Sairaanhoitajaksi kasvattaminen : Sairaanhoitajakoulutus ja siinä käytetyt oppikirjat Suomessa vuoteen 1967 asti

The historical development of Finnish nursing textbooks from the late 1880s to 1967: the training of nurses in the Foucauldian perspective. This study aims, first, to analyse the historical development of Finnish nursing textbooks in the training of nurses and in nursing education: what Foucauldian power processes operate in the writing and publishing processes? What picture of nursing did early nursing books portray and who were the decision makers? Second, this study also aims to analyse the processes of power in nurse training processes. The time frame extends from the early stages of nurse training in the late 1880s to 1967. This present study is a part of textbook research and of the history of professional education in Finland. This study seeks to explain how, who or what contributed the power processes involved in the writing of nursing textbooks and through textbooks. Did someone use these books as a tool to influence nursing education? The third aim of this study is to define and analyse the purpose of nurse training. Michel Foucault´s concept of power served as an explanatory framework for this study. A very central part of power is the assembling of data, the supplying of information and messages, and the creation of discourses. When applied to the training of nurses, power dictates what information is taught in the training and contained in the books. Thus, the textbook holds an influential position as a power user in these processes. Other processes in which such power is exercised include school discipline and all other normalizing processes. One of most powerful ways of adapting is the hall of residence, where nursing pupils were required to live. Trained nurses desired to separate themselves from their untrained predecessors and from those with less training by wearing different uniforms and living in separate housing units. The state supported the registration of trained nurses by legislation. With this decision the state made it illegal to work as a nurse without an authorised education, and use these regulations to limit and confirm the professional knowledge and power of nurses. Nurses, physicians and government authorities used textbooks in nursing education as tools to achieve their own purposes and principles. With these books all three groups attempted to confirm their own professional power and knowledge while at the same time limit the power and expertise of others. Public authorities sought to unify the training of nurses and the basis of knowledge in all nursing schools in Finland with similar and obligatory textbooks. This standardisation started 20 years before the government unified nursing training in 1930. The textbooks also served as data assemblers in unifying nursing practices in Finnish hospitals, because the Medical Board required all training hospitals to attach the textbooks to units with nursing pupils. For the nurses, and especially for the associations of Finnish nurses, making and publishing their own textbooks for the training of nurses was a part of their professional projects. With these textbooks, the nursing elite and the teachers tended to prepare nursing pupils’ identities for nursing’s very special mission. From the 1960s, nursing was no longer understood as a mission, but as a normal vocation. Nurses and doctors disputed this view throughout the period studied, which was the optimal relationship between theory and practice in nursing textbooks and in nurse education. The discussion of medical knowledge in nursing textbooks took place in the 1930s and 1940s. Nurses were very confused about their own professional knowledge and expertise, which explains why they could not create a new nursing textbook despite the urgency. A brand new nursing textbook was published in 1967, about 30 years after the predecessor. Keyword: nurse, nurse training, nursing education, power, textbook, Michel Foucault

Relationships in food chains: an empirical examination of trust, commitment and communication

This report derives from the EU funded research project “Key Factors Influencing Economic Relationships and Communication in European Food Chains” (FOODCOMM). The research consortium consisted of the following organisations: University of Bonn (UNI BONN), Department of Agricultural and Food Marketing Research (overall project co-ordination); Institute of Agricultural Development in Central and Eastern Europe (IAMO), Department for Agricultural Markets, Marketing and World Agricultural Trade, Halle (Saale), Germany; University of Helsinki, Ruralia Institute Seinäjoki Unit, Finland; Scottish Agricultural College (SAC), Food Marketing Research Team - Land Economy Research Group, Edinburgh and Aberdeen; Ashtown Food Research Centre (AFRC), Teagasc, Food Marketing Unit, Dublin; Institute of Agricultural & Food Economics (IAFE), Department of Market Analysis and Food Processing, Warsaw and Government of Aragon, Center for Agro-Food Research and Technology (CITA), Zaragoza, Spain. The aim of the FOODCOMM project was to examine the role (prevalence, necessity and significance) of economic relationships in selected European food chains and to identify the economic, social and cultural factors which influence co-ordination within these chains. The research project considered meat and cereal commodities in six different European countries (Finland, Germany, Ireland, Poland, Spain, UK/Scotland) and was commissioned against a background of changing European food markets. The research project as a whole consisted of seven different work packages. This report presents the results of qualitative research conducted for work package 5 (WP5) in the pig meat and rye bread chains in Finland. Ruralia Institute would like to give special thanks for all the individuals and companies that kindly gave up their time to take part in the study. Their input has been invaluable to the project. The contribution of research assistant Sanna-Helena Rantala was significant in the data gathering. FOODCOMM project was coordinated by the University of Bonn, Department of Agricultural and Food Market Research. Special thanks especially to Professor Monika Hartmann for acting as the project leader of FOODCOMM.

