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Biomedical subjects

J Greene

Publications and source records attributed to J Greene.

At least 19 recordsLinked to original sources

Modulation of cell firing in the nucleus accumbens.

Pennartz et al. have proposed that functions of the nucleus accumbens (NA) are subserved by the activity of ensembles of neurons rather than by an overall neuronal activation. Indeed, the NA is a site of convergence for a large number of inputs from limbic structures that may modulate the flow of prefrontal cortical information and contribute to defining such ensembles, as exemplified in the ability of hippocampal input to gate cortical throughput in the nucleus accumbens. NA neurons exhibit a bistable membrane potential, characterized by a very negative resting membrane potential (down state), periodically interrupted by plateau depolarizations (up state), during which the cells may fire in response to cortical inputs. A dynamic ensemble can be the result of a distributed set of neurons in their up state, determined by the moment-to-moment changes in the spatial distribution of hippocampal inputs responsible for transitions to the up state. Ensembles may change as an adaptation to the contextual information provided by the hippocampal input. Furthermore, for dynamic ensembles to be functionally relevant, the model calls for near synchronous transitions to the up state in a group of neurons. This can be accomplished by the cell-to-cell transfer of information via gap junctions, a mechanism that can allow for a transfer of slow electrical signals, including "up" events between coupled cells. Furthermore, gap junction permeability is tightly modulated by a number of factors, including levels of dopamine and nitric oxide, and cortical inputs, allowing for fine-tuning of this synchronization of up events. The continuous selection of such dynamic ensembles in the NA may be disputed in schizophrenia, resulting in an inappropriate level of activity of thalamocortical systems.

Afferent Pathways

Brain regions involved in articulation.

BACKGROUND: The left inferior frontal gyrus (Broca's area) is generally believed to be critical for the motor act of speech. A lesion-based analysis has, however, shown that the left anterior insula is necessary for accurate articulation. We used functional imaging in normal people to show the neural systems involved in speech during different speech tasks. METHODS: 12 normal people underwent positron emission tomography with oxygen-15-labelled water as tracer. We measured cerebral activity while participants performed three different tasks: repetition of heard nouns at different rates; listening to single nouns at different rates; and anticipation of listening or repetition. We analysed the data with imaging software. FINDINGS: Repetition of single words did not activate Broca's area but activity in three left-lateralised regions was seen: the anterior insula, a localised region in the lateral premotor cortex, and the posterior pallidum. The left anterior insula and lateral premotor cortex showed a conjunction of activity for hearing and articulation. In addition, articulation modulated the response to hearing words in the left dorsolateral temporal cortex, the physiological expression of the speaker's auditory attention being directed towards the stimuli and not his or her articulated responses. INTERPRETATION: The formulation of an articulatory plan is a function of the left anterior insula and lateral premotor cortex and not of Broca's area. The left basal ganglia seem to be dominant for speech, although the axial muscles involved receive their motor output from both cerebral hemispheres.

Adult

The impact of Medicaid managed care on community clinics in Sacramento County, California.

OBJECTIVES: The purpose of this study was to determine the impact of countywide Medicaid managed care on service use at community clinics. METHODS: Clinic use before and after introduction of Medicaid plans in one county was compared with that in a group of comparable counties without such plans. RESULTS: There were significant declines of 40% to 45% in the volumes of Medicaid clients, encounters, and revenues at clinics with the introduction of Medicaid plans. Declines of 23% in uninsured clients and encounters did not differ significantly. CONCLUSIONS: The introduction of Medicaid managed care with multiple commercial plans can have significant negative effects on nonprofit community clinics.

Analysis of Variance

From whodunit to what happened.

An amnesty on errors? A few hospitals are declaring one, finding that it actually helps reduce mistakes. "This is a very hard sell," acknowledges one nursing executive. "But once people trusted they wouldn't be disciplined for reporting mistakes, we were able to look at systems and solve problems."

Employee Discipline

Head games. Hiring trends.

The times demand executives who can deal well with doctors and handle the chaos of rapid change. And that's why your next job interview could include a personality test. "I can't supplement efficiencies in those areas with machinery or equipment or even training," says one recruiter. "A hospital can give you all the tools in the world, but the only one that counts is the one between your ears."

Hospital Administrators

Sizing up the sickest.

It's lurking all the time: Clues about patients prone to costly medical crises are already sitting in your computer system. The past opens a window on the future--if only you can ID the most vulnerable and guard against their getting sick in the first place.

Aged

Blue skies or black eyes? HEDIS puts not-for-profit plans on top.

For the first time, the Health Plan Employer Data and Information Set, better known as HEDIS 3.0, takes the lid off managed care quality and patient satisfaction on a national scale. Not-for-profit plans, our analysis shows, have the edge on both counts. They also lose the most money.

Financial Management