The Effects of Cannabidiol on Senior Equine Health

Cannabis sativa L., has been revealed to produce hundreds of phytocannabinoids, of which cannabidiol (CBD) is one of the most desired. It has been revealed that CBD can potentially treat inflammation and act as an analgesic in humans without psychoactive effects of delta-9-tetrahydrocannabinol (THC). Recently, there has been interest in understanding the potential health benefits of CBD for horses. With an increasing senior horse population (\u3c 15 years old), alternatives to the use of non-steroidal anti-inflammatory drugs (NSAIDs) such as phenylbutazone, firocoxib, and flunixin meglumine, are desired as these common anti-inflammatory treatments have negative side effects. Because senior horses may have chronic low-grade inflammation, termed inflamm-aging, they are a natural model to investigate the efficacy of CBD on inflammatory responses as well as other health parameters. Given this interest, and due to the lack of research conducted on CBD in the horse, the overall objective of this dissertation work was to conduct both basic and applied research investigating the effects of CBD on equine immune function and health. The first objective was to determine the in vitro effects of CBD as an anti-inflammatory. Peripheral blood mononuclear cells (PBMCs) from senior horses were cultured in vitro with increasing concentrations of pure CBD dissolved in dimethyl sulfoxide (DMSO). These cells were then stimulated, cell viability and cytokine production were measured. The concentration of CBD that did not affect cell viability was 4 µg/mL. CBD at 4 µg/mL significantly reduced production of TNFα and IFNγ. RT-PCR results for TNFα and IFNγ at 4 µg/mL showed a reduction compared with the positive control and IL-10 showed a similar reduction at 2 µg/mL and 4 µg/mL. RT-PCR gene expression results showed significance at 10 μg/mL CBD with an increase in gene expression of both CB1 and CB2. CBD reduced in vitro production of inflammatory cytokines from senior horses. The second objective was to determine the pharmacokinetics, bioavailability, and pharmacological effects of CBD in senior horses. In a cross-over trial using senior horses, a single oral dose of 2mg/kg CBD in soy oil was compared to a single intravenous (IV) dose of 0.1mg/kg CBD in DMSO. Blood samples were collected at specific time points. Plasma concentrations of CBD and metabolites (7-COH CBD and 7-COOH CBD), were detected in all plasma samples up to 8h post dosing (oral and IV) with 7-COOH CBD being the most predominant metabolite. Pharmacokinetics for CBD oral dosing at 2mg/kg were half-life 7.22 ± 2.86 hours, Cmax was 18.54± 9.80 and Tmax was 2.46 ± 1.62 hours. Oral bioavailability for CBD in senior horses was calculated at 7.92%. There were no significant effects of CBD on CBC, serum chemistry or vitals for all horses. Pharmacokinetics and bioavailability of CBD in senior horses was determined, and no adverse effects were found administering either an oral dose or an IV dose of CBD. Lastly, the third objective was to determine the effects of CBD on immune function by measuring inflammatory cytokines and antibody responses to vaccination, as well as various health parameters of body weight, body condition, lameness, and metabolic responses in senior horses. For 90 days two treatment groups of senior horses were orally-dosed once daily with CBD (treatment: 2mg/kg) or soy oil (control). Peripheral blood samples were collected prior to treatments on day 0 and post-treatment on days 30, 60, and 90. On day 90 all horses were vaccinated with a commercial equine influenza vaccine and blood samples were collected post-vaccination. Plasma concentrations of CBD and metabolites, 7-OH CBD, and 7-COOH CBD were measured with 7-COOH CBD the most significant of the two metabolites in the plasma post-treatment. At day 60 in RT-PCR, a significant reduction in the gene production of IFNγ occurred and IL-6 was also significantly reduced at day 60 and 90 for CBD treated horse when compared with control horses. There were no other significant changes in immune function, nor health parameters measured in response to CBD treatment. This body of work provides the foundation for understanding the effects of CBD on the health and well-being of the senior horse

An evaluation of the nursing care of renal transplant recipients: A qualitative study

