Controlled release ibuprofen-poloxamer gel for epidural use - A pharmacokinetic study using microdialysis in pigs

In order to avoid the risks of sideeffects of epidural local anesthetics and opioids, the use of nonsteroidal anti-inflammatory drugs (NSAIDs) epidurally would be an interesting option of analgesic therapy. The fairly short duration of action of spinally administered NSAIDs, e.g., ibuprofen, may be prolonged by using controlled release poloxamer gel formulation. Using a microdialysis technique we studied the epidural and intrathecal pharmacokinetics of ibuprofen after its epidural administration as a poloxamer 407 formulation or a solution formulation. In addition, plasma ibuprofen concentrations were analyzed from central venous blood samples. Ibuprofen concentrations in the epidural space were significantly higher and longer lasting after the epidural gel injection compared with the epidural solution injection. The epidural AUC of ibuprofen was over threefold greater after epidural ibuprofen gel injection compared with the ibuprofen solution injection (p <0.001). The systemic absorption of ibuprofen from 25% poloxamer 407 gel was very low. The in situ forming poloxamer gel acted as a reservoir allowing targeted ibuprofen release at the epidural injection site and restricted ibuprofen molecules to a smaller spinal area. Ibuprofen diffusion from the epidural space to the intrathecal space was steady and prolonged. These results demonstrate that the use of epidurally injectable poloxamer gel can increase and prolong ibuprofen delivery from epidural space to the CSF enhancing thus ibuprofen entry into the central neuroaxis for spinal analgesia. Further toxicological and dose-finding studies are justified. (C) 2016 Elsevier B.V. All rights reserved.Peer reviewe

A Plan for Reforming Federal Pleading, Discovery, and Pretrial Merits Review

We propose a fundamental restructuring of the federal civil pretrial process to address its great expense and unreliability in resolving cases on their merits-problems largely attributable to discovery. The proposed reforms establish an affirmative-disclosure mandate that sharply reduces the role of discovery by transferring most of the parties\u27 burden of fully revealing discoverable matter, favorable and unfavorable, to their pleadings. To effectuate the new function for pleadings, the reformed process replaces Rules 12(b)(6), (c), and (f) with pretrial merits review conducted exclusively pursuant to the procedures and standards for summary judgment under Rule 56. Responding parties will be required to fully disclose discoverable matter to which they have exclusive or superior practical access ( asymmetric information ), but only if the initiating party\u27s pleading makes a summary judgment-proof showing on all elements of their claims or defenses that are unaffected by the information asymmetry. Discovery, if any, would generally be deferred to the post-pleading stage and restricted to court-approved, targeted use as may be needed for purposes of facilitating resolution of cases by summary judgment, settlement, or trial preparation. Compared to the current regime, the reformed pretrial process should enable courts and parties to resolve more cases on the merits-more cheaply, quickly, and reliably-thus increasing deterrence and other social benefits from the use of civil liability to enforce the law. Courts in this country, including Mandatory Initial Discovery pilot projects, launched by the Federal Judicial Center last year, and abroad are testing the benefits of affirmative-disclosure reforms that resemble what we propose in this Article

Everybody’s Publishing but Me! How a Writing Group Can Help Actualize Your Publishing Dreams

On any given day, one can go to the Chronicle of Higher Education and see a new article on the trials and tribulations of publishing and seeking tenure in academia. Anxiety inducing titles such as “Measuring Up” and “The Stress of Academic Publishing” reaffirm the notion that one must publish, or perish. While this type of pressure pushes some to success, for others, it makes it harder to write. However, you don’t have to travel this writing and publishing road alone. Inspired by the book Every Other Thursday: Stories and Strategies from Successful Women Scientists by Ellen Daniell, a small group of women academics and professionals in Logan, Utah found their support team through the creation of a writing group in Spring 2009

Let us pick the organization: understanding adult student perceptions of service-learning practice

Service learning offers a pedagogy by which adult students are guided toward understanding their potential for leadership in civic life and community development, strengthening the impact that universities have in communities. In this study, qualitative data is analyzed to determine how adult students perceive their service-learning experiences and what the university could do to involve them more in the future. Respondents provide some evidence that they value opportunities to give back to communities where they have a connection; appreciate hands-on learning that is integrated with classroom learning; benefit from placement experiences that build upon prior knowledge and skills; and prefer greater choice in the selection of their service-learning placement. As the number of adult students entering higher education continues to rise and their retention remains a challenge, understanding how these students are engaged by service learning becomes an important area of exploration for post-secondary institution