Kielellinen erityisvaikeus : oirekuva ja familiaalisuus potilasasiakirjojen perusteella

Goals. Specific language impairment (SLI) has a negative impact on child s speech and language development and interaction. Disorder may be associated with a wide range of comorbid problems. In clinical speech therapy it is important to see the child as a whole so that the rehabilitation can be targeted properly. The aim of this study was to describe the linguistic-cognitive and comorbid symptoms of children with SLI at the age of five, as well as to provide an overwiew of the developmental disorders in the families. The study is part of a larger research project, which will examine paths of development and quality of life of children with SLI as young adults. Methods. The data consisted of patient documents of 100 5-year old children, who were examined in Lastenlinna mainly at 1998. Majority of the subjects were boys, and children s primary diagnosis was either F80.1 or F80.2, which was most common, or both. The diagnosis and the information about the linguistic-cognitive status and comorbid symptoms were collected from reports of medical doctors and experts of other fields, as well as mentions related to familiality. Linguistic-cognitive symptoms were divided into subclasses of speech motor functions, prosessing of language, comprehension of language and use of language. Comorbid symptoms were divided into subclasses of interaction, activity and attention, emotional and behavior problems and neurologic problems. Statistical analyses were based mainly on Pearson s Chi Square test. Results and conclusions. Problems in language processing and speech motor functions were most common of the linguistic-cognitive symptoms. Most of the children had symptoms from two or three symptom classes, and it seemed that girls had more symptoms than boys. Usually children did not have any comorbid symptoms, or had them from one or three symptom classes. Of the comorbid symptoms the most prevalent ones were problems in activity and attention and neurological symptoms, which consisted mostly of motoric and visuomotoric symptoms. The most common of the comorbid diagnoses was F82, specific developmental disorder of motor function. According to literature children with SLI may have problems in mental health, but the results of this study did not confirm that. Children with diagnosis F80.2 had more linguistic-cognitive and comorbid symptoms than children with diagnosis F80.1. The cluster analyses based on all the symtoms revealed four subgroups of the subjects. Of the subjects 85 percent had a positive family history of developmental disorders, and the most prevalent problem in the families was delayed speech development. This study outlined the symptom profile of children with SLI and laid a foundation for the future longitudinal study. The results suggested that there are differences between linguistic-cognitive symptoms of boys and girls, which is important to notice especially when assessing and diagnosing children with SLI.

Building Information Modelling – Experts´ Views on Standardisation and Industry Deployment

The goal of the single building information model has existed for at least thirty years and various standards have been published leading up to the ten-year development of the Industry Foundation Classes. These have been initiatives from researchers, software developers and standards committees. Now large property owners are becoming aware of the benefits of moving IT tools from specific applications towards more comprehensive solutions. This study addresses the state of Building Information Models and the conditions necessary for them to become more widely used. It is a qualitative study based on information from a number of international experts and has asked a series of questions about the feasibility of BIMs, the conditions necessary for their success, and the role of standards with particular reference to the IFCs. Some key statements were distilled from the diverse answers received and indicate that BIM solutions appear too complex for many and may need to be applied in limited areas initially. Standards are generally supported but not applied rigorously and a range of these are relevant to BIM. Benefits will depend upon the building procurement methods used and there should be special roles within the project team to manage information. Case studies are starting to appear and these could be used for publicity. The IFCs are rather oversold and their complexities should be hidden within simple-to-use software. Inevitably major questions remain and property owners may be the key to answering some of these. A framework for presenting standards, backed up by case studies of successful projects, is the solution proposed to provide better information on where particular BIM standards and solutions should be applied in building projects.

