The costs of surgical site infection after abdominal surgery in middle-income countries: Key resource use In Wound Infection (KIWI) study.

BACKGROUND: Surgical site infection (SSI) is the most common complication of abdominal surgery, with substantial costs to patients and health systems. Heterogeneity in costing methods in existing SSI studies makes multi-country comparison challenging. The objective of the study was to assess the costs of SSI across middle-income countries. METHODS: Centres from a randomized controlled trial assessing interventions to reduce SSI (FALCON, ClinicalTrials.gov, NCT03700749NCT) were sampled from two upper-middle- (India, Mexico) and two lower-middle- (Ghana, Nigeria) income countries. The Key resource use In Wound Infection (KIWI) study collected data on postoperative resource use and costs from consecutive patients undergoing abdominal surgery with an incision >5 cm (including caesarean section) that were recruited to FALCON between April and October 2020. The overall costs faced by patients with and without SSI were compared by operative field contamination (clean-contaminated vs contaminated-dirty), country and timing (inpatient vs outpatient). FINDINGS: A total of 335 patients were included in KIWI; SSI occurred in 7% of clean-contaminated cases and 27% of contaminated-dirty cases. Overall, SSI was associated with an increase in postoperative healthcare costs by 75.3% (€412 international Euros) after clean-contaminated surgery and 66.6% (€331) after contaminated-dirty surgery. The highest and lowest cost increases were in India for clean-contaminated cases (€517) and contaminated-dirty cases (€223), respectively. Overall, inpatient costs accounted for 96.4% of the total healthcare costs after clean-contaminated surgery and 92.5% after contaminated-dirty surgery. CONCLUSION: SSI was associated with substantial additional postoperative costs across a range of settings. Investment in health technologies to reduce SSI may mitigate the financial burden to patients and low-resource health systems.

Recurrent focal segmental glomerulosclerosis in the renal allograft: single center experience in the era of modern immunosuppression.

FSGS is an important cause of ESRD and tends to recur in allografts (rFSGS). Older series suggest recurrence rates of 30-60%. In the modern era of transplant immunosuppression, recurrence rates are unknown. There are also few data regarding prevalence of known genetic mutations in adult FSGS patients who undergo transplantation. Recently, FSGS has been subdivided into histological variants, which may predict renal outcomes; there is little information on patterns of recurrence and outcomes in these variants. Finally, treatment for rFSGS relies upon up-titrating calcineurin inhibitors and plasmapheresis. Insufficient information exists on the use of these regimens for rFSGS in the era of modern immunosuppression. We conducted a retrospective chart review involving all renal transplant recipients at Columbia University Medical Center from December 1999 to March 2007. Those with biopsy confirmed primary FSGS were included and information regarding baseline characteristics, histologic variants, genetics, treatment, and clinical outcomes were collected. FSGS recurred in 23% of patients. Those with collapsing histology on native kidney biopsy, tended to recur with the same histology. No known genetic mutations were identified among those with recurrence. Plasmapheresis resulted in complete or partial remission in 75% of those with recurrence. Recurrent FSGS resulted in a trend toward the combined outcome of ESRD or death compared to those without recurrence (27% vs. 12%). Modern immunosuppression does not reduce the rate of rFSGS, known genetic mutations are uncommon in such adult patients, collapsing FSGS tends to recur with the same histology, and plasmapheresis may be helpful in the treatment of recurrence.

Evaluation of a co-facilitated information and learning programme for service users: the EOLAS programme.

BACKGROUND: The co-production and co-facilitation of recovery-focused education programmes is one way in which service users may be meaningfully involved as partners. OBJECTIVES: To evaluate the impact of a clinician and peer co-facilitated information programme on service users' knowledge, confidence, recovery attitudes, advocacy and hope, and to explore their experience of the programme. METHODS: A sequential design was used involving a pre-post survey to assess changes in knowledge, confidence, advocacy, recovery attitudes and hope following programme participation. In addition, semi-structured interviews with programme participants were completed. Fifty-three participants completed both pre- and post-surveys and twelve individuals consented to interviews. RESULTS: The results demonstrated statistically significant changes in service users' knowledge about mental health issues, confidence and advocacy. These improvements were reflected in the themes which emerged from the interviews with participants (n = 12), who reported enhanced knowledge and awareness of distress and wellness, and a greater sense of hope. In addition, the peer influence helped to normalise experiences for participants, while the dual facilitation engendered equality of participation and increased the opportunity for meaningful collaboration between service users and practitioners. CONCLUSIONS: The evaluation highlights the potential strengths of a service user and clinician co-facilitated education programme that acknowledges and respects the difference between the knowledge gained through self-experience and the knowledge gained through formal learning.

