Inhibition of climbing and mossy fiber, and basket and stellate cell inputs to mouse cerebellar Purkinje cells by novel anti-ischemic agents, ifenprodil and BMY-14802.

Cerebellar cyclic guanosine monophosphate (cGMP) levels reflect the ongoing neuronal activity mediated by the N-methyl-D-aspartate (NMDA) receptor complex. Due to the putative role of the NMDA receptor complex in the etiology of ischemic neuronal injury, the effects of two novel anti-ischemic agents, ifenprodil and BMY-14802, were examined on cGMP responses mediated by harmaline, methamphetamine (MA), and pentylenetetrazol (PTZ), agents which modulate the Purkinje cell activity by three distinct pharmacological mechanisms. Similar to the competitive NMDA antagonist, CPP [(+/-)-3-carboxypiperazin-4-yl)propyl-1-phosphonic acid], ifenprodil and BMY-14802 reversed the harmaline-, MA- and PTZ-induced cGMP levels.

Continuity and change in preferred provider organizations.

This paper presents the results from a national survey of preferred provider organizations (PPOs) that was conducted in 1988. It is based on telephone interviews conducted by the authors with executives in over 170 PPOs in the United States. We compare the survey results with those obtained from similar surveys conducted in 1985 and 1986, allowing us to assess the extent to which PPOs have grown and changed.

In vivo modulation of the N-methyl-D-aspartate receptor complex by D-serine: potentiation of ongoing neuronal activity as evidenced by increased cerebellar cyclic GMP.

Direct intracerebellar injections of N-methyl-D-aspartate (NMDA) or D-serine elicited dose-dependent increases in cerebellar cyclic GMP levels, in vivo in the mouse. The actions of D-serine were antagonized by the competitive NMDA receptor antagonist 3-(2-carboxypiperazin-4-yl) propyl-1-phosphonic acid and by the phencyclidine receptor agonist MK-801, observations supporting actions at the NMDA-coupled glycine receptor. In addition, the actions of D-serine were antagonized by a partial agonist (D-cycloserine) and an antagonist (HA-966) of the NMDA-coupled glycine receptor.

Phencyclidine-like effects of tetrahydroisoquinolines and related compounds.

A series of 1,2,3,4-tetrahydroisoquinolines, tetrahydrothieno[2,3-c]pyridines, and related compounds were evaluated for their ability to inhibit binding of [3H]-1-[1-(2-thienyl)piperidine and [3H]-N-allylnormetazocine to phencyclidine (PCP) and sigma receptors, respectively. A representative series of compounds was evaluated in behavioral assays to determine the ability of the compounds to induce PCP-like stereotyped behavior and ataxia. All of the compounds caused stereotyped behavior and ataxia, indicating their agonist actions at the PCP site.

The decision to integrate vertically in health care organizations.

A scheme to help health care managers make decisions regarding vertical integration (and deintegration) strategies and to alert health care managers to a more analytic view of vertical integration that may help avoid costly mistakes is presented. Central to the decision-making scheme is the comparison between the costs of purchasing goods and services from (and selling them to) other organizations and the costs of acquiring (and supplying) the same goods and services within one's own organization. Whether outside or inside an organizational boundary, these costs (called transaction costs) may be important in determining whether vertical integration is an appropriate organizational strategy (Williamson 1975).

Induction of eIF-4E phosphorylation by the addition of L-pyrroline-5-carboxylic acid to rabbit reticulocyte lysate.

Addition of L-pyrroline-5-carboxylic acid to reticulocyte lysates inhibits protein synthesis and induced phosphoproteins of 25 and 14 kDa. The 25 kDa phosphoprotein had the same Mr and pI as phosphorylated eIF-4E. Incubation of lysates with L-pyrroline-5-carboxylic acid did not alter the crosslinking of eIF-4E to reovirus mRNA caps.

Synthesis, configuration, and evaluation of two conformationally restrained analogues of phencyclidine.

Brown oxidation of cis-bicyclo[3.1.0]hexan-3-ol afforded bicyclo[3.

Selective inhibition of proteins synthesized from different mRNA species in reticulocyte lysates containing L-pyrroline-5-carboxylic acid.