Learning challenges of NGOs in development : Co-operation of Finnish NGOs in Morogoro, Tanzania

Non-governmental organisations (NGOs) have gained an important role in development co-operation during the last two decades. The development funding channelled through NGOs has increased and the number of NGOs engaged in development activities, both North and South, has been growing. Supporting NGOs has been seen as one way to strengthen civil society in the South and to provide potential for enhancing more effective development than the state, and to exercise participatory development and partnership in their North-South relationships. This study focuses on learning in the co-operation practices of small Finnish NGOs in Morogoro, Tanzania. Drawing on the cultural-historical activity theory and the theory of expansive learning, in this study I understand learning as a qualitative change in the actual co-operation practices. The qualitative change, for its part, emerges out of attempts to deal with the contradictions in the present activity. I use the concept of developmental contradiction in exploring the co-operation of the small Finnish NGOs with their Tanzanian counterparts. Developmental contradiction connects learning to actual practice and its historical development. By history, in this study I refer to multiple developmental trajectories, such as trajectories of individual participants, organisations, co-operation practices and the institutional system in which the NGO-development co-operation is embedded. In the empirical chapters I explore the co-operation both in the development co-operation projects and in micro-level interaction between partners taking place within the projects. I analyse the perceptions of the Finnish participants about the different developmental trajectories, the tensions, inclusions and exclusions in the evolving object of co-operation in one project, the construction of power relations in project meetings in three projects, and the collision of explicated partnership with the emerging practice of trusteeship in one project. On the basis of the empirical analyses I elaborate four developmental contradictions and learning challenges for the co-operation. The developmental contradictions include: 1) implementing a ready-made Finnish project idea vs. taking the current activities of Tanzanian NGO as a starting point; 2) gaining experiences and cultural interaction vs. access to outside funding; 3) promoting the official tools of development co-operation in training vs. use of tools and procedures taken from the prior activities of both partners in actual practice; and 4) asymmetric relations between the partners vs. rhetoric of equal partnership. Consequently, on the basis of developmental contradictions four learning challenges are suggested: a shift from legitimation of Finnish ideas to negotiation, transcending the separate objects and finding a partly joint object, developing locally shared tools for the co-operation, and identification and reflection of the power relations in the practice of co-operation. Keywords: activity theory; expansive learning; NGO development co-operation; partnership; power

Characterization of genomic diversity in extraintestinal pathogenic Escherichia coli (ExPEC) and development of a diagnostic DNA microarray for the differentiation of ExPEC isolates causing urinary tract infections

