doi.org/10.1111/bph.2014.171.issue-6.

The effect of body condition at calving and supplementation with Saccharomyces cerevisiae on energy status and some reproductive parameters in early lactation dairy cows.

Improving the energy status of dairy cows during the early post-partum (PP) period by adding a safe dietary supplement such as live yeast culture (YS) may have a positive effect on reproductive function. The objective was to examine potential benefits of YS supplementation on PP energy status and fertility indices of dairy cows managed to have low or high body condition score (BCS, 1-5 scale) at calving. Forty (10 primiparous and 30 multiparous) Holstein/Friesian dairy cows were blocked by yield, parity, BCS, and predicted calving date. Within each block, cows were randomly allocated to a 2 x 2 factorial arrangement of treatments which were: BCS at calving (low < or =3.5 or high > or =3.75; n=20) and YS supplementation (2.5g/cow/day for pre-calving and 10g/cow/day for post-calving x 10(8) CFU of Saccharomyces cerevisiae/g) (supplemented or control; n=20). Daily milk yield was recorded and weekly milk composition, BCS and BW were assessed from calving to week 10 PP. Forage (100% grass silage pre-calving; 50% grass silage, 50% maize silage post-calving; ad libitum) intake was recorded individually. Concentrate (2kg of pre-calver nuts+/-YS for pre-calving and 8 kg of lactating nuts+/-YS for post-calving) feeding was controlled individually. Estimated energy balance PP was calculated on a weekly basis individually as the difference between the net energy (NE) intake and the sum of NE for maintenance and milk production. Insulin and IGF-I concentrations were determined on days 14 and 7 pre-calving and 1, 5, 15, 25 and 35 post-calving. Daily ovarian ultrasonography was performed from day 10 PP to monitor the size and development of the first dominant follicle (>10mm in diameter with absence of other large growing follicles), first ovulatory follicle and days to first ovulation PP. Pre-ovulatory peak of serum oestradiol concentration was determined during the 2 days before ovulation day. Cows with high BCS (over-conditioned) at calving ingested less NE, produced more milk NE output, and consequently had a significantly (P<0.05) exacerbated negative energy balance in comparison with low BCS cows (moderately conditioned) during early lactation. Higher (P<0.05) insulin concentrations and a tendency for higher (P=0.06) pre-ovulatory peak oestradiol concentrations in low BCS group were detected in the early PP period. Supplementing the diet with YS had no effect (P>0.10) on NE intake, NE milk output or energy balance. On the other hand it increased (P<0.01) insulin concentration and tended to increase (P=0.07) pre-ovulatory peak oestradiol concentrations and the size of first ovulatory follicle (P=0.09) early PP. Feeding YS had no effect on energy status of lactating dairy cows with high or low BCS at calving, whilst it improved serum insulin concentration, pre-ovulatory peak of oestradiol and the size of first ovulatory follicle in the early PP period. These observed effects of YS supplementation require to be substantiated with further research.

Effect of prepartum diet on postpartum ovarian activity in Holstein cows in a pasture-based dairy system.

The hypothesis was that supplementation during the late prepartum period will differentially affect reproductive and productive variables according to parity. Primiparous (n=22) and multiparous (n=22) pregnant autumn calving Holstein cows were stratified in two groups according to parity (primiparous or multiparous) and within each group were randomly assigned to two treatments: (a) low supplemented (LS) or (b) high supplemented (HS) prepartum diet. The LS group was offered 5.2 kg/cow/day (DM basis) of wheat silage, and the HS group 4.7 kg cow/day (DM basis)/of corn silage and 3.6 kg (DM basis) of wheat bran+12 g of urea. Both groups grazed on natural pastures. After calving, all cows received the same diet. The experimental period was from 3 weeks before calving to 7 weeks postpartum (PP); body condition score (BCS) and blood samples for hormonal analyses were obtained weekly and ovarian ultrasonography was conducted three times per week. The loss in BCS around calving was less pronounced in HS cows, but only multiparous supplemented cows maintained BCS throughout the study. Non-esterified fatty acids (NEFA) increased during the prepartum period in the LS but not in the HS cows, with peak values occurring on day 14 PP in all groups. During the remainder of the experiment NEFA was greater in LS than in HS cows. Prepartum treatment did not affect the proportion of cows that had ovulations from the first dominant follicle postpartum, but decreased the interval to first ovulation in multiparous cows (22.9 compared with 38.2 days; P<0.05). This was associated with greater plasma IGF-I concentrations at the time the dominant follicle of the first follicular wave reached its maximum diameter (8.0 compared with 3.6 nmol/L; P<0.05). However, prepartum treatment had no effect on onset of ovarian activity in primiparous cows. Supplementation had no effect on milk production or milk protein percentage but increased milk fat percentage. We conclude that feeding a high-supplemented prepartum diet to multiparous cows allowed them to maintain BCS around calving, and this was associated with greater concentrations of IGF-I and an earlier onset of estrous cycles after calving.