Synthetic polypeptide antagonists of the hypothalamic luteinizing hormone releasing factor.

Two analogs of the hypothalamic luteinizing hormone releasing factor modified at the histidine-2 position were tested for biological activity (secretion of luteinizing hormone) in cultures of dispersed rat anterior pituitary cells. The analog in which glycine was substituted for histidine at position 2, [Gly(2)]LRF, behaves as a partial agonist releasing less than 50 percent of the luteinizing hormone secreted at maximum concentrations of the releasing factor, while the analog in which histidine at position 2 is deleted has no significant agonist activity at any of the doses tested. When added to the cultured cells at molar ratios 10(3) to 10(4) times that of the luteinizing hormone releasing factor, both analogs decrease the amount of luteinizing hormone secreted in response to the releasing factor.

Economic evaluation of strategies for restarting anticoagulation therapy after a first event of unprovoked venous thromboembolism.

Essentials Correct duration of treatment after a first unprovoked venous thromboembolism (VTE) is unknown. We assessed when restarting anticoagulation was worthwhile based on patient risk of recurrent VTE. When the risk over a one-year period is 17.5%, restarting is cost-effective. However, sensitivity analyses indicate large uncertainty in the estimates. SUMMARY: Background Following at least 3 months of anticoagulation therapy after a first unprovoked venous thromboembolism (VTE), there is uncertainty about the duration of therapy. Further anticoagulation therapy reduces the risk of having a potentially fatal recurrent VTE but at the expense of a higher risk of bleeding, which can also be fatal. Objective An economic evaluation sought to estimate the long-term cost-effectiveness of using a decision rule for restarting anticoagulation therapy vs. no extension of therapy in patients based on their risk of a further unprovoked VTE. Methods A Markov patient-level simulation model was developed, which adopted a lifetime time horizon with monthly time cycles and was from a UK National Health Service (NHS)/Personal Social Services (PSS) perspective. Results Base-case model results suggest that treating patients with a predicted 1 year VTE risk of 17.5% or higher may be cost-effective if decision makers are willing to pay up to £20 000 per quality adjusted life year (QALY) gained. However, probabilistic sensitivity analysis shows that the model was highly sensitive to overall parameter uncertainty and caution is warranted in selecting the optimal decision rule on cost-effectiveness grounds. Univariate sensitivity analyses indicate variables such as anticoagulation therapy disutility and mortality risks were very influential in driving model results. Conclusion This represents the first economic model to consider the use of a decision rule for restarting therapy for unprovoked VTE patients. Better data are required to predict long-term bleeding risks during therapy in this patient group.

Radiographic localisation of the entheses of the equine stifle.

REASON FOR PERFORMING STUDY: Injury to the tendons and ligaments of the equine stifle is a common cause of lameness in horses. Individual radiographic localisation of each tendon and ligament of the stifle has not been previously reported or demonstrated in multiple radiographic projections. OBJECTIVE: To create a series of radiographs identifying the origins and/or insertions of the tendons and ligaments of the equine stifle. STUDY DESIGN: Descriptive study of radiographic anatomy. METHODS: The location of all entheses were determined by gross dissection. The proximal tibia and fibula, distal femur, patella and menisci were isolated from one horse and used as a template. A series of 4 radiographs was obtained with each enthesis identified with barium paste. The radiographic landmarks for each enthesis were described and the best projection(s) for evaluation of each structure of interest identified. RESULTS: Forty-eight radiographic images were produced that demonstrated the best radiographic projections to define each enthesis. CONCLUSIONS: Radiography is the imaging modality most frequently used to evaluate the equine stifle. The images presented here will serve as a guide for evaluating radiographs of the equine stifle, particularly identifying avulsions and enthesopathies of ligamentous and tendinous origins and insertions.

A participatory approach to the development of a co-produced and co-delivered information programme for users of services and family members: the EOLAS programme (paper 1).