Extraintestinal pathogenic Escherichia coli (ExPEC) represent a diverse group of strains of E. coli, which infect extraintestinal sites, such as the urinary tract, the bloodstream, the meninges, the peritoneal cavity, and the lungs. Urinary tract infections (UTIs) caused by uropathogenic E. coli (UPEC), the major subgroup of ExPEC, are among the most prevalent microbial diseases world wide and a substantial burden for public health care systems. UTIs are responsible for serious morbidity and mortality in the elderly, in young children, and in immune-compromised and hospitalized patients. ExPEC strains are different, both from genetic and clinical perspectives, from commensal E. coli strains belonging to the normal intestinal flora and from intestinal pathogenic E. coli strains causing diarrhea. ExPEC strains are characterized by a broad range of alternate virulence factors, such as adhesins, toxins, and iron accumulation systems. Unlike diarrheagenic E. coli, whose distinctive virulence determinants evoke characteristic diarrheagenic symptoms and signs, ExPEC strains are exceedingly heterogeneous and are known to possess no specific virulence factors or a set of factors, which are obligatory for the infection of a certain extraintestinal site (e. g. the urinary tract). The ExPEC genomes are highly diverse mosaic structures in permanent flux. These strains have obtained a significant amount of DNA (predictably up to 25% of the genomes) through acquisition of foreign DNA from diverse related or non-related donor species by lateral transfer of mobile genetic elements, including pathogenicity islands (PAIs), plasmids, phages, transposons, and insertion elements. The ability of ExPEC strains to cause disease is mainly derived from this horizontally acquired gene pool; the extragenous DNA facilitates rapid adaptation of the pathogen to changing conditions and hence the extent of the spectrum of sites that can be infected. However, neither the amount of unique DNA in different ExPEC strains (or UPEC strains) nor the mechanisms lying behind the observed genomic mobility are known. Due to this extreme heterogeneity of the UPEC and ExPEC populations in general, the routine surveillance of ExPEC is exceedingly difficult. In this project, we presented a novel virulence gene algorithm (VGA) for the estimation of the extraintestinal virulence potential (VP, pathogenicity risk) of clinically relevant ExPECs and fecal E. coli isolates. The VGA was based on a DNA microarray specific for the ExPEC phenotype (ExPEC pathoarray). This array contained 77 DNA probes homologous with known (e.g. adhesion factors, iron accumulation systems, and toxins) and putative (e.g. genes predictably involved in adhesion, iron uptake, or in metabolic functions) ExPEC virulence determinants. In total, 25 of DNA probes homologous with known virulence factors and 36 of DNA probes representing putative extraintestinal virulence determinants were found at significantly higher frequency in virulent ExPEC isolates than in commensal E. coli strains. We showed that the ExPEC pathoarray and the VGA could be readily used for the differentiation of highly virulent ExPECs both from less virulent ExPEC clones and from commensal E. coli strains as well. Implementing the VGA in a group of unknown ExPECs (n=53) and fecal E. coli isolates (n=37), 83% of strains were correctly identified as extraintestinal virulent or commensal E. coli. Conversely, 15% of clinical ExPECs and 19% of fecal E. coli strains failed to raster into their respective pathogenic and non-pathogenic groups. Clinical data and virulence gene profiles of these strains warranted the estimated VPs; UPEC strains with atypically low risk-ratios were largely isolated from patients with certain medical history, including diabetes mellitus or catheterization, or from elderly patients. In addition, fecal E. coli strains with VPs characteristic for ExPEC were shown to represent the diagnostically important fraction of resident strains of the gut flora with a high potential of causing extraintestinal infections. Interestingly, a large fraction of DNA probes associated with the ExPEC phenotype corresponded to novel DNA sequences without any known function in UTIs and thus represented new genetic markers for the extraintestinal virulence. These DNA probes included unknown DNA sequences originating from the genomic subtractions of four clinical ExPEC isolates as well as from five novel cosmid sequences identified in the UPEC strains HE300 and JS299. The characterized cosmid sequences (pJS332, pJS448, pJS666, pJS700, and pJS706) revealed complex modular DNA structures with known and unknown DNA fragments arranged in a puzzle-like manner and integrated into the common E. coli genomic backbone. Furthermore, cosmid pJS332 of the UPEC strain HE300, which carried a chromosomal virulence gene cluster (iroBCDEN) encoding the salmochelin siderophore system, was shown to be part of a transmissible plasmid of Salmonella enterica. Taken together, the results of this project pointed towards the assumptions that first, (i) homologous recombination, even within coding genes, contributes to the observed mosaicism of ExPEC genomes and secondly, (ii) besides en block transfer of large DNA regions (e.g. chromosomal PAIs) also rearrangements of small DNA modules provide a means of genomic plasticity. The data presented in this project supplemented previous whole genome sequencing projects of E. coli and indicated that each E. coli genome displays a unique assemblage of individual mosaic structures, which enable these strains to successfully colonize and infect different anatomical sites.