Effect of ketoprofen, lidocaine local anesthesia, and combined xylazine and lidocaine caudal epidural anesthesia during castration of beef cattle on stress responses, immunity, growth, and behavior.

To determine the effects of burdizzo castration alone or in combination with ketoprofen (K), local anesthesia (LA), or caudal epidural anesthesia (EPI) on plasma cortisol, acute-phase proteins, interferon-gamma production, growth, and behavior of beef cattle, 50 Holstein x Friesian bulls (13 mo old, 307 +/- 5.3 kg) were assigned to (n = 10/treatment): 1) control (handled; C); 2) burdizzo castration (B); 3) B following K (3 mg/ kg of BW i.v.; BK); 4) B following LA (8 mL into each testis and 3 mL s.c. along the line where the jaws of the burdizzo were applied with 2% lidocaine HCl; BLA); and 5) B following EPI (0.05 mg/kg of BW of xylazine HCl and 0.4 mg/kg of BW of lidocaine HCl as caudal epidural; BEPI). The area under the cortisol curve against time was lower (P < 0.05) in BK than in B, BLA, or BEPI animals. On d 1 after treatment, plasma haptoglobin concentrations were higher (P < 0.05) in B, BLA, and BEPI than in BK animals. On d 3, haptoglobin and plasma fibrinogen concentrations were higher (P < 0.05) in all castration groups than in C. On d 7, haptoglobin and fibrinogen concentrations remained higher (P < 0.05) in BLA than in B and C animals. On d 1, concanavalin A-induced interferon-gamma production was lower (P < 0.05) in B, BLA, and BEPI than in C, but there was no difference between BK and C animals. From d -1 to 35, ADG was lower (P < 0.05) in B, BLA, and BEPI animals, but not in BK compared with C animals. Overall, there was a higher (P < 0.05) incidence of combined abnormal postures in B than in C, BK and BEPI animals. Although the use of K and EPI decreased (P < 0.05) these postures compared with B alone or B with LA, there was no difference between the K and EPI treatment. In conclusion, burdizzo castration increased plasma cortisol and acute-phase proteins, and suppressed immune function and growth rates. Local anesthesia prolonged the increase in acute-phase proteins. Ketoprofen was more effective than LA or EPI in decreasing cortisol and partially reversed the reduction in ADG following castration. The use of K or EPI was more effective than LA in decreasing pain-associated behavioral responses observed during the first 6 h after treatment. Systemic analgesia with ketoprofen, a non-steroidal antiinflammatory drug, was more effective in reducing inflammatory responses associated with castration than LA or EPI.

Effects of beta-hydroxy-beta-methylbutyrate and creatine monohydrate supplementation on the aerobic and anaerobic capacity of highly trained athletes.

AIM: The aim of this study was to investigate the effects of 6 wks oral supplementation of beta-hydroxy-beta-methylbutyrate (HMB) and a mixture of HMB and creatine monohydrate (HMBCr) on aerobic and anaerobic capacity in highly trained athletes. It was hypothesised that HMB and HMBCr would have positive effects on aerobic and anaerobic power. METHODS: A prospective study involving a repeated measures design was utilised where subjects underwent testing prior to, and immediately after, a 6 wks supplementation period. Elite, male rugby league players (n=27) were divided into 3 groups, a control group (n=6), a HMB group (3 g/d; n=10) and a HMBCr group (3 g/d HMB + 3 g/d Cr; n=11). Testing involved a multistage fitness test to determine aerobic power and a 60 sec maximal cycle test to determine anaerobic capacity. Peak power, total work and peak lactate levels were measured in the anaerobic cycle test. RESULTS: Two-way repeated measures ANOVA revealed no effect of HMB or HMBCr on any of the measured parameters in comparison to the control group. CONCLUSION: Aerobic and anaerobic ability of highly trained male athletes is unaffected by 6 wks oral supplementation with HMB or a combination of HMB and creatine monohydrate.

