Technical efficiency of blood component preparation in blood centres of 10 European countries

Various reasons, such as ethical issues in maintaining blood resources, growing costs, and strict requirements for safe blood, have increased the pressure for efficient use of resources in blood banking. The competence of blood establishments can be characterized by their ability to predict the volume of blood collection to be able to provide cellular blood components in a timely manner as dictated by hospital demand. The stochastically varying clinical need for platelets (PLTs) sets a specific challenge for balancing supply with requests. Labour has been proven a primary cost-driver and should be managed efficiently. International comparisons of blood banking could recognize inefficiencies and allow reallocation of resources. Seventeen blood centres from 10 countries in continental Europe, Great Britain, and Scandinavia participated in this study. The centres were national institutes (5), parts of the local Red Cross organisation (5), or integrated into university hospitals (7). This study focused on the departments of blood component preparation of the centres. The data were obtained retrospectively by computerized questionnaires completed via Internet for the years 2000-2002. The data were used in four original articles (numbered I through IV) that form the basis of this thesis. Non-parametric data envelopment analysis (DEA, II-IV) was applied to evaluate and compare the relative efficiency of blood component preparation. Several models were created using different input and output combinations. The focus of comparisons was on the technical efficiency (II-III) and the labour efficiency (I, IV). An empirical cost model was tested to evaluate the cost efficiency (IV). Purchasing power parities (PPP, IV) were used to adjust the costs of the working hours and to make the costs comparable among countries. The total annual number of whole blood (WB) collections varied from 8,880 to 290,352 in the centres (I). Significant variation was also observed in the annual volume of produced red blood cells (RBCs) and PLTs. The annual number of PLTs produced by any method varied from 2,788 to 104,622 units. In 2002, 73% of all PLTs were produced by the buffy coat (BC) method, 23% by aphaeresis and 4% by the platelet-rich plasma (PRP) method. The annual discard rate of PLTs varied from 3.9% to 31%. The mean discard rate (13%) remained in the same range throughout the study period and demonstrated similar levels and variation in 2003-2004 according to a specific follow-up question (14%, range 3.8%-24%). The annual PLT discard rates were, to some extent, associated with production volumes. The mean RBC discard rate was 4.5% (range 0.2%-7.7%). Technical efficiency showed marked variation (median 60%, range 41%-100%) among the centres (II). Compared to the efficient departments, the inefficient departments used excess labour resources (and probably) production equipment to produce RBCs and PLTs. Technical efficiency tended to be higher when the (theoretical) proportion of lost WB collections (total RBC+PLT loss) from all collections was low (III). The labour efficiency varied remarkably, from 25% to 100% (median 47%) when working hours were the only input (IV). Using the estimated total costs as the input (cost efficiency) revealed an even greater variation (13%-100%) and overall lower efficiency level compared to labour only as the input. In cost efficiency only, the savings potential (observed inefficiency) was more than 50% in 10 departments, whereas labour and cost savings potentials were both more than 50% in six departments. The association between department size and efficiency (scale efficiency) could not be verified statistically in the small sample. In conclusion, international evaluation of the technical efficiency in component preparation departments revealed remarkable variation. A suboptimal combination of manpower and production output levels was the major cause of inefficiency, and the efficiency did not directly relate to production volume. Evaluation of the reasons for discarding components may offer a novel approach to study efficiency. DEA was proven applicable in analyses including various factors as inputs and outputs. This study suggests that analytical models can be developed to serve as indicators of technical efficiency and promote improvements in the management of limited resources. The work also demonstrates the importance of integrating efficiency analysis into international comparisons of blood banking.