L-Pyrroline-5-carboxylic acid is a naturally occurring nonprotein amino acid present in human plasma that changes concentrations with diet. L-pyrroline-5-carboxylic acid inhibited net synthesis of globin in untreated reticulocyte lysates in a dose dependent manner. This inhibition was greater than that observed with equimolar GSSG or NADP+ and was prevented by a NADPH generating system.

The future role of foreign medical graduates in U.S. medical practice: projections into the 1990s.

Projections of the effect of actual and hypothesized declines in the proportion of foreign medical graduates (FMGs) in residency training on the future distribution of physicians are explored. We find potential proportionate declines in the eventual location of physicians in rural areas and small towns in the North Central regions, and in solo and partnership arrangements in the Northeast, North Central, and Southern regions. Reductions in FMG house officers now could also lead to an increased proportionate presence of physicians in subspecialty practices in the largest U.

A theory of organizational response to hospital regulation: a reply.

A recently published general theory of organizational response to regulation is examined. A number of problems are observed in regard to the basic assumption underlying the theory, the directionality of predicted relationships forming the theory, the exclusion of goal attainment as a realistic motivation for managing, and the generality of the theory.

Impact of women and foreign medical graduates on specialty distribution of U.S. house officers.

The increase in the number of women and the decline in the number of foreign medical graduates (both foreign- and U.S.-born graduates of medical schools outside the United States) in U.

Foreign and United States medical graduates in practice. A follow-up.

A 9-year follow-up study of a national probability sample (n = 865) of foreign medical graduates (FMGs) and United States medical graduates (USMGs) who were house officers in United States hospitals in 1973-1974 reveals that more than three fourths of the alien FMGs were located in the United States in 1983. FMGs were distributed disproportionately across United States census regions (P less than 0.001), specialty areas (P = 0.

Foreign medical graduates in the 1980s: trends in specialization.

Secondary analysis of data collected by the American Medical Association and the Graduate Medical Education National Advisory Committee (GMENAC) suggests that measures to diminish the flow of alien Foreign Medical Graduates (FMGs) into the United States have been less effective than planned. Declining trends in the proportion of FMG house officers in the mid- to late-1970s have recently stabilized around 19 per cent. There has also been a dramatic increase in the number of US citizen Foreign Medical Graduates ( USFMGs ) in house officer positions.

Public attitudes toward health planning under the Health Systems Agencies.

The demise of the National Health Planning and Resources Development Act of 1974 (PL 93-641) raises questions about the degree of public support it had for planning goals. The results of a 1978 nationwide public opinion poll reveal (1) low confidence in and recognition of the Act's institutional arms, the Health Systems Agencies; (2) little support for hospital cost containment strategies and their consequences; and (3) less than average support for these goals and consequences among those groups traditionally under-represented in health planning activities. The results suggest that the Act did not reconcile centralized federal goal formation with democratic local health planning.

Physician turnover in eight New England prepaid group practices: an analysis.

The objectives of this questionnaire study of all primary care physicians (N = 154) who had ever worked in eight New England prepaid group practices (PGPs) include 1) calculation of turnover rates, 2) comparison of those who stayed in (stayers) versus those who left (leavers) the PGPs, and 3) description of reasons given for leaving. An annual turnover rate of 3.9 to 6.

Knowledge and attitudes toward Tay-Sachs disease among a college student population.

To assess the feasibility of screening the single Jewish population for Tay-Sachs disease (TSD), a questionnaire examining the knowledge of and attitudes toward TSD and genetic screening was sent to 348 Yale University Jewish undergraduates. Of those students responding (63 percent), 78 percent were able to answer general genetic questions correctly while only 1.9 percent could answer specific Tay-Sachs questions correctly.

Graduate medical education as a policy instrument: promise and problems.

Increasingly, graduate medical education (residency training) is being proposed as a policy instrument to reform the traditional manpower problems of distribution of physicians. This article suggests why graduate medical education has become the latest policy device in the decades-old effort to rectify physician imbalances, and it discusses the potential for reform contained in this approach. It then presents a number of problems that will probably hinder the effective implementation of such policy and concludes that future federal policy directives are uncertain.