OBJECTIVE: The EOLAS programme is a peer and clinician-led mental health information programme on recovery from mental health difficulties, specifically for people with a diagnosis of schizophrenia spectrum or bipolar disorders, their family members and significant others. METHOD: This article, the first of a two part series, outlines the background to and the rationale behind the EOLAS programme, and traces the participatory process used to inform the development and implementation of the pilot phase of the project. The aims of the programme, and the overarching principles that guided its development, delivery and evaluation, including the set-up of the project steering group are outlined and discussed. Findings Two separate programmes, one for family members and one for service users were designed. In addition, participant and facilitator handbooks were developed for each programme, including a training programme for facilitators. CONCLUSION: Central to a recovery oriented service is the involvement of service users and families in the design and delivery of services. EOLAS is one potential model for achieving this aim.

The interaction of polyene antibiotics with thin lipid membranes.

Optically black, thin lipid membranes prepared from sheep erythrocyte lipids have a high dc resistance (R(m) congruent with 10(8) ohm-cm(2)) when the bathing solutions contain NaCl or KCl. The ionic transference numbers (T(i)) indicate that these membranes are cation-selective (T(Na) congruent with 0.85; T(Cl) congruent with 0.15). These electrical properties are independent of the cholesterol content of the lipid solutions from which the membranes are formed. Nystatin, and probably amphotericin B, are cyclic polyene antibiotics containing approximately 36 ring atoms and a free amino and carboxyl group. When the lipid solutions used to form membranes contained equimolar amounts of cholesterol and phospholipid, these antibiotics reduced R(m) to approximately 10(2) ohm-cm(2); concomitantly, T(Cl) became congruent with0.92. The slope of the line relating log R(m) and log antibiotic concentration was congruent with4.5. Neither nystatin (2 x 10(-5)M) nor amphotericin B (2 x 10(-7)M) had any effect on membrane stability. The antibiotics had no effect on R(m) or membrane permselectivity when the lipids used to form membranes were cholesterol-depleted. Filipin (10(-5)M), an uncharged polyene with 28 ring atoms, produced striking membrane instability, but did not affect R(m) or membrane ionic selectivity. These data suggest that amphotericin B or nystatin may interact with membrane-bound sterols to produce multimolecular complexes which greatly enhance the permeability of such membranes for anions (Cl(-), acetate), and, to a lesser degree, cations (Na(+), K(+), Li(+)).

The effects of a nonsteroid antiandrogen, flutamide, on sebaceous gland activity.

Flutamide (alpha,alpha,alpha-trifluoro-2-methyl-4'-nitro-m-propionotoluidide), at daily oral doses of 20 mg/day for 24 days, reduced the number and size of skin sebaceous gland cells, and reduced sebum production in ovariectomized, testosterone-stimulated rats. The weight of the preputial glands was also reduced. Unilateral topical application of flutamide (0.1-3.0 mg/day) to flank organs (androgen-sensitive cutaneous sebaceous structures) of testosterone propionate-treated female hamsters for 14 days resulted in bilateral reductions in flank organ weight and in inhibition of in vitro incorporation of 14-C from sodium [1--14C]acetate into lipids. Flutamide inhibition of flank organ weight paralleled the drug effect on lipogenesis. Unilateral topical application of flutamide to flank organs of intact male hamsters for 14 days resulted in significant bilateral reductions of flank organ weight at doses as low as 0.375 mg/day (the lowest dose tested). These weight changes were marked by reduction in sebaceous gland size, accompanied by focal cytoplasmic degeneration, and reductions in cytoplasmic organelles and in the size of the lipid bodies. Flutamide did not, however, seemingly alter the pattern of endogenous total lipids in sebaceous glands, nor did it alter the pattern of 14-C-incorporation into the lipids of male flank organ epidermis and isolated sebaceous glands, when compared to control, untreated preparations.

Synthesis and structure-activity studies of a series of 7 alpha-halogeno corticosteroids.

The preparation and topical antiinflammatory potencies of a series of 7 alpha-halogeno-16-substituted-prednisolone derivatives are described. The 7 alpha-chloro, 7 alpha-bromo, and 7 alpha-iodo corticosteroids were obtained by addition of hydrogen halide to the 6,7-dehydro compounds. The extent of addition of HCl varied with substitution at C-11, while no addition of HF was observed at all. The 7 alpha-fluoro corticosteroids were prepared by reaction of the appropriate 7 beta-hydroxy compounds with N,N-diethyl(2-chloro-1,1,2-trifluoroethyl)amine. The 7 beta-hydroxy steroids were obtained, in turn, from the 6,7-dehydro compounds via the 6 beta,7 beta-dihydroxy derivatives. Antiinflammatory potencies were measured in mice by the Tonelli croton oil ear assay. The greatest effect of a 7 alpha-halogen was observed in the 16 alpha-methylprednisolone series, where 7 alpha-chloro and 7 alpha-bromo substitution increased potency 2.5- to 3.5-fold. Compounds 4b and 5b were equipotent to betamethasone dipropionate. 7 alpha-Halogen substitution in other series produced more variable effects and sometimes led to a reduction of antiinflammatory potency.