Community forestry and environmental literacy in northern Thailand : Towards collaborative natural resource management and conservation

Conservation and sustainable management of tropical forests needs a holistic approach: in addition to ecological concerns, socio-economic issues including cultural aspects must be taken into consideration. An ability to adapt practices is a key to successful collaborative natural resource management. Achieving this requires local participation and understanding of local conceptions of the environment. This study examined these issues in the context of northern Thailand. Northern uplands are the home of much of the remaining natural forest in Thailand and several ethnic minority groups commonly referred to as hill tribes. The overall purpose of this study was to grasp a regional view of an ethnically diverse forested area and to elicit prospects to develop community forestry for conservation purposes and for securing people s livelihood. Conservation was a central goal of management as the forests in the area were largely designated as protected. The aim was to study local perceptions, objectives, values and practices of forest management, under the umbrella of the concept environmental literacy, as well as the effects of forest policy on community management goals and activities. Environmental literacy refers to holistic understanding of the environment. It was used as a tool to examine people s views, interests, knowledge and motivation associated to forests. The material for this study was gathered in six villages in Chiang Mai Province. Three minority groups were included in the study, the Karen, Hmong and Lawa, and also the Thai. Household and focus group interviews were conducted in the villages. In addition, officials at district, regional and national levels, workers of non-governmental organisations, and academics were interviewed, and some data were gathered from the students of a local school. The results showed that motivation for protecting the forests existed among each ethnic group studied. This was a result of culture and traditions evolved in the forest environment but also of a need to adapt to a changed situation and environment and to outside pressures. The consequences of deforestation were widely agreed on in the villages, and the impact of socio-economic changes on the forests and livelihood was also recognised. The forest was regarded as a source of livelihood providing land, products and services essential to the people inhabiting rural uplands. Traditions, fire control, cooperation, reforestation, separation of protected and utilisable areas, and rules were viewed as central for conservation. For the villagers, however, conservation meant sustainable use, whereas the government has tended to prefer strict restrictions on forest resource use. Thus, conflicts had arisen. Between communities, cooperation was more dominant than conflict. The results indicated that the heterogeneity of forest dwellers, although it has to be recognised, should not be overemphasised: ethnic diversity can be considered as no major obstacle for successful community forestry. Collaborative management is particularly important in protected areas in order to meet the conservation goals while providing opportunities for livelihood. Forest management needs more positive incentives and increased dialogue.

Voiko sota olla oikeutettu? : Kirkkojen maailmanneuvoston yleiskokousten kannanotot sotaan kriisien ratkaisuna

Can war be justified? Expressions of opinions by the general assemblies of the World Council of Churches on the question of war as a method of settling conflicts. The purpose of this study is to describe and analyse the expressions of opinions recorded in the documents of the general assemblies of the WCC during the Cold War period from 1948 to 1983 on the use of war as a method of settling international and national conflicts. The main sources are the official reports of the WCC´s assemblies during the years 1948 to 1983. This study divides the discussions into three periods. The first period (1949-1968) is dominated by the pressures arising from the Second World War. Experiences of the war led the assemblies of the WCC to the conclusion that modern warfare as a method of settling conflicts should be rejected. Modern war was contrary to God´s purposes and the whole meaning of creation, said the assembly. Although the WCC rejected modern war, it left open the possibility of conflict where principles of just war may be practised. The question of war was also linked to the state and its function, which led to the need to create a politically neutral doctrine for the socio-ethical thinking of churches and of the WCC itself. The doctrine was formulated using the words "responsible society". The question of war and socio-ethical thinking were on the WCC`s agenda throughout the first period. Another issue that had an influence on the first period was the increasing role of Third World countries. This new dimension also brought new aspects to the question of war and violence. The second period (1968-1975) presented greater challenges to the WCC, especially in traditional western countries. The Third World, political activity in the socialist world and ideas of revolution were discussed. The WCC`s fourth Assembly in Uppsala was challenged by these new ideas of revolution. The old doctrine of "responsible society" was seen by many participants as unsuitable in the modern world, especially for Third World countries. The situation of a world governed by armaments, causing social and economic disruption, was felt by churches to be problematic. The peace movement gathered pace and attention. There was pressure to see armed forces as an option on the way to a new world order. The idea of a just war was challenged by that of just revolution. These ideas of revolution did not receive support from the Uppsala Assembly, but they pressured the WCC to reconsider its socio-ethical thinking. Revolution was seen as a possibility, but only when it could be peaceful. In the Nairobi Assembly the theme of just, participatory and sustainable society provided yet another viewpoint, dealing with the life of the world and its problems as a whole. The third period (1975-1983) introduced a new, alternative doctrine the "JPIC Process", justice, peace and the integrity of creation for social thinking in the WCC. The WCC no longer wanted to discuss war or poverty as separate questions, but wanted to combine all aspects of life to see the impact of an arms-governed world on humankind. Thus, during the last period, discussions focused on socio-ethical questions, where war and violence were only parts of a larger problem. Through the new JPIC Process, the WCC`s Assembly in Vancouver looked for a new world, one without violence, in all aspects of life. Despite differing opinions in socio-ethical thinking, the churches in the WCC agreed that modern warfare cannot be regarded as acceptable or just. The old idea of a "just war" still had a place, but it was not seen by all as a valid principle. As a result the WCC viewed war as a final solution to be employed when all other methods had failed. Such a war would have to secure peace and justice for all. In the discussions there was a strong political east-west divide, and, during the last two decades, a north-south divide as well. The effect of the Cold War was obvious. In the background to the theological positions were two main concepts namely the idea of God´s activity in man´s history through the so-called regiments and, the concept of the Kingdom of God on Earth.

