Boundaries in Action : An Activity-theoretical Study of Development, Learning, and Change in Health Care Organization for Patients with Multiple and Chronic Illnesses

This study examines boundaries in health care organizations. Boundaries are sometimes considered things to be avoided in everyday living. This study suggests that boundaries can be important temporally and spatially emerging locations of development, learning, and change in inter-organizational activity. Boundaries can act as mediators of cultural and social formations and practices. The data of the study was gathered in an intervention project during the years 2000-2002 in Helsinki in which the care of 26 patients with multiple and chronic illnesses was improved. The project used the Change Laboratory method that represents a research assisted method for developing work. The research questions of the study are: (1) What are the boundary dynamics of development, learning, and change in health care for patients with multiple and chronic illnesses? (2) How do individual patients experience boundaries in their health care? (3) How are the boundaries of health care constructed and reconstructed in social interaction? (4) What are the dynamics of boundary crossing in the experimentation with the new tools and new practice? The methodology of the study, the ethnography of the multi-organizational field of activity, draws on cultural-historical activity theory and anthropological methods. The ethnographic fieldwork involves multiple research techniques and a collaborative strategy for raising research data. The data of this study consists of observations, interviews, transcribed intervention sessions, and patients' health documents. According to the findings, the care of patients with multiple and chronic illnesses emerges as fragmented by divisions of a patient and professionals, specialties of medicine and levels of health care organization. These boundaries have a historical origin in the Finnish health care system. As an implication of these boundaries, patients frequently experience uncertainty and neglect in their care. However, the boundaries of a single patient were transformed in the Change Laboratory discussions among patients, professionals and researchers. In these discussions, the questioning of the prevailing boundaries was triggered by the observation of gaps in inter-organizational care. Transformation of the prevailing boundaries was achieved in implementation of the collaborative care agreement tool and the practice of negotiated care. However, the new tool and practice did not expand into general use during the project. The study identifies two complementary models for the development of health care organization in Finland. The 'care package model', which is based on productivity and process models adopted from engineering and the 'model of negotiated care', which is based on co-configuration and the public good.

Learning Challenges in Biogas Production for Sustainability : An activity theoretical study of a network from a swine industry chain