Analogues of luteinizing hormone releasing factor modified at positions 2, 6, and 10.

Eighteen analogues of luteinizing hormone releasing factor (LRF, pGlu-His-Trp-Ser-Tyr-Gly-Leu-Arg-Pro-Gly-NH2) were synthesized. The ten agonistic analogues were [D-Lys6], [D-Orn6], [D-Lys6,des-Gly10,Pro9-NHEt], [D-Orn6,-des-Gly10,Pro9-NHEt]-LRF plus their respective lauric acid conjugates as well as [(Nepsilon-Ac)-D-Lys6] and [(Ndelta-Ac)-D-Orn6]-LRF. The eight antagonistic analogues were [des-His2,D-Lys6], [des-His2,D-Orn6], [des-His2,D-Lys6,des-Gly10,Pro9-NHEt], [des-His2,D-Orn6,des-Gly10,Pro9-NHEt]-LRF as well as their respective lauric acid conjugates. Biological activities of these analogues were determined in vitro, using LRF as the standard for the agonists and [des-His2,D-Ala6]-LRF for the antagonists. The potency of the agonists ranged from 1 to 17 times the activity of LRF while the antagonists had between 1 and 3 times the potency of [des-His2,D-Ala6]-LRF.

HIV-associated nephropathy: an urban epidemic.

Human immunodeficiency virus-associated nephropathy (HIVAN) is the most common form of chronic renal disease in HIV-1-seropositive patients. Over 85% of cases of HIVAN occur in African-American patients and it is the third leading cause of ESRD in blacks age 20 to 64. Changes in incidence rates of HIVAN have coincided with changes in AIDS incidence rates. The demographics of the AIDS/HIV-1 epidemic indicate that the risk pool for HIVAN will continue to grow and that urban Nephrology centers will continue to see high rates of HIVAN. In addition, improvements in survival rates of HIV-1-seropositive patients on hemodialysis and improved treatment of HIVAN with highly active antiretroviral therapy (HAART) and angiotensin-converting enzyme (ACE)-inhibitors will result in an increased prevalence of HIVAN in the end-stage renal disease (ESRD) and pre-ESRD patient populations.

Pharmacological characterization of histamine H3 receptors in isolated guinea pig pulmonary artery and ileum.

We characterized the histamine H3 receptors involved in the modulation of electrical field stimulated neurogenic contraction of guinea pig pulmonary artery sympathetic, and guinea pig ileum parasympathetic preparations. Simultaneous measures of electrical field stimulation-evoked 3H overflow and tension in [3H]norepinephrine-loaded pulmonary artery were sensitive to tetrodotoxin (300 nM) and insensitive to hexamethonium (100 microM). Only the contractile response was inhibited by prazosin (100 nM). (R)-alpha-Methylhistamine's inhibition of the pulmonary artery contraction and 3H overflow were dose-dependently antagonized by thioperamide (30-100 nM). (R)-alpha-Methylhistamine also inhibited the neurogenic contractions of the isolated ileum (pD2 = 8.2). In the pulmonary artery, the relative potency of the histamine H3 receptor antagonists vs. (R)-alpha-methylhistamine inhibition of neurogenic contractions (pD2 = 7.1) was thioperamide (pA2 = 8.6 +/- 0.1) > burimamide (pA2 = 7.6 +/- 0.2) > impromidine (pA2 = 6.9 +/- 0.02). Similarly, the relative potency of histamine H3 receptor antagonists in the isolated ileum was thioperamide > burimamide > or = impromidine, with pA2 estimates of 8.7 +/- 0.1, 7.3 +/- 0.1 and 7.1 +/- 0.1, respectively. Antagonist potencies suggest a predominant histamine H3A-like receptor population on postganglionic sympathetic neurons innervating the pulmonary artery and parasympathetic neurons innervating the ileum longitudinal muscle.

The diagnosis of autism by state agencies.

A four-question survey form was sent to the Departments of Public Instruction and Departments of Mental Health in all 50 states. The survey solicited information on agency diagnostic practices regarding autism. A 100% return was achieved as an outcome of various follow-up procedures. Considerable variability in diagnostic practice was found between the two agencies and among the states.