Incidence of Pseudomonas aeruginosa in recreational and hydrotherapy pools.

Pseudomonas aeruginosa remains an important agent of opportunistic infection in patients, particularly those with respiratory complications and burns. One natural niche of this organism is water and water-associated facilities, hence the aim of this study was to examine specimens from recreational and hydrotherapy pools in Northern Ireland over a two-year period. Water specimens (n = 3,510) were obtained from three amenity categories, namely, 13 hydrotherapy pools (specimen number [n] = 323), 51 Jacuzzis/spas (n = 1,397) and 68 swimming pools (n = 1,790). Specimens (100 ml) were filtered through a cellulose acetate (0.45 micron pore size) gridded filter and the membrane was placed on Pseudomonas CFC agar (Oxoid CM559 + SR103) and incubated at 37 degrees C for 48 +/- 2 h. Colonies that clearly showed pyocyanin production or met other identification criteria were considered P. aeruginosa. Of the amenities examined 4/13 hydrotherapy pools (30.8%), 37/51 Jacuzzis/spas (72.5%) and 26/68 swimming pools (38.2%) were positive for P. aeruginosa. The most heavily contaminated amenity category was the Jacuzzi/spa, where 34.7% and 12% of private and public sites respectively were positive for P. aeruginosa at a level of greater than 1,000 cfu 100 ml-1. Approximately twice as many samples were positive in private Jacuzzis/spas compared to publicly operated facilities. There was a similar trend with respect to public and private hydrotherapy pools, though bacterial counts did not exceed 1,000 cfu 100 ml-1. Recreational and therapeutic amenities involving the use of water may be a potential source of P. aeruginosa for susceptible patient groups, including patients with cystic fibrosis and bronchiectasis. This may vary depending on amenity type and public/private ownership of such amenities.

Effects of suppressing cortisol following castration of bull calves on adrenocorticotropic hormone, in vitro interferon-gamma production, leukocytes, acute-phase proteins, growth, and feed intake.

The objective was to determine the effects of reducing the plasma cortisol rise in calves following castration on plasma ACTH concentrations, keyhole limpet hemocyanin (KLH)- and concanavalin A (Con A)-induced in vitro interferon (IFN)-gamma production, white blood cell (WBC) numbers, neutrophil:lymphocyte (N:L) ratio, plasma haptoglobin and fibrinogen concentrations, ADG, and ADFI. Forty 5-mo-old Friesian bull calves (169 +/- 1.7 kg) were assigned to four treatments: 1) control (CON); 2) oral metyrapone administration (MET); 3) surgical castration at 0 h on d 0 (SURG); and 4) oral metyrapone administration and surgical castration (MET+SURG). Cortisol, ACTH, IFN-gamma production, haptoglobin, fibrinogen, ADFI, and ADG were not different between CON and MET animals. The MET+SURG calves had lower (P < .001) peak and mean cortisol during .25 to 1.5 h than SURG animals, but area under the cortisol vs time curve from 0 to 12 h did not differ (P > .39) between SURG and MET+SURG calves. Peak ACTH concentrations and area under the ACTH vs time curve from 0 to 6 h were greater (P < .05) for MET+SURG than for SURG calves. There were no differences between MET+SURG and SURG animals in IFN-gamma production, WBC numbers, and ADFI. On d 1, MET+SURG and SURG animals had lower (P < .01) KLH- and Con A-induced IFN-gamma production and higher (P < .05) neutrophil numbers and N:L ratio compared with CON animals. Plasma haptoglobin on d 1 and 3 and fibrinogen concentrations on d 3 and 7 were elevated (P < .05) for MET+SURG and SURG compared with CON animals, whereas SURG animals had greater (P < .05) haptoglobin and fibrinogen concentrations than MET+SURG animals on d 7. The ADG of SURG calves was lower (P < .05) than that of MET+SURG calves during d 0 to 7. Metyrapone treatment partially suppressed cortisol and increased ACTH in castrated calves but did not alter the castration-induced suppression of IFN-gamma and increases in neutrophil numbers and the N:L ratio.

Becoming a registered nurse.

This paper describes research carried out with clinical agencies and former students to ascertain the effectiveness of curriculum design within the third year of a problem-based Bachelor of Nursing programme. It shows that where holistic care, time management, prioritization of care, working as a team member, and sophisticated clinical reasoning were introduced as deliberate strategies in students' learning, the transition to the workplace was more successful.