This study is about the challenges of learning in the creation and implementation of new sustainable technologies. The system of biogas production in the Programme of Sustainable Swine Production (3S Programme) conducted by the Sadia food processing company in Santa Catarina State, Brazil, is used as a case example for exploring the challenges, possibilities and obstacles of learning in the use of biogas production as a way to increase the environmental sustainability of swine production. The aim is to contribute to the discussion about the possibilities of developing systems of biogas production for sustainability (BPfS). In the study I develop hypotheses concerning the central challenges and possibilities for developing systems of BPfS in three phases. First, I construct a model of the network of activities involved in the BP for sustainability in the case study. Next, I construct a) an idealised model of the historically evolved concepts of BPfS through an analysis of the development of forms of BP and b) a hypothesis of the current central contradictions within and between the activity systems involved in BP for sustainability in the case study. This hypothesis is further developed through two actual empirical analyses: an analysis of the actors senses in taking part in the system, and an analysis of the disturbance processes in the implementation and operation of the BP system in the 3S Programme. The historical analysis shows that BP for sustainability in the 3S Programme emerged as a feasible solution for the contradiction between environmental protection and concentration, intensification and specialisation in swine production. This contradiction created a threat to the supply of swine to the food processing company. In the food production activity, the contradiction was expressed as a contradiction between the desire of the company to become a sustainable company and the situation in the outsourced farms. For the swine producers the contradiction was expressed between the contradictory rules in which the market exerted pressure which pushed for continual increases in scale, specialisation and concentration to keep the production economically viable, while the environmental rules imposed a limit to this expansion. Although the observed disturbances in the biogas system seemed to be merely technical and localised within the farms, the analysis proposed that these disturbances were formed in and between the activity systems involved in the network of BPfS during the implementation. The disturbances observed could be explained by four contradictions: a) contradictions between the new, more expanded activity of sustainable swine production and the old activity, b) a contradiction between the concept of BP for carbon credits and BP for local use in the BPfS that was implemented, c) contradictions between the new UNFCCC1 methodology for applying for carbon credits and the small size of the farms, and d) between the technologies of biogas use and burning available in the market and the small size of the farms. The main finding of this study relates to the zone of proximal development (ZPD) of the BPfS in Sadia food production chain. The model is first developed as a general model of concepts of BPfS and further developed here to the specific case of the BPfS in the 3S Programme. The model is composed of two developmental dimensions: societal and functional integration. The dimension of societal integration refers to the level of integration with other activities outside the farm. At one extreme, biogas production is self-sufficient and highly independent and the products of BP are consumed within the farm, while at the other extreme BP is highly integrated in markets and networks of collaboration, and BP products are exchanged within the markets. The dimension of functional integration refers to the level of integration between products and production processes so that economies of scope can be achieved by combining several functions using the same utility. At one extreme, BP is specialised in only one product, which allows achieving economies of scale, while at the other extreme there is an integrated production in which several biogas products are produced in order to maximise the outcomes from the BP system. The analysis suggests that BP is moving towards a societal integration, towards the market and towards a functional integration in which several biogas products are combined. The model is a hypothesis to be further tested through interventions by collectively constructing the new proposed concept of BPfS. Another important contribution of this study refers to the concept of the learning challenge. Three central learning challenges for developing a sustainable system of BP in the 3S Programme were identified: 1) the development of cheaper and more practical technologies of burning and measuring the gas, as well as the reduction of costs of the process of certification, 2) the development of new ways of using biogas within farms, and 3) the creation of new local markets and networks for selling BP products. One general learning challenge is to find more varied and synergic ways of using BP products than solely for the production of carbon credits. Both the model of the ZPD of BPfS and the identified learning challenges could be used as learning tools to facilitate the development of biogas production systems. The proposed model of the ZPD could be used to analyse different types of agricultural activities that face a similar contradiction. The findings could be used in interventions to help actors to find their own expansive actions and developmental projects for change. Rather than proposing a standardised best concept of BPfS, the idea of these learning tools is to facilitate the analysis of local situations and to help actors to make their activities more sustainable.

Unraveling the helix of change : An activity-theoretical study of health care change efforts and their consequences

M.A. (Educ.) Anu Kajamaa from the University of Helsinki, Center for Research on Activity, Development and Learning (CRADLE), examines change efforts and their consequences in health care in the public sector. The aim of her academic dissertation is, by providing a new conceptual framework, to widen our understanding of organizational change efforts and their consequences and managerial challenges. Despite the multiple change efforts, the results of health care development projects have not been very promising, and many developmental needs and managerial challenges exist. The study challenges the predominant, well-framed health care change paradigm and calls for an expanded view to explore the underlying issues and multiplicities of change efforts and their consequences. The study asks what kind of expanded conceptual framework is needed to better understand organizational change as transcending currently dominant oppositions in management thinking, specifically in the field of health care. The study includes five explorative case studies of health care change efforts and their consequences in Finland. Theory and practice are tightly interconnected in the study. The methodology of the study integrates the ethnography of organizational change, a narrative approach and cultural-historical activity theory. From the stance of activity theory, historicity, contradictions, locality and employee participation play significant roles in developing health care. The empirical data of the study has mainly been collected in two projects, funded by the Finnish Work Environment Fund. The data was collected in public sector health care organizations during the years 2004-2010. By exploring the oppositions between distinct views on organizational change and the multi-site, multi-level and multi-logic of organizational change, the study develops an expanded, multidimensional activity-theoretical framework on organizational change and management thinking. The findings of the study contribute to activity theory and organization studies, and provide information for health care management and practitioners. The study illuminates that continuous development efforts bridged to one another and anchored to collectively created new activity models can lead to significant improvements and organizational learning in health care. The study presents such expansive learning processes. The ways of conducting change efforts in organizations play a critical role in the creation of collective new practices and tools and in establishing ownership over them. Some of the studied change efforts were discontinuous or encapsulated, not benefiting the larger whole. The study shows that the stagnation and unexpected consequences of change efforts relate to the unconnectedness of the different organizational sites, levels and logics. If not dealt with, the unintended consequences such as obstacles, breaks and conflicts may stem promising change and learning processes.