Due to the complexity of their medical management, renal transplant recipients are actively encouraged to self-manage their own medication regimens, diet and lifestyle modifications after transplant. Motivation for this study arose from comments made by hospitalised renal transplant recipients regarding aspects of their clinical care that were not given high priority by the ward nurses. The aim of this study was to investigate renal transplant recipients\u27 experience of the care they received while they were inpatients on the renal ward. In this qualitative study the stories of 12 renal transplant recipients were used to evaluate how they felt about their experiences as an inpatient. Patients felt that ward nurses did not understand the importance of immunosuppressive medication and did not value the patient\u27s opinion. They also expressed a fear of contracting an infection. Renal transplant recipients have high expectations about the care they receive when admitted to hospital. As a well-informed group of patients, who would normally be managing their own care at home, renal transplant recipients should be treated with respect and included in decisions about their care

Shelley Phillips and Denise Masters in a Junior Recital

This is the program for the junior recital of mezzo-soprano, Shelley Phillips, accompanied by pianist, Chris Norris, and soprano, Denise Masters, accompanied by pianist, John Turner. The recital was held on March 9, 1990, in the Mabee Fine Arts Center Recital Hall

Chapter 8 Now what?

Co-production; prisons; criminal justice; youth detentio

The Circumnuclear Star Formation Environment of NGC 6946: Br γ and H_2 Results from Keck Integral Field Spectroscopy

We present a 3-dimensional data cube of the K band continuum and the Brγ, H_2 S(0) and S(1)lines within the central 18.”5 x 13.”8 (520 pc x 390 pc) region of NGC6946. Data were obtained using OSIRIS, a near-infrared Integral Field Unit at Keck Observatory, with Laser Guide Star Adaptive Optics. The 0."3 resolution allows us to investigate the stellar bulge and the forming star clusters in the nuclear region on 10 pc scales. We detect giant H II regions associated with massive young star clusters in the nuclear spiral/ring (R~30 pc) and in the principal shocks along the nuclear bar. Comparisons of the Br γ fluxes with Pa α line emission and radio continuum indicate A_K ~ 3, A_V ~ 25 for the nuclear star forming regions. The most luminous H II regions are restricted to within 70 pc of the center, despite the presence of high gas columns at larger radii (R~200 pc). H_2 emission is restricted to clouds within R~60 pc of the center, and in this sense resembles the distribution of the HCN line emission. We propose that gas-assisted migration of the young star clusters is contributing to the buildup of the nuclear bar and nuclear star cluster (R<30 pc) in this galaxy

Introducing Medical Students into the Emergency Department: The Impact upon Patient Satisfaction

Introduction: Performance on patient satisfaction surveys is becoming increasingly important for practicing emergency physicians and the introduction of learners into a new clinical environment may impact such scores. This study aimed to quantify the impact of introducing fourth-year medical students on patient satisfaction in two university-affiliated community emergency departments (EDs). Methods: Two community-based EDs in the Indiana University Health (IUH) system began hosting medical students in March 2011 and October 2013, respectively. We analyzed responses from patient satisfaction surveys at each site for seven months before and after the introduction of students. Two components of the survey, “Would you recommend this ED to your friends and family?” and “How would you rate this facility overall?” were selected for analysis, as they represent the primary questions reviewed by the Center for Medicare Services (CMS) as part of value-based purchasing. We evaluated the percentage of positive responses for adult, pediatric, and all patients combined. Results: Analysis did not reveal a statistically significant difference in the percentage of positive response for the “would you recommend” question at both clinical sites with regards to the adult and pediatric subgroups, as well as the all-patient group. At one of the sites, there was significant improvement in the percentage of positive response to the “overall rating” question following the introduction of medical students when all patients were analyzed (60.3% to 68.2%, p=0.038). However, there was no statistically significant difference in the “overall rating” when the pediatric or adult subgroups were analyzed at this site and no significant difference was observed in any group at the second site. Conclusion: The introduction of medical students in two community-based EDs is not associated with a statistically significant difference in overall patient satisfaction, but was associated with a significant positive effect on the overall rating of the ED at one of the two clinical sites studied. Further study is needed to evaluate the effect of medical student learners upon patient satisfaction in settings outside of a single health system

Cannabis Therapy Knowledge Study: Toward Establishing a Pedagogical Tool

Upcoming legalization of cannabis calls for physicians to increase knowledge on medical and recreational cannabis use. We analyzed physician knowledge and opinions on i) mechanism of the endocannabinoid system, ii) current training with cannabis, iii) risks associated with cannabis use, iv) creating effective treatment plans using cannabis and v) future training needs. Physician knowledge and opinions on cannabis are limited and divided. Physicians support integration of cannabis training through webinars, in person training, peer reviewed literature and clinical guidelines. A curriculum must be developed for current and future physicians to create a standard of care as it relates to cannabis