Effect of castration method and the provision of local anesthesia on plasma cortisol, scrotal circumference, growth, and feed intake of bull calves.

To determine the effects of castration of calves, with or without local anesthesia, on plasma cortisol, scrotal circumference, ADG, and ADFI, 56 Friesian bulls (5.5 mo of age; mean +/- SE BW = 173 +/- 2 kg) were randomly assigned to each of seven treatments: 1) control (CON); 2) s.c. injection of .1 mg of a human serum albumin-GnRH conjugate with DEAE-dextran adjuvant (HSA-GnRH); 3) burdizzo castration without local anesthetic (BURD); 4) burdizzo castration following local anesthetic administration (BURD + LA); 5) surgical castration without local anesthetic (SURG); 6) surgical castration following local anesthetic administration (SURG + LA); and 7) local anesthetic administration alone (LAA). Blood samples for cortisol analyses were taken via jugular catheter from -2 to 10 h and at 24, 48, and 72 h relative to treatment. Average daily feed intakes were recorded for 5-d periods and calves weighed at 7-d intervals before and after treatment. Local anesthetic alone had no effect (P > .10) on any variable. The HSA-GnRH calves had elevated (P < .05) plasma cortisol from 2 to 6 h compared with CON calves. Peak plasma cortisol was elevated (P < .01) in BURD, BURD + LA, SURG, and SURG + LA compared with CON calves. The SURG calves (46.0 ng/mL) had higher (P < .03) peak cortisol than BURD (31.4 ng/mL) and SURG + LA (35.4 ng/mL) calves. There was no difference in peak cortisol between BURD and BURD + LA (26.5 ng/mL) calves. The ADG from d 0 to 7 was reduced (P < .05) in calves in BURD + LA, SURG, and SURG + LA treatments (-.01, -.83 and -.24 kg, respectively) compared with CON calves (.54 kg). The ADFI were reduced (P < .05) in BURD and BURD + LA calves during d 1 to 5 and in BURD + LA, SURG, and SURG + LA calves during d 6 to 10 compared with CON calves. The scrotal circumferences of BURD and BURD + LA calves were greater (P < .05) than those of CON calves for 7- and 35-d periods post-castration, respectively. Castration induced increases in cortisol and decreases in ADG and ADFI. Surgical castration induced a greater plasma cortisol response than burdizzo castration, and the administration of local anesthetic reduced the cortisol response of surgical castrates but was less effective for burdizzo castrates.

Clinical features and antibiotic treatment of septic arthritis and osteomyelitis due to Yersinia enterocolitica.

Yersinia enterocolitica bone and joint infections are rare. Over a period of 7 months four patients with deep-seated skeletal infections due to Y. enterocolitica were seen at the University Hospital, Nottingham. Sites of infection included the knee (one patient) the hip (one) and the spine (two). None of the patients had major underlying disease or risk factors for developing invasive Y. enterocolitica infection. The organisms were sensitive to the second- and third-generation cephalosporins, gentamicin and fluoroquinolones. A literature search covering the period 1970-1994 revealed 20 other cases of skeletal infections due to Y. enterocolitica; there was no uniformity in the choice of antimicrobial agent for treating these infections. Oral ciprofloxacin was used as the principal antimicrobial agent in the patients described here and therapeutic success was achieved in three of these patients. Ciprofloxacin should be considered as first line therapy for invasive infections due to Y enterocolitica.

Examination of the energetics of aging skeletal muscle using nuclear magnetic resonance.

Human skeletal muscle has been studied in vivo by 31P nuclear magnetic resonance. Young adult subjects were compared with healthy elderly subjects aged 70-80 years. Intracellular pH and concentrations of adenosine triphosphate (ATP), phosphocreatine and inorganic phosphate were measured. At rest, no differences were found between the two age groups. Aerobic dynamic exercise resulted in a similar reduction of phosphocreatine in both groups while the ATP concentration did not change. The pH fall in exercise was not significantly different in the elderly and younger subjects. The time to resynthesize ATP in the recovery period as measured by the time to replete phosphocreatine was also not different in the two groups. The results suggest that the aging process does not affect the metabolic ability of human skeletal muscle to respond to exercise and that changes found in muscle of the elderly are not due to alterations in energy production.