Contributions to the Theory of Finite-State Based Grammars

This dissertation is a theoretical study of finite-state based grammars used in natural language processing. The study is concerned with certain varieties of finite-state intersection grammars (FSIG) whose parsers define regular relations between surface strings and annotated surface strings. The study focuses on the following three aspects of FSIGs: (i) Computational complexity of grammars under limiting parameters In the study, the computational complexity in practical natural language processing is approached through performance-motivated parameters on structural complexity. Each parameter splits some grammars in the Chomsky hierarchy into an infinite set of subset approximations. When the approximations are regular, they seem to fall into the logarithmic-time hierarchyand the dot-depth hierarchy of star-free regular languages. This theoretical result is important and possibly relevant to grammar induction. (ii) Linguistically applicable structural representations Related to the linguistically applicable representations of syntactic entities, the study contains new bracketing schemes that cope with dependency links, left- and right branching, crossing dependencies and spurious ambiguity. New grammar representations that resemble the Chomsky-Schützenberger representation of context-free languages are presented in the study, and they include, in particular, representations for mildly context-sensitive non-projective dependency grammars whose performance-motivated approximations are linear time parseable. (iii) Compilation and simplification of linguistic constraints Efficient compilation methods for certain regular operations such as generalized restriction are presented. These include an elegant algorithm that has already been adopted as the approach in a proprietary finite-state tool. In addition to the compilation methods, an approach to on-the-fly simplifications of finite-state representations for parse forests is sketched. These findings are tightly coupled with each other under the theme of locality. I argue that the findings help us to develop better, linguistically oriented formalisms for finite-state parsing and to develop more efficient parsers for natural language processing. Avainsanat: syntactic parsing, finite-state automata, dependency grammar, first-order logic, linguistic performance, star-free regular approximations, mildly context-sensitive grammars

Arjen hallinta kotitalouden toiminnan tavoitteena : Kotitalouden toiminnan filosofista ja teoreettista tarkastalua

The aim of this philosophical and theoretical study is to outline a conceptual framework, which could be used to describe the qualitative characteristics of household activities from a holistic point of view. The philosophical part of the study deals with ontological and epistemological approaches. Ontological questions of existence are based on the holistic notion of man. The epistemological approach to household activities is based on the Aristotelian concept of knowledge, according to which actions are viewed as being praxis and poiesis in type. The concept of rationality is essential. As a result of the study, concepts describing the qualitative contents of the concept of mastery of everyday life are presented. Mastery of everyday life describes an individual's understanding of how to act in a household and promote the common good. The qualitative dimensions are the aims of actions, knowledge that guides actions and interaction. From the standpoint of these dimensions, the development of mastery of everyday life means an increase in the individual's sense of responsibility, so that s/he is gradually able to deal responsibility with the whole household, the immediate environment and the surrounding community and society. The quality of interaction develops so that the significance of communicative interaction becomes central. There are three levels in the mastery of everyday life, which differ from one other in respect to the development of reflective thought and the scope of understanding. The whole conceptual framework will contribute to the study of both household activities and the teaching of home economics. Key words: holistic notion of man, rationality, interaction.

