Simultaneous assessment of ecto- and cytosolic-5'-nucleotidase activities in brain micropunches.

We propose a new methodology for simultaneous assessment of ecto- and cytosolic-5'-nucleotidase that can be utilized in brain to measure the activity of these enzymes in micropunches of tissues. It is based on the differential sensitivity of both enzymes to alpha,beta-methyleneadenosine 5'-diphosphate (AMP-CP) and the requirements for magnesium as a co-factor. The design of assay protocol contains an internal validation by allowing comparisons between total level of 5'-nucleotidase activity with that calculated from the sum of individual activities of the ecto- and cytosolic-5'-nucleotidases. We have applied this new approach to assess the activity of ecto- and cytosolic-5'-nucleotidase in the brain regions relevant to sleep regulation. The level of both enzymes was significantly lower in the cerebral cortex than other brain regions tested.

Specialty networking in pediatric surgery: a paradigm for the future of academic surgery.

OBJECTIVE: To review retrospectively a 4-year experience with pediatric surgical networking at a major academic medical center in the Midwest. BACKGROUND: The growth of managed care in the United States during the past decade has had a major impact on the practice of medicine in general, but especially on academic medicine. In some academic medical centers, the loss of market share has not only affected clinical activity but has also compromised the educational and research missions of these institutions. METHODS: At the authors' institution, a networking strategy in pediatric surgery was established in 1993 and implemented on July 1, 1994. In 1994, one new satellite practice was established; over the next 4 years, four additional practices were added, including one in another state. To assess the impact on financial status, clinical activity, education, and academic productivity, the following parameters were analyzed: gross and net revenue, surgical cases, clinic visits, ranking of the pediatric surgery residency, publications, grant support, and development and endowment funds. RESULTS: Gross and net revenue increased from $3,273,000 and $302,000 in 1993 to $10,087,000 and $2,826,000, respectively, in 1998. Surgical cases and clinic visits increased from 1240 and 3751 in 1993 to 5872 and 11,604, respectively, in 1998. At the medical center's children's hospital, surgical cases and clinic visits increased from 1240 and 3751 to 2592 and 4729 during the same time period. During this 4-year period, the faculty increased from 4 to 11. Since 1997, the National Resident Matching Program has provided data on how pediatric surgery residency candidates ranked a training program. In 1997, this program received the second-most one to five rankings; in 1998, it tied for first. This exceeds the faculty's perception of previous years' rankings. Publications increased from 26 in 1993 to a peak number of 62 in 1996; in 1997 and 1998 the publications were 48 and 37, respectively. External grant support increased from $139,882 in 1993 to a total of $6,109,971 in 1998. Development and endowment funds increased from $103,559 in 1993 to $2,702,2777 in 1998. CONCLUSIONS: Pediatric surgical networking at the authors' institution has had a markedly positive impact on finances, clinical activity, education, and academic productivity during a 4-year period. The residency training program appears to have improved in popularity among candidates, probably because of the increased referral of complex cases to the medical center from the various networking satellites. External grant support and basic laboratory research significantly increased, most likely because of the greater number of faculty with protected time for research recruited. Development and endowment funds dramatically grew because of the excellent fiscal health of the pediatric surgical program. This experience may serve as a model for other academic surgical specialties.

The market for pediatric surgeons: a survey of recent graduates.

PURPOSE: The aim of this study was to identify the demand for pediatric surgeons as perceived and experienced by recent graduates of North American training programs. METHODS: A survey questionnaire was mailed to every pediatric surgeon who had completed a certified training program in the United States or Canada between 1992 and 1997; 84% of the 165 responded. The data were then analyzed using univariate and bivariate statistics and content analysis. RESULTS: The number trained has risen since 1992 from 21 to 35 per year, exceeding previous definitions of need. However, recently trained pediatric surgeons found positions, and their first-year incomes had risen oven the 6-year period. In contrast, just 54% found first positions in the type of hospital desired, and the percent working in a children's hospital dropped from 65% in 1992 to 32% in 1997; 34% cover between four and ten hospitals. The majority of those in practice for more than 2 years expressed the perception of a decline in market demand with just 30% of those 1996 to 1997 graduates perceiving a strong market. The clinical scope of practice was less than that for which they were trained. Three specified complex cases were managed by fewer than 30% of recent graduates during practice despite more than 60% having had fellowship experience. The scope of practice, as measured by variables of index procedures, was strongly associated with hospital type (children's or general) and by practice region. Although satisfaction with practice is lower for each successive class, 96% of the graduates were satisfied with their training programs, and 98% believed they had been well prepared, although 46% indicated they desired some additional training. Sixty-one percent believed the role of pediatric surgeons will change over the next 5 years. CONCLUSIONS: The market demand was strong as measured by employment and income. This was in contrast to the striking recent changes in the market for new pediatric surgeons, including a migration of practice from children's to general hospitals, a reduced scope of practice, a more negative perception of the pediatric surgery market, and concerns for narrowing of the specialty.