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Who's up and who's down UpMiddlesex Hospital, Middletown, Conn.Rating: A3Outlook: PositiveAffected debt: $42 million Agency: Moody's Investors ServiceRemarks: A wholly owned subsidiary of Middlesex Health System Inc., Middlesex Hospital represents 96 percent of the system's assets and revenues, holds a dominant position in a demographically favorable area, and boasts good inpatient volume growth in recent years. DownNew Hanover Regional Medical Center, Wilmington, N.C.Rating: A1Outlook: NegativeAffected debt: $310.8 million Agency: Moody's Investors ServiceRemarks: Investors are still concerned over an ongoing Federal Trade Commission investigation into its acquisition of Cape Fear Memorial Hospital in 1998.UpJackson Hospital and Clinic, Montgomery, Ala.Rating: BBB-Outlook: PositiveAffected debt: $113.6 millionAgency: Standard & Poor'sRemarks: Increasing operating profitability and patient volumes for two straight fiscal years, but offset somewhat by fairly high debt burden and rising bad debt expense.DownUniversity of Maryland Medical System, BaltimoreRating: AOutlook: StableAffected debt: $400 millionAgency: Standard & Poor's Remarks: Lowered rating from A+ reflects concerns about a "sizable" increase in debt to fund a new inpatient tower at Baltimore Washington Medical Center, a 480,000-square-foot ambulatory medical center and an expansion of the emergency department at Easton Hospital.-Philip Betbeze