Kestävä kehitys globaalin ajan hyvinvointiyhteiskunnan haasteena

The objective of the dissertation was to determine the concept of sustainable development according to current understanding and to analyze the structuration of sustainable daily life and how it varies between different groups. The present dissertation is both a literature-based theoretical study and data-based empirical research. The theoretical framework of the study was a greated model of the Structuration of Sustainability in Everyday Life. The model is based on a synthesis of Giddens Theory of Structuration (1984), Spaargaren JA van Vliet's Theory of Consumption as Social Practices (2000) and principles of sustainable development. According to the model created, sustainable everyday life is generated in a context of internal and external factors compromising the interests of ecosystems, society and business. The literature used in the thesis included international and national statements on sustainable development and research into sustainability and the transition to sustainable societies. The data were collected at Helsinki Metropolia University of Applied Sciences. The discretionary sample consisted of students of social services (n = 210) and were collected using the semantic differential technique. The data were analyzed using quantitative and qualitative methods. The results showed that the value placed on ecological, economic and social sustainability increased with age. Activity in non governmental organizations was associated with the acceptance of sustainable development as a whole and especially with global responsibility. Women's everyday life promoted sustainability more than men´s. People living in Helsinki had more sustainable ways of living than those living in the surrounding municipalities because of greater recycling and the low importance given to ownership. Prefering vegetarian food turned out to be a real opportunity for a more sustainable way of living because there were few barriers identified. Contradictory human behavior occurred when advanced sustainable consumer were ready to risk their health. The importance of communality was high and it was considered an aspect of health. The most significant obstacles to sustainable development in daily life were high costs, lack of knowledge and busyness. Similar attitudes towards sustainable development translate into different people´s behavior, which indicates complexities of the behaviour change in the context of sustainable development. The role of non governmental organizations is significant in increasing global responsibility. Education presents an opportunity to increase sustainability, but there are challenges to face from system thinking and in understanding entities in a state of transition towards sustainable everyday life. The responsibility of policy makers is paramount because high costs create a barrier to a sustainable way of living. The implementation of the concept of sustainable development should be focused on the planetary ethics which cover humans, animals, plants and ecosystems. Keywords: Sustainable development, sustainable thinking, behaviour change  

Optical Tweezers for Single Molecule Biology

Molecular machinery on the micro-scale, believed to be the fundamental building blocks of life, involve forces of 1-100 pN and movements of nanometers to micrometers. Micromechanical single-molecule experiments seek to understand the physics of nucleic acids, molecular motors, and other biological systems through direct measurement of forces and displacements. Optical tweezers are a popular choice among several complementary techniques for sensitive force-spectroscopy in the field of single molecule biology. The main objective of this thesis was to design and construct an optical tweezers instrument capable of investigating the physics of molecular motors and mechanisms of protein/nucleic-acid interactions on the single-molecule level. A double-trap optical tweezers instrument incorporating acousto-optic trap-steering, two independent detection channels, and a real-time digital controller was built. A numerical simulation and a theoretical study was performed to assess the signal-to-noise ratio in a constant-force molecular motor stepping experiment. Real-time feedback control of optical tweezers was explored in three studies. Position-clamping was implemented and compared to theoretical models using both proportional and predictive control. A force-clamp was implemented and tested with a DNA-tether in presence of the enzyme lambda exonuclease. The results of the study indicate that the presented models describing signal-to-noise ratio in constant-force experiments and feedback control experiments in optical tweezers agree well with experimental data. The effective trap stiffness can be increased by an order of magnitude using the presented position-clamping method. The force-clamp can be used for constant-force experiments, and the results from a proof-of-principle experiment, in which the enzyme lambda exonuclease converts double-stranded DNA to single-stranded DNA, agree with previous research. The main objective of the thesis was thus achieved. The developed instrument and presented results on feedback control serve as a stepping stone for future contributions to the growing field of single molecule biology.

Teachers' attitudes to and beliefs about web-based Collaborative Learning Environments in the context of an international implementation

