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Ment of Surgery, School of Medicine, University of Pennsylvania, Philadelphia, PA; 3 VA-MD Regional College of Veterinary Medicine, Blacksburg, VA; 4Department of Comparative Medicine, University of Washington, Seattle, WA Our institutional veterinary staff is committed to the provision of appropriate dosing and administration of post-operative pain relief in animals that have undergone major surgical procedures. To provide 24-h oversight for post-surgical animals, one must consider personnel shortages, the relatively short duration of commonly used analgesics, and compliance. In larger laboratory animals, specifically sheep, the best-case scenario would typically require injecting a 12-h analgesic such as buprenorphine ; and requiring the technician to administer the medication outside the normal work day. This study examined the application of the fentanyl patches for long-term analgesia and to confirm therapeutic plasma levels of the analgesic. Male and female Dorsett-cross sheep 30 to 50 kg, n 8 ; with 50 g h patches were studied over 5 d. We applied the patches 0-2 h pre-operatively, in the axillary region, wrapped with a light bandage, to sheep undergoing cardiovascular surgery with an open thoracotomy. Plasma fentanyl levels were measured and pain scoring assessed incrementally at 0, 6, 12, 24, and 120 h post-patch placement. Efficacy of the fentanyl patches was confirmed with a comprehensive pain scoring system, coupled with the plasma fentanyl levels. Plasma fentanyl levels attained in the sheep were comparable to therapeutic range of fentanyl demonstrated in humans through 96 h. Control animals n 8 ; received 2 g kg buprenorphine and flunixin meglumine 2 mg kg every 12 h for and cefaclor. 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LT ASC responses to LT peaked on day 7 or 10 and were low on days 14 and 28 ; . One volunteer had 123 ASC per 106 PBMC on day 14, and another had 57 ASC per 106 PBMC on day 28. The volunteers with late ASC responses to CFA I were not remarkable in terms of the severity of illness, volume of diarrheal stools, onset of diarrhea, or number of days of shedding H10407. There were no significant differences between doses with respect to the frequency and magnitude of anti-CFA I or anti-LT ASC responses. There were no significant differences between the dose groups with regard to the frequency and magnitude of serum anti-CFA I and anti-LT responses. H10407 challenge induced significant serum IgA and IgG anti-CFA I responses in all 15 volunteers Table 5 ; . In these volunteers, the peak geometric mean increases in CFA I-specific IgA and IgG titers compared with the baseline titers were 40-fold range, 4.1- to 1, 070-fold ; and 30-fold range, 4.3- to 830-fold ; , respectively Fig. 3 ; , with the highest anti-CFA I titers 28 days after challenge. H10407 challenge induced significant serum IgA and IgG anti-LT responses in 75% of the volunteers Table 5 ; . Among the responders, the peak geometric mean increases in LTspecific IgA and IgG titers compared with the baseline titers were 6.3-fold range, 2.3- to15-fold ; and 6.8-fold range, 2.3- to 32-fold ; , respectively Fig. 3 ; . In the majority of the volunteers, the peak anti-LT antibody titers were detected on day 14 for IgA and on days 14 and 28 for IgG. DISCUSSION This study was the first direct comparison of the clinical courses following oral inoculation with the same dose 109 CFU ; of ETEC strains B7A and H10407 and the first time that the immune response to CS6 was quantified after infection with wild-type ETEC. The onset of shedding and clinical symptoms appeared earlier in volunteers challenged with B7A than in volunteers challenged with H10407, but the number and volume of stools were smaller and the symptoms were milder in volunteers challenged with B7A. Patel et al. 46 ; suggested that the difference in virulence could result from an autotransporter, EatA, that is present in H10407 but not in B7A. Other possible explanations for differences between the ETEC strains could be differences in the CS6 and CFA I colonization factors, the amount of LT expressed 10, 56 ; or released 15, 16, 31 ; , or genes present only in H10407 15 ; or B7A 19, 33, 38 ; . The significance of other genes is consistent with recent publications that have suggested that other antigens, yet to be defined, should be included in vaccine development 3, 51 ; . This paper provides the first quantitative data for the immune response to CS6 after experimental infection with a wild-type ETEC strain. Helander et al. 23 ; found that four of. CT Registry ID #7505 hypoglycemic episodes resulted in coma or discontinuation from the study Table IOOM.13. Advanced practice nursing is the application of nursing principles, including those in subsection n ; of this section, at an advanced level and includes: a. For those advanced practice nurses who do not perform independent acts of diagnosis or prescription, the authority is granted within the scope of practice rules and regulations promulgated by the Board of Nursing; and b. For those advanced practice nurses performing independent acts of diagnosis and prescriptions with the collaboration of a licensed physician, dentist, podiatrist, or licensed Delaware health care delivery system without written guidelines or protocols and within the scope of practice as defined in rules and regulations promulgated by the Joint Practice Committee and approved by the Board of Medical Practice. Note: Subsection n ; describes the scope of practice of a registered nurse. Citation: DEL. CODE ANN. tit. 24, 1902 b ; 1 ; . Generic functions of the advanced registered nurse practitioner within the specialized scope of practice, include but are not limited to: Eliciting detailed health history s ; Defining nursing problem s ; Performing physical examination s ; Collecting and performing laboratory tests Interpreting laboratory data Initiating requests for essential laboratory procedures Initiating requests for essential X-rays Screening patients to identify abnormal problems Initiating referrals to appropriate resources and services as necessary Initiating or modifying treatment s ; within established guidelines Assessing and reporting changes in the health of individuals, families, and communities Providing health education through teaching and counseling Planning and or instituting health care programs in the community with other health care professionals and the public. 18 Moser, M. and Black, H. R. 1998 ; The role of combination therapy in the treatment of hypertension. Am. J. Hypertens. 11, 73S78S 19 Bradford, M. M. 1976 ; A rapid and sensitive method for the quantitation of microgram quantities of protein utilizing the principle of protein dye binding. Anal. Biochem. 72, 248254 20 Yagi, K. 1976 ; A simple fluorimetric assay for lipoperoxide in blood plasma. Biochem. Med. 15, 212216 21 Gonzalez, W., Fontaine, V., Pueyo, M. E. et al. 2000 ; Molecular plasticity of the vascular wall during l-NAME-induced hypertension: modulation of pro-inflammatory signals. Hypertension 36, 103109 22 Corseaux, D., Ollivier, V., Huisse, M.-G. et al. 2002 ; Hemostasis imbalance in an experimental hypertension model. Mol. Med. 8, 169178 23 Ranadive, S. A., Chen, A. X. and Serajuddin, A. T. M. 1992 ; Relative lipophilicities and structuralpharmacological considerations of various angiotensinconverting enzyme ACE ; inhibitors. Pharm. Res. 9, 14801486 24 Cushman, D. W., Wang, F. L., Fung, W. C. et al. 1989 ; Comparisons `in vitro', `ex vivo', and `in vivo' of the actions of seven structurally diverse inhibitors of angiotensin converting enzyme ACE ; . Br. J. Clin. Pharmacol. 28, 115S131S. 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