Yksilöllisyys ja yhteisöllisyys K. E. Nipkowin uskonnonpedagogisen teorian kehityksessä 1960-1990

Individuality and the Community in the Development of K. E. Nipkow's Theory of Religious Education from 1960 to 1990 The purpose of this study was to describe and analyze the development occurred between 1960 and 1990 of the theory of religious education as proposed by K. E. Nipkow, the German Religious Education specialist, from the point of view of individuality and the community. Nipkow's methodological approach of dialectic convergence theory resulted in a dialogue between theological and educational factors, which supported the thirty-year development of Nipkow's models, theoretical foundations, and theory of religious education. Nipkow's doctoral dissertation, published in 1960, deals with individuality in the thinking of Pestalozzi, Humboldt and Schleiermacher. Nipkow regarded individuality as one of the basic concepts of education, which were to be interpreted anew as social and historical situations changed. In the late 1960s Nipkow developed the so-called experiential hermeneutically oriented context model for the needs of religious education. In this model, individuality is expressed in the attention paid to pupils' life situations and the educational reality. The multi-dimensional theoretical framework of religious education in 1975 emphasized supporting identity as a fundamental task of religious education. The concept of individuality was thus given a new form, in accordance with contemporary theories of developmental psychology. Other fundamental tasks, such as the socio-ethical task, the task of critical religious thinking, and that of ecumenical learning, meant a more specific emphasis on the community. It was an outline of a liberating education, which faced the individualistic-existential and social-ecclesiastical challenges of the time with a critical attitude. The further development of the theoretical outline in 1982 continued to uphold the perspectives of both individuality and the community, as Nipkow combined a historical-social dimension with theories of developmental psychology, especially that of life-span research. According to him, the development of the individual and communal life-reality belonged together. The fundamental task of religious education came to be learning to live and believe together. Nipkow transferred the idea of dialogue into inter-generational learning and developed elementarization as a methodology of Religious Education, which takes into account the point of departure of each age group. His theory of educational responsibility in the church (1990) contained the tasks of walking alongside the individual and the renewal of church communities as prerequisites of communicating the Christian faith in an era characterized by multifaceted Christianity. The "geisteswissenschaftliche" school and its concepts (Ger. Individualität; Bildung) were found to be the explanatory factor of the concepts of individuality and the community in the development of Nipkow's theory of religious education. The concept of education employed by Nipkow (Ger. Bildung) implies, on one hand, the individuality, autonomy, freedom and personal responsibility of people of different ages, and on the other hand, the dialogical nature of education in the community facilitated by this concept. Theologically, Nipkow associates himself in his views on individuality and the community with Schleiermacher's understanding of faith, of which openness towards the world was characteristic. The significance of individuality and the community in Nipkow's thinking was, furthermore, deepened by his participation, as a member of working parties, in the educational discussions of the World Council of Churches.

