The effect of propranolol dose and novelty of the reactivation procedure on the reconsolidation of a morphine place preference.

Previously consolidated memories may become labile when they are reactivated and require reconsolidation. It has been suggested that when novel information is present at the time of memory reactivation reconsolidation is engaged but when no new information is present, reconsolidation may not occur, and extinction may be the dominant process instead. To test this idea we trained rats to associate a context with the rewarding properties of morphine (5 mg/kg, sc) over four conditioning pairings. Following training, animals were reactivated by a 30-min test session, once a day for 3 days. Rats were injected with the amnestic drug propranolol (10 or 40 mg/kg, sc) following reactivation either on the first or on the second day. They received saline on the alternate day. Propranolol disrupted reconsolidation for a conditioned place preference only when given on the first reactivation day, and this effect was more robust following the higher dose of propranolol. In contrast, animals given propranolol on the second reactivation day still displayed a preference for the morphine-paired context on the final test day. These results support the view that for memory to return to a labile state, the situation that evokes reactivation needs to be novel in some way. If the reactivation situation is familiar, reconsolidation may not occur.

Ocular motor measures in migraine with and without aura.

The purpose of this study was to examine basic ocular motor function in individuals with migraine. We used an infrared eye-tracking system to measure horizontal smooth pursuit to a sinusoidal target, saccades to horizontal target displacements of 5-20 degrees , and the stability of fixation in 19 migraine without aura (MoA), 19 migraine with aura (MA) and 19 headache-free control (C) subjects. Eye movement measurements were made at two target displacement rates and against both homogeneous grey and patterned backgrounds. We found no statistically significant differences between migraine and control subjects in any of the eye movement parameters measured, but did find highly significant effects of both target speed and background pattern in all groups. Our results do not provide support for subclinical cerebellar impairment in migraineurs, and do provide evidence that previously described visual abnormalities in migraine are not artefacts of abnormal fixation or eye movements.

Will managed care ever deliver on its promises? Managed care, public policy, and consumers of mental health services.

Advocates of managed care have promised to greatly improve delivery of services to persons with serious mental illness by focusing on effectiveness and accountability. With the exception of a few beacons of success, experience shows that managed care has not delivered on its promises. This article examines several areas of the public mental health system that still have major flaws, hindering adequate provision of services. Such flaws include the absence of integration of Medicaid and the public mental health system; general lack of publicly documented performance measurements that demonstrate accountability; absence of meaningful and authentic consumer, family, and enrollee participation in service planning, implementation, and evaluation; among others. Are we ready to replicate the lessons from the few beacons of success, or will we just continue to fail persons with the most serious mental illnesses?

NCQA requirements: friend or foe?

In this time of intensified cost-containment pressures and low funding for behavioral healthcare services, organizations are particularly sensitive to externally imposed requirements that add expense and administrative burden. As a tradeoff, the contribution of such requirements to the overall quality of behavioral health services is vitally important. The requirements of the National Committee for Quality Assurance (NCQA) have stimulated many intensely felt reactions among a wide range of managed behavioral healthcare stakeholders, undoubtedly because of the substantial impact those requirements are creating. The reactions portrayed in this dialogue section, from representatives of the payor, purchaser, provider and consumer communities and from NCQA itself, indicate the ambivalence stakeholders have toward the quality-assurance movement.

Regulating managed care: interest group competition for control and behavioral health care.

In this essay I identify how historic patterns of competition among health care interest groups have simultaneously retained their past contours and also changed significantly as a result of the jolt created by the rise of managed care. I explain why it is that I and other executives of for-profit managed behavioral health care organizations, traditionally advocates of market-based approaches to accountability, have begun to support some versions of regulation by the national government in order to restore consumer confidence in the credibility of managed health plans. Key concepts that are addressed include notions of public accountability, control of the purse strings, consumer protections, and provider privileges.

Managed behavioral health care premises, accountable systems of care, and AMBHA'S perms. American Managed Behavioral Healthcare Association.

This article discusses the concepts and approaches underlying managed behavioral health care and the need to assess quality of care. The author describes the Performance Measures for Managed Behavioral Healthcare Programs (PERMS) developed by the American Managed Behavioral Healthcare Association (AMBHA), which is offered as a first step toward enhanced quality of care assessment in managed behavioral health care.

The effects of resistance level on muscle coordination patterns and movement profile during trunk extension.

The objective of this research was to investigate the effects of varying resistance level on patterns of muscle activity and trunk motion during the performance of dynamic trunk extension. Twenty-five female subjects were tested at four resistance levels: nominal resistance, and 30%, 50%, and 70% of maximum isometric extension strength. Peak truncal velocity, acceleration, and deceleration decreased with increased resistance, although no difference existed between the nominal and 30% maximum voluntary contraction (MVC) conditions. Coactivation of abdominal muscles was present at all resistance levels, although it was greater for the nominal resistance condition than the other conditions. The timing of EMG activity of the extensor and abdominal muscles was significantly affected by resistance. The amplitude and time course of peak muscle activity are discussed in terms of the implications for spinal loading.