"Fifty-six teachers, from four European countries, were interviewed to ascertain their attitudes to and beliefs about the Collaborative Learning Environments (CLEs) which were designed under the Innovative Technologies for Collaborative Learning Project. Their responses were analysed using categories based on a model from cultural-historical activity theory [Engestrom, Y. (1987). Learning by expanding.- An activity-theoretical approach to developmental research. Helsinki: Orienta-Konsultit; Engestrom, Y., Engestrom, R., & Suntio, A. (2002). Can a school community learn to master its own future? An activity-theoretical study of expansive learning among middle school teachers. In G. Wells & G. Claxton (Eds.), Learning for life in the 21st century. Oxford: Blackwell Publishers]. The teachers were positive about CLEs and their possible role in initiating pedagogical innovation and enhancing personal professional development. This positive perception held across cultures and national boundaries. Teachers were aware of the fact that demanding planning was needed for successful implementations of CLEs. However, the specific strategies through which the teachers can guide students' inquiries in CLEs and the assessment of new competencies that may characterize student performance in the CLEs were poorly represented in the teachers' reflections on CLEs. The attitudes and beliefs of the teachers from separate countries had many similarities, but there were also some clear differences, which are discussed in the article. (c) 2005 Elsevier Ltd. All rights reserved."

Tiedostumaton nykytaiteessa : Katse, ääni ja aika vuosituhannen taitteen suomalaisessa nykytaiteessa

Leevi Haapala explores moving image works, sculptures and installations from a psychoanalytic perspective in his study The Unconscious in Contemporary Art. The Gaze, Voice and Time in Finnish Contemporary Art at the Turn of the Millennium . The artists included in the study are Eija-Liisa Ahtila, Hans-Christian Berg, Markus Copper, Liisa Lounila and Salla Tykkä. The theoretical framework includes different psychoanalytic readings of the concepts of the gaze, voice and temporality. The installations are based on spatiality and temporality, and their detailed reading emphasizes the medium-specific features of the works as well as their fragmentary nature, heterogeneity and affectivity. The study is cross-disciplinary in that it connects perspectives from the visual culture, new art history and theory to the interpretation of contemporary art. The most important concepts from psychoanalysis, affect theory and trauma discourse used in the study include affect, object a (objet petit a) as articulated by Jacques Lacan, Sigmund Freud s uncanny (das Unheimliche) and trauma. Das Unheimliche has been translated as uncanny in art history under the influence of Rosalind Krauss. The object of the study, the unconscious in contemporary art, is approached through these concepts. The study focuses on Lacan s additions to the list of partial drives: the gaze and voice as scopic and invocative drives and their interpretations in the studies of the moving image. The texts by the American film theorist and art historian Kaja Silverman are in crucial role. The study locates contemporary art as part of trauma culture, which has a tendency to define individual and historical experiences through trauma. Some of the art works point towards trauma, which may appear as a theoretic or fictitious construction. The study presents a comprehensive collection of different kinds of trauma discourse in the field of art research through the texts of Hal Foster, Cathy Caruth, Ruth Leys and Shoshana Felman. The study connects trauma theory with the theoretical analysis of the interference and discontinuity of the moving image in the readings by Susan Buck-Morss, Mary Ann Doane and Peter Osborn among others. The analysis emphasizes different ways of seeing and multisensoriality in the reception of contemporary art. With their reflections and inverse projections, the surprising mechanisms of Hans-Christian Berg s sculptures are connected with Lacan s views on the early mirroring and imitation attempts of the individual s body image. Salla Tykkä s film trilogy Cave invites one to contemplate the Lacanian theory of the gaze in relation to the experiences of being seen. The three oceanic sculpture installations by Markus Copper are studied through the vocality they create, often through an aggressive way of acting, as well as from the point of view of the functioning of an invocative drive. The study compares the work of fiction and Freud s texts on paranoia and psychosis to Eija-Liisa Ahtila s manuscripts and moving image installations about the same topic. The cinematic time in Liisa Lounila s time-slice video installations is approached through the theoretical study of the unconscious temporal structure. The viewer of the moving image is inside the work in an in-between state: in a space produced by the contents of the work and its technology. The installations of the moving image enable us to inhabit different kinds of virtual bodies or spaces, which do not correspond with our everyday experiences. Nevertheless, the works of art often try to deconstruct the identification to what has been shown on screen. This way, the viewer s attention can be fixed on his own unconscious experiences in parallel with the work s deconstructed nature as representation. The study shows that contemporary art is a central cultural practice, which allows us to discuss the unconscious in a meaningful way. The study suggests that the agency that is discursively diffuse and consists of several different praxes should be called the unconscious. The emergence of the unconscious can happen in two areas: in contemporary art through different senses and discursive elements, and in the study of contemporary art, which, being a linguistic activity is sensitive to the movements of the unconscious. One of the missions of art research is to build different kinds of articulated constructs and to open an interpretative space for the nature of art as an event.