Hiippakunta diakoniatyön tekijänä ja tukijana : Diakoniatyön kehitys Mikkelin hiippakunnassa 1945-1991

ABSTRACT The diocese as the agent and advocate of diaconial work. The development of diaconial work in the Mikkeli diocese 1945–1991. The roots of Finnish diacony are in the individual devotional life of Pietism. An acting faith had to be evident in acts of love. Following German institutional diacony, diaconial institutions were established in Finland until congregational diacony emerged alongside these institutions in the 1890s. Pastor Otto Aarnisalo acted as a pathfinder in this. He aimed to unite diacony with the Church and the life of the congregation. Diacony had been based on the idea of volunteering to separate it from statutory social work. In 1944 the church law was amended, which made diacony the concern of every member of the congregation. In the years immediately following the Second World War, discussion took place in the Church of Finland about the direction that diacony should take. In the consequential debate, caritative services overcame social diacony. The diocese administration moved to Mikkeli in 1945, when the majority of the Vyborg diocese became part of the USSR in the armistice negotiations. The Mikkeli diocese acted in its diaconial work with the same objectives as the diaconial solutions of the whole church. The acting principle of the diocese diacony became a form of helping which emphasised assistance of the individual. Especially from the 1960s onwards, the country's industrialisation and the reduction of agricultural trade had an effect on the Mikkeli diocese. The diocese administration, specifically Bishop Martti Simojoki and his successor Osmo Alaja, aimed to open up connections to the political left and people working in industry. At least indirectly this helped the diaconial work in industrial localities. In the Mikkeli diocese, a diaconial committee was established in 1971, and its work was overseen by the diocesan chapter of the bishop's office. This enabled the work of the diocese to be organised for the different areas of diacony. Previously, the diaconial work of the Finnish church had primarily been in nursing. The Health Insurance Law of 1972 brought a change to this when the responsibility for health services was transferred to the municipalities. Diacony began to move towards a psychological and spiritual emphasis. Beginning in the 1970s, the diocese started holding diaconial themed days at prescribed intervals. Although these did not result in great realignments, they did help clarify the direction that diacony would take. Large international collections were also carried out, especially in the 1980s. At the same time, socio-ethical activity vitalised and diversified Christian services. The idea that every member of the congregation should practice diacony was a strong factor in the Mikkeli diocese as well. The diocese's vision for diacony was holistic; Christian service was the responsibility of every member of the congregation. During the period of study (1945–1991), the theology of diacony was rather tenuous. Bishop Kalevi Toiviainen, however, brought forth the viewpoint of church doctrine and officially sanctioned theology. Diacony was part of the complete faith of the Church.

Patents, Ethics and Stem Cell Research : The Case of hESC Innovation in Australia, Europe and the United States