Laboratory biology of Ornithodoros (Alectorobius) puertoricensis (Acari: Argasidae).

The laboratory biology of Ornithodoros (Alectorobius) puertoricensis Fox was studied over a 2-yr period. Approximately 100-150 ticks were reared individually at each of four temperatures: 22, 27, 33, and 40 degrees C and 90-95% RH. The mean egg incubation periods at those temperatures were 20.3, 11.1, 7.3, and 6.1 d, respectively. The average larval feeding period was 5.8 +/- 1.5 d for 15,875 larvae that fed on guinea pigs. The development times for first to fourth nymphal instars were as follows: 11.7, 48.5, 75.1, and 92.1 d, respectively, at 22 degrees C; 5.8, 18.8, 38.0, and 36.0 d, respectively, at 27 degrees C; 4.2, 10.5, 14.9, and 38.1 d, respectively, at 33 degrees C; and 5.8, 10.7, 21.2, and 35.3 d, respectively, at 40 degrees C. Males usually eclosed after three or four molts, and females usually eclosed after four or five molts. Approximately 10% of all nymphs required more than one blood meal per instar at least once during development. Twenty pairs of adults were held at each of three temperatures (22, 27, and 33 degrees C) for a year to study reproductive behavior. The number of gonotrophic cycles per female per year was 6.9, 9.8, and 10.8 at 22, 27, and 33 degrees C, respectively. The mean duration of the gonotrophic cycle was 42.3 d at 22 degrees C, 25.5 d at 27 degrees C, and 20.5 d at 33 degrees C. Mean egg production per female per gonotrophic cycle was 151 at 22 degrees C, 117 at 27 degrees C, and 130 at 33 degrees C and was not affected by temperature. O. puertoricensis did not exhibit autogeny or parthenogenesis. Hyperparasitism was observed in immatures and adults.

Comparison of continuous single layer polypropylene anastomosis with double layer and stapled anastomoses in elective colon resections.

The documented leak rate of the continuous single layer polypropylene (CSLP) anastomosis in elective colon resection is 0-6 per cent. It is more cost effective than stapling (S), and should be faster and easier to perform than the double-layer (DL) technique. However, there have been no reported series comparing the outcome of the CSLP anastomosis with the DL and S techniques. We reviewed the charts of 100 patients with elective colon resections. Eighty-four had data sufficient for analysis. There were 44 CSLP, 21 DL, and 19 S. The groups were comparable with respect to 12 preoperative variables. Proportionately more large-small bowel anastomoses were performed in the S group, and no patient in the S group was actively taking steroids. Clinical outcome was assessed. All leaks were clinically apparent and documented with contrast enema or laparotomy. The leak rate for the CSLP was 6.8 per cent (3/44). Two of the three patients with leaks were taking steroids. There were two leaks in the DL group (9.5%), one of which was taking steroids, and no leaks in the S group. The difference in leak rate between the three groups was not statistically significant. The average cost for CSLP at our institution is $4.00 compared with $8.00 and $35.00 for the DL and S, respectively. We conclude that the CSLP is a reasonable and safe alternative to DL and S anastomoses.

Potential arthropod vectors of African swine fever virus in North America and the Caribbean basin.

In an effort to identify arthropods that might serve as vectors and perhaps reservoirs of African swine fever virus (ASFV) if it were to enter the U.S.A., the blood-sucking insect Triatoma gerstaeckeri and four species of ticks of the genus Ornithodoros were established in colonies capable of reproducing in numbers sufficient to enable thorough studies to be made of their ASFV vector potentials. A nymphal stage of T. gerstaeckeri carried the virus for 41 days and retained it through one molt, but was unable to transmit it to susceptible pigs. Studies on O. coriaceus revealed that the species is able to harbor and transmit the virus for greater than 440 days, passing it trans-stadially from the first nymphal stage to the adult, sustaining it through at least four molts. Trans-ovarial passage was not demonstrated and nearly 40% of the ticks died, apparently, of the ASFV infection. O. turicata collected in Florida was also found to be capable of becoming infected with ASFV and transmitting it by bite to susceptible pigs. O. puertoricensis collected during the ASF eradication programs in the Dominican Republic and Haiti was not only readily infected experimentally, but it was also able to transmit the virus trans-stadially and trans-ovarially. However, ASFV was not isolated from any of the 350 O. puertoricensis collected in the Dominican Republic and Haiti. O. parkeri from a long-established laboratory colony were able to carry the virus through at least one molt, but they were unable to transmit it to susceptible pigs.