Shooting from the Wild Zone : A Study of the Chicana Art Photographers Laura Aguilar, Celia Álvarez Muñoz, Delilah Montoya, and Kathy Vargas

The dissertation analyzes and elaborates upon the changing map of U.S. ethno-racial formation from the vantage point of North American Studies, multi-disciplinary cultural studies, and the criticism of visual culture. The focus is on four contemporary Mexican American (Chicana) women photographers, whose art production is discussed, on the one hand, in the context of the Euro-American history of photographic genres and, on the other hand, in the context of so-called decolonizing cultural and academic discourses produced by Mexican Americans themselves. The manuscript consists of two parts. Part I outlines the theoretical and methodological domain of the study, positioning it in the interstices of American studies, European postmodern criticism, postcolonial feminist theory, and the theories of visual culture, particularly of art photography. In addition, the main issues and paradigms of Chicano Studies (Mexican American ethnic studies) are introduced. Part II consists of seven essays, each of which discusses rather independently a particular photographic work or a series of photographs, formulating and defending arguments about their meaning, position in the history of photographic genres, and their cultural and socio-political significance. The study closes with a discussion about ethno-racial identity formation and the role of Chicana photography therein - in embodying and reproducing new subjectivities, alternative categories of knowledge, and open ended historical narratives. It is argued that, symbolically, the "Wild Zone" of gendered and race-specific knowledge becomes associated with the body of the mother, a recurrent image in Chicana art works under discussion. Embedded in this image, the construction of an alternative notion of a family thus articulates the parameters of a matrifocal ethno-racial community unified by the proliferation of differences rather than by conformities typical of nationalistic ideologies. While focusing on art photography, the study as a whole simultaneously constructs, from a European vantage point, a "thick" description of Mexican American history, identities, communities, cultural practices, and self-representations about which very little is known in Finland.

The Saintly Madman : A Study of the Scholarly Reception History of Buile Shuibhne

This study examines the scholarly reception history of an early Irish text, Buile Shuibhne (The Frenzy of Suibhne), by focusing on the various theoretical and methodological presuppositions which have determined the scholars’ understanding of the text’s religious allegorical significance in the course of the 20th century. The reception-oriented inquiry takes the intersubjective aspect of literary interpretation as the basis for accentuating the importance of communally shared presumptions and reading strategies in the explication of interpretive variety. The materials of the study have been divided into four frameworks of interpretation: historical, pre-Christian, Christian and anthropological. This heuristic division does not denote mutually exclusive paradigms, but rather refers to perceived similarities within each group regarding the questions posed, and the evidence adduced, in textual analysis. The historical framework concentrates on the issues of the origins of the tale and the possible historicity of its main protagonist. The pre-Christian framework covers the theories of the shamanic, Indo-European and Celtic elements in the text, whereas the Christian framework includes readings emphasising the biblical, monastic and ascetic aspects of the tale. The anthropological framework in turn focuses on the parallels drawn between the narrative and the universal structure of the rites of passage. In addition to the examination of these four frameworks, the study also links the question of methodology with wider issues of authorship and textual integrity, and critically reconsiders the manner in which J.G. O'Keeffe's 1913 edition of the text has been reified in previous scholarship as a representation of a 12th century authorial original. The overall objective of the present case-study is to relate theoretical conceptions of literary theory, comparative religion and historiography to the study of early Irish narrative material by considering the communal and institutional dimension of meaning-making, and the implications of comparative methodology for historical research. In this aim, the prevailing methodological presuppositions informing the scholarly discourse on Buile Shuibhne are set against the wider context of Celtic Studies scholarship, in order to draw attention to the need to critically reflect upon the operations of knowledge production in future research.