Embryonic stem cells offer potentially a ground-breaking insight into health and diseases and are said to offer hope in discovering cures for many ailments unimaginable few years ago. Human embryonic stem cells are undifferentiated, immature cells that possess an amazing ability to develop into almost any body cell such as heart muscle, bone, nerve and blood cells and possibly even organs in due course. This remarkable feature, enabling embryonic stem cells to proliferate indefinitely in vitro (in a test tube), has branded them as a so-called miracle cure . Their potential use in clinical applications provides hope to many sufferers of debilitating and fatal medical conditions. However, the emergence of stem cell research has resulted in intense debates about its promises and dangers. On the one hand, advocates hail its potential, ranging from alleviating and even curing fatal and debilitating diseases such as Parkinson s, diabetes, heart ailments and so forth. On the other hand, opponents decry its dangers, drawing attention to the inherent risks of human embryo destruction, cloning for research purposes and reproductive cloning eventually. Lately, however, the policy battles surrounding human embryonic stem cell innovation have shifted from being a controversial research to scuffles within intellectual property rights. In fact, the ability to obtain patents represents a pivotal factor in the economic success or failure of this new biotechnology. Although, stem cell patents tend to more or less satisfy the standard patentability requirements, they also raise serious ethical and moral questions about the meaning of the exclusions on ethical or moral grounds as found in European and to an extent American and Australian patent laws. At present there is a sort of a calamity over human embryonic stem cell patents in Europe and to an extent in Australia and the United States. This in turn has created a sense of urgency to engage all relevant parties in the discourse on how best to approach patenting of this new form of scientific innovation. In essence, this should become a highly favoured patenting priority. To the contrary, stem cell innovation and its reliance on patent protection risk turmoil, uncertainty, confusion and even a halt on not only stem cell research but also further emerging biotechnology research and development. The patent system is premised upon the fundamental principle of balance which ought to ensure that the temporary monopoly awarded to the inventor equals that of the social benefit provided by the disclosure of the invention. Ensuring and maintaining this balance within the patent system when patenting human embryonic stem cells is of crucial contemporary relevance. Yet, the patenting of human embryonic stem cells raises some fundamental moral, social and legal questions. Overall, the present approach of patenting human embryonic stem cell related inventions is unsatisfactory and ineffective. This draws attention to a specific question which provides for a conceptual framework for this work. That question is the following: how can the investigated patent offices successfully deal with patentability of human embryonic stem cells? This in turn points at the thorny issue of application of the morality clause in this field. In particular, the interpretation of the exclusions on ethical or moral grounds as found in Australian, American and European legislative and judicial precedents. The Thesis seeks to compare laws and legal practices surrounding patentability of human embryonic stem cells in Australia and the United States with that of Europe. By using Europe as the primary case study for lessons and guidance, the central goal of the Thesis then becomes the determination of the type of solutions available to Europe with prospects to apply such to Australia and the United States. The Dissertation purports to define the ethical implications that arise with patenting human embryonic stem cells and intends to offer resolutions to the key ethical dilemmas surrounding patentability of human embryonic stem cells and other morally controversial biotechnology inventions. In particular, the Thesis goal is to propose a functional framework that may be used as a benchmark for an informed discussion on the solution to resolving ethical and legal tensions that come with patentability of human embryonic stem cells in Australian, American and European patent worlds. Key research questions that arise from these objectives and which continuously thread throughout the monograph are: 1. How do common law countries such as Australia and the United States approach and deal with patentability of human embryonic stem cells in their jurisdictions? These practices are then compared to the situation in Europe as represented by the United Kingdom (first two chapters), the Court of Justice of the European Union and the European Patent Office decisions (Chapter 3 onwards) in order to obtain a full picture of the present patenting procedures on the European soil. 2. How are ethical and moral considerations taken into account at patent offices investigated when assessing patentability of human embryonic stem cell related inventions? In order to assess this part, the Thesis evaluates how ethical issues that arise with patent applications are dealt with by: a) Legislative history of the modern patent system from its inception in 15th Century England to present day patent laws. b) Australian, American and European patent offices presently and in the past, including other relevant legal precedents on the subject matter. c) Normative ethical theories. d) The notion of human dignity used as the lowest common denominator for the interpretation of the European morality clause. 3. Given the existence of the morality clause in form of Article 6(1) of the Directive 98/44/EC of the European Parliament and of the Council of 6 July 1998 on the legal protection of biotechnological inventions which corresponds to Article 53(a) European Patent Convention, a special emphasis is put on Europe as a guiding principle for Australia and the United States. Any room for improvement of the European morality clause and Europe s current manner of evaluating ethical tensions surrounding human embryonic stem cell inventions is examined. 4. A summary of options (as represented by Australia, the United States and Europe) available as a basis for the optimal examination procedure of human embryonic stem cell inventions is depicted, whereas the best of such alternatives is deduced in order to create a benchmark framework. This framework is then utilised on and promoted as a tool to assist Europe (as represented by the European Patent Office) in examining human embryonic stem cell patent applications. This method suggests a possibility of implementing an institution solution. 5. Ultimately, a question of whether such reformed European patent system can be used as a founding stone for a potential patent reform in Australia and the United States when examining human embryonic stem cells or other morally controversial inventions is surveyed. The author wishes to emphasise that the guiding thought while carrying out this work is to convey the significance of identifying, analysing and clarifying the ethical tensions surrounding patenting human embryonic stem cells and ultimately present a solution that adequately assesses patentability of human embryonic stem cell inventions and related biotechnologies. In answering the key questions above, the Thesis strives to contribute to the broader stem cell debate about how and to which extent ethical and social positions should be integrated into the patenting procedure in pluralistic and morally divided democracies of Europe and subsequently Australia and the United States.