The RATAS-project, in the Light of 25 Years of Development Towards Computer-Integrated Construction

In smaller countries where the key players in construction IT development tend to know each other personally and where public R&D funding is concentrated to a few channels, IT roadmaps and strategies would seem to have a better chance of influencing development than in the bigger industrial countries. In this paper Finland and the RATAS-project is presented as a historical case illustrating such impact. RATAS was initiated as a construction IT roadmap project in 1985, involving many of the key organisations and companies active in construction sector development. Several of the individuals who took an active part in the project have played an important role in later developments both in Finland and on the international scene. The central result of RATAS was the identification of what is nowadays called Building Information Modelling (BIM) technology as the central issue in getting IT into efficient use in the construction sector. BIM, which earlier was referred to as building product modelling, has been a key ingredient in many roadmaps since and the subject of international standardisation efforts such as STEP and IAI/IFCs. The RATAS project can in hindsight be seen as a forerunner with an impact which also transcended national borders.

Use of Standards for CAD Layers in Building

One of the central issues in making efficient use of IT in the design, construction and maintenance of buildings is the sharing of the digital building data across disciplines and lifecycle stages. One technology which enables data sharing is CAD layering, which to be of real use requires the definition of standards. This paper focuses on the background, objectives and effectiveness of the International standard ISO 13567, Organisation and naming of layers for CAD. In particular the efficiency and effectiveness of the standardisation and standard implementation process are in focus, rather than the technical details. The study was conducted as a qualitative study with a number of experts who responded to a semi-structured mail questionnaire, supplemented by personal interviews. The main results were that CAD layer standards based on the ISO standard have been implemented, particularly in northern European countries, but are not very widely used. A major problem which was identified was the lack of resources for marketing and implementing the standard as national variations, once it had been formally accepted.

Struggling over subjectivity: A discursive analysis of strategic development in a group

We have seen growing interest in discursive perspectives on strategy. This perspective holds great promise for development of an understanding on how strategy discourse and subjectivity are intertwined. We wish to add to this existing research by outlining a discursive struggle approach to subjectivity. To understand the complex subjectification and empowering/disempowering effects of organizational strategy discourse, this approach focuses on organization-specific discourse mobilizations an various ways of resistance. Drawing on an analysis of the discourses and practices of ‘strategic development’ in an engineering and consulting group we provide an empirical illustration of such struggles over subjectivity. In particular, we report three examples of competing ways of making sense of and giving sense to strategic development, with specific subjectification tendencies. First, we show how corporate management can mobilize and appropriate a specific kind of discourse to attempt to gain control of the organization, which tends to reproduce managerial hegemony, but also trigger discursive and other forms of resistance. Second, we will illustrate how middle managers resist this hegemony by initiating a strategy discourse of their own to create room for manoeuvre in controversial situations. Third, we show how project engineers can distance themselves from managerial-initiated strategy discourses to maintain a viable identity despite all kinds of pressures. Although our examples are case-specific, we believe that similar discursive dynamics also characterize strategizing in other organizations.

Managing Project Business Development: an Inter-Organizational and Intra-Organizational Perspective (summary section only)

The driving force behind this study is the gap between the reality of the firms engaged in project business and the available studies covering project management and business process development. Previous studies show that project-based organizations were ‘immature’ in terms of the project-management ‘maturity model’, as few firms were found to be optimizing processes. Even within those, very little attention was paid to combine inter-organizational and intra-organizational perspectives. In this study an effort is made to elaborate some thoughts and views on project management, which interrelate firms’ external and internal activities. In line with the integration, the dissertation uses an approach to the management of project-business interdependencies in the networks of actors, activities and resources. Firstly, the study develops an understanding for inter-organizational perspectives by exploring the complementarities of process activities in the basic development of project business. It presents a framework that is elaborated on the basis of the reciprocal interactions of activities within and outside the organization—thus providing a coherent basis for continuous business-process improvement. In addition, the study presents new tools that can be used to develop project-business processes in each of its functional areas. The research demonstrates how project-business activities can be optimized using the right resources at the right time with the right actors and the right actions. The selected five articles included in this dissertation explain the basic framework for the development of project business. Each paper covers various aspects of inter-organizational and intra-organizational perspectives for project management. The study develops a valuable and procedural model for business-process improvement using the Delphi method that can be used not only in academia but also as a guide for practitioners that takes them through a series of well-defined steps when making informed, consistent and efficient changes to their business processes.