ObjectiveThe authors review their initial experience with laparoscopic splenectomy in patients with hematologic diseases. Efficacy, morbidity, and mortality of the technique are presented, and other patient recovery parameters are discussed. Summary Background DataLaparoscopic splenectomy is performed infrequently and data regarding its safety and efficacy are scarce. Factors such as a high level of technical difficulty, the potential for sudden, severe hemorrhage, and slow accrual of operative experience due to a relatively limited number of procedures are-responsible. The potential patient benefits from the development of a minimally invasive form of splenectomy are significant. MethodsClinical follow-up, a prospective longitudinal database, and review of medical records were analyzed for all patients referred for elective splenectomy for hematologic disease from March 1992 to March 1995. ResultsLaparoscopic splenectomy was attempted in 43 patients and successfully completed in 35 (81%). Therapeutic platelet response to splenectomy occurred in 82% of patients with immune thrombocytopenic purpura and hematocrit level increased in 60% of patients with autoimmune hemolytic anemia undergoing successful laparoscopic splenectomy. The morbidity rate was 11.6% (5 of 43 patients), and the mortality rate was 4.7% (2 of 43 patients). Return
Three types of analogues of unsaturated phosphatidylethanolamines (PE) have been prepared: phosphatidyl-omega-amino-1-alkanols, N-alkyl-PE's, and C2-alkyl-PE's, with alkyl substitution of carbon-2 of the ethanolamine head group. The physical properties of dioleoyl, dielaidoyl, and 1-palmitoyl-2-oleoyl phospholipids with these head groups have been examined by calorimetry, 31P NMR, freeze-fracture electron microscopy, and X-ray diffraction. N-Alkylation of PE, or substitution of the ethanolamine moiety by 3-amino-1-propanol or 4-amino-1-butanol, decreases the transition temperature of the hydrated gel phase (Tc) and considerably increases the temperature of the lamellar to hexagonal II transition (TH). The pattern of these effects for various PE analogues suggests that head group size and hydrophobicity as well as hydrogen bonding are important determinants of the phase behavior of these lipids. C2-Alkylated PE analogues exhibit several rather surprising properties, notably the ready formation of a quasi-crystalline "high-melting" solid phase even for di-cis-unsaturated species and substantially lower TH values than are observed for the parent PE species. The behavior of these compounds suggests that "hydration forces" can be more important than considerations of lipid "dynamic shape" in predicting the relative stabilities of lamellar vs. nonlamellar phases for at least some zwitterionic phospholipids.
This article considers the background and provisions of the New Secondary Curriculum in England. Attention is drawn to the extent of the policy changes by comparing the ten‐year old demands of the Swift & Steers ‘Manifesto for art in schools’ (1999) with the new legislation and guidance. In particular, while there is strong support for overdue recognition of the importance of creativity in the curriculum it is argued that its inclusion remains problematic because the ‘risky thinking’ involved will be difficult in the many schools that have become risk averse in the face of ever increasing accountability. Nevertheless, there are very significant opportunities for art and design provided a number of key challenges are faced and acted upon.
PrefaceThis manifesto bases its suggestions on a postmodern view of art in education with an emphasis on difference, plurality and independence of mind. The proposals derive from the rationale and argue for more decision-making and autonomy for teachers and learners within a climate that emphasises and expects enquiry, experiment and creative opportunity. For this to happen the subject matter of art, ways of approaching it, and improved means of encouraging diversity and innovation must be developed. This implies that the values within the current statutory Orders for Art, the initial education and in-service development of teachers, and the nature and purpose of assessment must be reconsidered. This manifesto addresses the areas that impinge on the activity of art in schools, makes critical comment on the effect of current ideology and practice, and provides a rationale and proposals for its implementation. RationaleThe rationale is based on three fundamental principles: difference, plurality, and independent thought. Through their application in © NSEAD, 1999 art practice and theory, knowledge and knowing will become understood as a negotiation of ideas which arise from asking pertinent questions, and testing provisional answers rather than seeking predetermined ones. The emphasis is on the learner and learning, negotiating what they learn, learning how to learn, and understanding knowledge as a multiplicity of changing hypotheses or theories which are subject to evidence, proof, argument and embodiment. As such difference becomes a locus for action and discussion at a personal and social level, plurality points to a variety of methods, means, solutions and awareness for any issue, and independent thought develops individuality, the capacity to challenge, and creativity through introspection into the nature of learning and teaching in art. These abilities are as vital for teachers as they are for learners.
Reforming the School Curriculum and Assessment in England to Match the Best in the World -A Cautionary Tale John SteersThis article traces the development of a new National Curriculum in England following the general election of 2010. The prevailing political ideology of an approach based on securing 'core knowledge' in a limited range of preferred 'academic' subjects and its deleterious impact on the arts in schools is described. The vigorous debate accompanying these 'reforms' is summarised.
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