The management of public services in the 1990s raises a number of central issues which require to be resolved. On the one hand, efficiency and effectiveness require attention, as in the 1980s or indeed anytime. On the other hand, the distinctive nature of public (and governmental) services needs to be recognized or reasserted. This Keynote Address to the Keele University, Centre for Health Planning and Management MBA (Health Executive) Programme Alumni Association by Howard Davies, Director General of the Confederation of British Industry, sets out some key principles based on the 'British Debate' which are nevertheless generalizable in a number of cases to a wholly international audience.

Economic Competition↗

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Desamino-D-arginine-vasopressin (DDAVP) in Alzheimer's disease.

Fourteen Alzheimer subjects participated in a parallel group study of desamino-D-arginine-vasopressin (DDAVP, desmopressin). All subjects received one week of single-blind placebo. Then on a double-blind basis, the active group received DDAVP intranasally in doses starting at 30 micrograms per day and increasing over a 3 week period to 180 micrograms per day; the control group received an identical placebo. Using a repeated measures ANOVA, three measures out of thirty-one were found to be statistically significant for DDAVP treatment: the Hamilton depression scale and the affect and interpersonal subscales of the SCAG. However, the magnitude of these changes was probably too small to be clinically significant. Except for one subject who transiently became hyponatremic (Na of 120) and confused while receiving 180 micrograms of DDAVP, there were no adverse effects. There were no significant group changes in sodium, potassium, plasma osmolality, blood pressure, and weight.

Administration, Intranasal↗

PubMedDate not supplied

Antibody responses in early graft rejection in pig-to-primate renal xenotransplantation.

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Acute Disease↗

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The psychology of anxiety.

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Anxiety↗

PubMedDate not supplied

Dietary manipulation of methotrexate-induced enterocolitis.

Administration of chemotherapy is limited by host toxicity, which is often manifested by severe enterocolitis. This study evaluated the effects of a liquid, elemental, chemically defined diet (ED) supplemented with 2% glutamine (Glu-ED) compared with a polypeptide diet (PPD) on the morbidity and mortality after methotrexate (MTX) administration. Fischer 344 rats (n = 80) were fed either a regular rat chow diet (RD), a 2% glycine supplemented elemental diet (Gly-ED), a 2% glutamine-supplemented elemental diet (GLU-ED), and a glycine-supplemented polypeptide diet(Gly-PPD) for 7 days prior to administration of MTX (20 mg/kg, ip). After 72 hours, eight rats per group were killed; portal vein and vena cava blood, mesenteric lymph nodes (MLN), liver, small intestine, and cecum were sampled for bacterial culture. Remaining animals were followed to calculate survival. One hundred percent of the Gly-PPD and 25% of the Glu-ED animals survived compared with 0% of the Gly-ED animals. Our data showed that ED resulted in an increased quantity of intestinal Gram-negative bacteria and diminished intestinal mucosal height and mucosal DNA/protein content. The polypeptide diet prevented intestinal mucosal atrophy, avoided MTX-induced enterocolitis and significantly improved animal survival compared with an elemental diet with or without glutamine supplementation.

Animals↗