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Neoliberal reforms of public education do more than shape policy and curriculum; they also influence educators’ understanding of themselves as professionals, driving at the very core of what it means to be a teacher or leader.  This article explores the effects of Neoliberal policies and New Public Management pracitces on teachers and principals and the ways they result in a “new professionalism.” The authors provide a framework for studying how these new polices and practices might be resisted, as well as a description of characteristics of the new professional and what professionalism might look like if it were grounded in community and advocacy.

BackgroundHeart failure is common in the elderly and is associated with high rates of hospitalisation, readmission and mortality. International guidelines however are not frequently implemented in this population.MethodsWe retrospectively studied the clinical profile, investigations, treatment on discharge, length of hospital stay, readmission rate and mortality in 261 patients, aged ≥75 years, with a discharge diagnosis of heart failure. Clinical frailty was estimated using the Canadian Study of Health and Aging clinical frailty scale.ResultsHypertension (64%), atrial fibrillation (50.6%) and ischaemic heart disease (46%) were common, and 75.6% of patients were clinically vulnerable or frail. 23.5% of admitters had an inpatient echocardiogram and 20% of patients had at least one readmission episode for heart failure. On discharge, 64.6% of admissions were treated with an ACE inhibitor or angiotensin II receptor antagonist, 49.3% with a β blocker and 28.7% with an aldosterone receptor antagonist (ARA). Patients discharged from cardiology wards were more likely to receive a β blocker (p<0.05) versus care of elderly (COE) wards and readmitters were more likely to receive an ARA (p<0.05) versus patients with a single admission. In total, 34 inpatient deaths were recorded (13%) and 80 deaths (30.7%) were recorded long-term (median follow-up 337 days). Long-term mortality was significantly lower in single admitters versus readmitters (p<0.0001) and in those managed on cardiology wards versus COE wards (p<0.05).ConclusionsCompared with patients hospitalised on geriatric wards, those admitted to cardiology units were discharged more frequently with recommended medications and had a lower long-term mortality.

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This is the sixth article in our series on the history of pediatric specialties. The authors describe the interesting history of the evolution of adolescent medicine from the specialties of internal medicine, pediatrics, psychiatry, and The field of adolescent medicine is unique as a subspecialty in that the practice of providing care to teenagers has always been viewed historically as a responsibility of generalists. Scientific advances in subspecialty fields such as endocrinology, gynecology, gastroenterology, infectious disease, and sports medicine were incorporated with considerable success into the general practices of not only pediatricians but also internists and family practitioners. However, societal changes in the past century began to shape the way health professionals thought about adolescents and their families and significantly influenced the practice of providing health care to adolescents. The most notable change, however, was the shift from the traditional role of providing anticipatory guidance to parents toward a reduction of risk-taking behaviors aimed directly at the adolescent. The subspecialty of adolescent medicine thus emerged as an amalgam of researchers, clinicians, and educators, who, through a variety of settings, hoped to advance science, moderate public and social policy, improve health care, and stimulate health promotion to this special population of patients. MAJOR SCIENTIFIC ADVANCES IN ADOLESCENT MEDICINELandmark scientific advances of the past century contributed greatly to the growth of the field of adolescent medicine. Some of these advances resulted from primary efforts to directly improve the health of adolescents, whereas others were derived from advances in other fields of medicine that secondarily benefited adolescents. Although at times it is difficult to distinguish between these two contributors toward change, the compilation of these scientific advances were instrumental in promoting the field of adolescent medicine. The physical and hormonal changes that define puberty have been elucidated, as have major psychological, cognitive, and behavioral developments characterizing the transition from childhood to adulthood. Great strides have been made in the management of mental illnesses and chronic medical illness, in technological advancements in the field of gynecology, and in the development of birth control methods.

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ExtractA modification ofa previous method for the assay ofy glutamyI transpeptidase (GGTP) was developed.Substrate solubility difficulties alluded to by other investigators were avoided by employing heating and solubilization of the chromogenic substrate y glutamyl-P-naphthylamide in a medium of carbonate 0.05 M and Tris buffer 0.1 M a t p H 9.5. The kinetics and conditions for such an assay are described. Whole intestinal homogenates of adult male guinea pigs were used as the source of the enzyme.The developmental pattern of this enzyme was determined in fetuses at 55 and 63 days of gestation and at varying times from 1 to 90 days of age. A total of 69 animals was assayed. The general pattern was that ofhigh specific activity during prenatal life, with a rapid decline during the neonatal period (3-24 days of age) and a slight increase after 55 days of age.Other guinea pig organs were studied. Liver and kidney were found to contain enzyme activity greater than that of the intestine. Subcellular fractionation of intestinal mucosa using ultracentrifugation revealed a twenty-fold enrichment of activity in jejunal brush border membrane, compared with whole jejunal homogenates when expressed as specific enzyme activity per mg of protein. The stability characteristics of GGTP disclosed no loss of specific activity when stored a t -28' for 50 days.This simple enzyme assay, stability of the enzyme when frozen, subcellular distribution in the intestinal brush border membrane, and an unusual developmental pattern made this enzyme a useful adjunct to the study of intestinal protein metabolism. SpeculationThe unique ability of GGTP to hydrolyze y glutamic acid-peptide bonds and the location of the enzyme in the intestinal brush border suggest a role for this enzyme in the metabolism of an unusual group of physiologically important peptides such as glutathione, folic acid, and gluten-gliadin. The significance of these y-bonded compounds may now be approached in order to investigate the role of this enzyme in gluten enteropathy and related disorders.