Single-photon counting system for measuring laser parameters.

A single-photon counting system has been developed for measuring gas laser parameters. A linear accelerator provides nanosecond-wide pulses of heavy charged particles which are injected into a specially designed cell. The charged particles excite gas mixtures, and the temporal response of the emitted radiation is observed as a function of wavelength. The resulting data is analyzed to obtain pertinent parameters such as excited-state lifetimes, reaction rate constants, and quenching rate constants. At the present time nuclear pumper laser candidate gases are being examined.

Increased blocking activity of combined tachykinin NK1- and NK2-receptor antagonists on tachykinergic bronchomotor responses in the guinea-pig.

1. The present study compared the effect of the administration of tachykinin NK1- and NK2-receptor antagonists alone and in combination on exogenous and endogenous tachykinin-induced contractions using three different guinea-pig airway preparations: isolated bronchus, isolated perfused lung and in vivo. 2. In the isolated bronchi, the tachykinin NK1-receptor antagonist CP 99994 (0.01-1 microM) produced concentration-dependent inhibition of contractions induced the tachykinin NK1-receptor agonists substance P (SP) and [Met-OMe11] SP ([Met-OMe11]SP), whereas the tachykinin NK2-receptor antagonist SR 48968 (0.1 microM) had no effect. SR 48968 (0.001-0.01 microM) concentration-dependently inhibited contractions induced by the tachykinin NK2-receptor agonists neurokinin A (NKA) and [beta-Ala8]-neurokinin A (4-10) ([betaAla8]-NKA) whereas CP 99994 (0.1 microM) did not inhibit the contractions. The contractile activity of capsaicin, an agent that releases endogenous tachykinins from sensory C-fibres, was inhibited in a concentration dependent manner by SR 48968 (0.001-0.03 microM) but not by CP 99994 (0.1 microM). Combination of CP 99994 and SR 48968 caused increased inhibitory effects on the concentration-response curves to SP, [Met-OMe1l]SP, NKA, [beta-Ala8]-NKA and capsaicin. 3. In isolated perfused lungs, SR 48968 concentration (0.01-10 microM) dependently inhibited NKA-, [beta-Ala8]-NKA- and capsaicin-induced bronchoconstriction whereas CP 99994 (30 microM) had no effect on SP-, NKA-, [beta-Ala8]-NKA- and capsaicin-induced bronchoconstriction. Combination of inactive concentrations of CP 99994 and SR 48968 produced an increased inhibitory effect on all previous stimuli-induced bronchoconstriction. 4. In in vivo guinea-pig studies, intravenous and oral pretreatment with SR 48968 (0.01-1 mg kg(-1) i.v. and 0.1-3 mg kg(-1) p.o., respectively), but not with CP 99994 (1 mg kg(-1) i.v. and 0.3-30 mg kg(-1) p.o., respectively), produced a dose-dependent inhibition of the bronchoconstrictor responses induced by NKA, [beta-Ala8]-NKA and capsaicin. CP 99994 intravenously (0.3 mg kg(-1)) and orally (3-10 mg kg(-1)) inhibited SP-induced bronchoconstriction only. Intravenous and oral low dose combinations of CP 99994 and SR 48968 produced an increased inhibition of SP-, NKA-, [beta-Ala8]-NKA- and capsaicin-induced bronchoconstriction, respectively. The present data indicate that combined tachykinin NK1- and NK2-receptor antagonist treatment compared with single antagonist treatment, using CP 99994 and SR 48968, produced an augmented blockade of tachykinin NK1-, NK2- and capsaicin-mediated contractions in guinea pig airways. These findings support the hypothesis that a dual NK1- and NK2-receptor antagonist may provide an advantage over single activity tachykinin NK1- or NK2-receptor antagonists in pulmonary obstructive diseases.

Research priorities of VA nurses: a Delphi study.

The purpose of this study was to conduct a Delphi survey of a sample of Gainesville Veterans Affairs Medical Center staff and head nurses. The study consisted of three rounds of questionnaires completed by the nurses as they identified and narrowed the most pressing nursing research questions. Results indicated that in five of the six clinical settings, despite investigators' instructions to identify clinical nursing research questions, administrative research questions were identified and ranked consistently higher in priority than clinical research questions. The single exception was in home care, where clinical questions received the highest priority. This phenomena may suggest that institutional constraints interfere with nurses' full expression of their clinical practice.