The effect of community service learning on undergraduate persistence in three institutional contexts

This study explores the role of community service learning (CSL) in promoting undergraduate persistence relative to other experiences students have in college, their entering characteristics, and institutional features. By following the 2009 freshmen cohort at three Midwestern universities over three years, this study finds that students’ experiences while in college (CSL, full-time enrollment, and GPA) have a stronger effect on the likelihood of reenrollment than students’ entering characteristics (age, gender, and race). Our separate analyses for each institution allow us to consider how the differences between the three universities (student body composition, retention rate, CSL program) might lead CSL courses to play a particularly critical role in student persistence in certain types of universities

The effect of community service learning on undergraduate persistence in three institutional contexts.

This study explores the role of community service learning (CSL) in promoting undergraduate persistence relative to other experiences students have in college, their entering characteristics, and institutional features. By following the 2009 freshmen cohort at three Midwestern universities over three years, this study finds that students’ experiences while in college (CSL, full-time enrollment, and GPA) have a stronger effect on the likelihood of reenrollment than students’ entering characteristics (age, gender, and race). Our separate analyses for each institution allow us to consider how the differences between the three universities (student body composition, retention rate, CSL program) might lead CSL courses to play a particularly critical role in student persistence in certain types of universities

Idiopathic granulomatous mastitis masquerading as carcinoma of the breast: a case report and review of the literature

BACKGROUND: Idiopathic granulomatous mastitis is an uncommon, benign entity with a diagnosis of exclusion. The typical clinical presentation of idiopathic granulomatous mastitis often mimics infection or malignancy. As a result, histopathological confirmation of idiopathic granulomatous mastitis combined with exclusion of infection, malignancy and other causes of granulomatous disease is absolutely necessary. CASE PRESENTATION: We present a case of a young woman with idiopathic granulomatous mastitis, initially mistaken for mastitis as well as breast carcinoma, and successfully treated with a course of corticosteroids. CONCLUSION: There is no clear clinical consensus regarding the ideal therapeutic management of idiopathic granulomatous mastitis. Treatment options include expectant management with spontaneous remission, corticosteroid therapy, immunosuppressive agents and extensive surgery for refractory cases

Systematic Multi-Domain Alzheimer's Risk Reduction Trial (SMARRT): Study Protocol.

This article describes the protocol for the Systematic Multi-domain Alzheimer's Risk Reduction Trial (SMARRT), a single-blind randomized pilot trial to test a personalized, pragmatic, multi-domain Alzheimer's disease (AD) risk reduction intervention in a US integrated healthcare delivery system. Study participants will be 200 higher-risk older adults (age 70-89 years with subjective cognitive complaints, low normal performance on cognitive screen, and ≥ two modifiable risk factors targeted by our intervention) who will be recruited from selected primary care clinics of Kaiser Permanente Washington, oversampling people with non-white race or Hispanic ethnicity. Study participants will be randomly assigned to a two-year Alzheimer's risk reduction intervention (SMARRT) or a Health Education (HE) control. Randomization will be stratified by clinic, race/ethnicity (non-Hispanic white versus non-white or Hispanic), and age (70-79, 80-89). Participants randomized to the SMARRT group will work with a behavioral coach and nurse to develop a personalized plan related to their risk factors (poorly controlled hypertension, diabetes with evidence of hyper or hypoglycemia, depressive symptoms, poor sleep quality, contraindicated medications, physical inactivity, low cognitive stimulation, social isolation, poor diet, smoking). Participants in the HE control group will be mailed general health education information about these risk factors for AD. The primary outcome is two-year cognitive change on a cognitive test composite score. Secondary outcomes include: 1) improvement in targeted risk factors, 2) individual cognitive domain composite scores, 3) physical performance, 4) functional ability, 5) quality of life, and 6) incidence of mild cognitive impairment, AD, and dementia. Primary and secondary outcomes will be assessed in both groups at baseline and 6, 12, 18, and 24 months