The Church and Its Boundaries : A Study of the Special Commission on Orthodox Participation in the WCC

The relationship between the Orthodox Churches and the World Council of Churches (WCC) became a crisis just before the 8th Assembly of the WCC in Harare, Zimbabwe in 1998. The Special Commission on Orthodox Participation in the WCC (SC), inaugurated in Harare, worked during the period 1999 2002 to solve the crisis and to secure the Orthodox participation in the WCC. The purpose of this study is: 1) to clarify the theological motives for the inauguration of the SC and the theological argumentation of the Orthodox criticism; 2) to write a reliable history and analysis of the SC; 3) to outline the theological argumentation, which structures the debate, and 4) to investigate the ecclesiological questions that arise from the SC material. The study spans the years 1998 to 2006, from the WCC Harare Assembly to the Porto Alegre Assembly. Hence, the initiation and immediate reception of the Special Commission are included in the study. The sources of this study are all the material produced by and for the SC. The method employed is systematic analysis. The focus of the study is on theological argumentation; the historical context and political motives that played a part in the Orthodox-WCC relations are not discussed in detail. The study shows how the initial, specific and individual Orthodox concerns developed into a profound ecclesiological discussion and also led to concrete changes in WCC practices, the best known of which is the change to decision-making by consensus. The Final Report of the SC contains five main themes, namely, ecclesiology, decision-making, worship/common prayer, membership and representation, and social and ethical issues. The main achievement of the SC was that it secured the Orthodox membership in the WCC. The ecclesiological conclusions made in the Final Report are twofold. On the one hand, it confirms that the very act of belonging to the WCC means the commitment to discuss the relationship between a church and churches. The SC recommended that baptism should be added as a criterion for membership in the WCC, and the member churches should continue to work towards the mutual recognition of each other s baptism. These elements strengthen the ecclesiological character of the WCC. On the other hand, when the Final Report discusses common prayer, the ecclesiological conclusions are much more cautious, and the ecclesiological neutrality of the WCC is emphasized several times. The SC repeatedly emphasized that the WCC is a fellowship of churches. The concept of koinonia, which has otherwise been important in recent ecclesiological questions, was not much applied by the SC. The comparison of the results of the SC to parallel ecclesiological documents of the WCC (Nature and Mission of the Church, Called to Be the One Church) shows that they all acknowledge the different ecclesiological starting points of the member churches, and, following that, a variety of legitimate views on the relation of the Church to the churches. Despite the change from preserving the koinonia to promises of eschatological koinonia, all the documents affirm that the goal of the ecumenical movement is still full, visible unity.

Lasten sitoutuneisuus toimintaan : kvantitatiivinen havainnointitutkimus

Children s involvement is a key quality factor in Early Years Education. As a process variable it concentrates on children s actions and experiences. The involved children are operating in their zone of proximal development. The aim of this study was to find out how the children involved themselves in the Finnish day care centres. The problems of the study were: (1) how the children are involved in different situations between the hours 8.00 and 12.00, (2) how do the skills of children whose involvement level is high differ from the skills of children whose involvement level is low and (3) how do the learning environments of the children whose involvement level is high differ from the learning environments of the children whose involvement level is low? The research method was observation and children s involvement levels were assessed using LIS-YC Scale. In addition, the kindergarten teachers evaluated the children s skills and the team workers did the evaluations of the educational settings. The data used in this study was a part of the Orientaation lähteillä research. The 802 children, who took part in the study, were from 48 different groups of eight different municipalities in Central Uusimaa. There were 18358 observations of children s involvement and the quantitative data was analyzed using correlation, cross tabulation and t-test. Children s involvement was an average at a moderate level. The involvement levels were the highest during playing time and adult guided tasks and lowest during eating and basic care situations. The level of involvement was higher if the children were adaptable, proactive, self-motivated and good players. The involvement lever was lower if the children needed some special care. The children s involvement is supported if the educators had at least once a week a meeting and if children s confidence and identity construction was frequently considered in educational discussions. Furthermore, the appreciation of the ethical issues and positive atmosphere appeared to confirm the involvement. The children s involvement is decreased if the educators had been perpetually short of time or resources or there has been lack of joy and humour in the group.

Christian-Muslim Dialogue : Perspectives of Four Lebanese Thinkers

This study describes and analyses two Lebanese Muslims and two Lebanese Christians ideas about Christian-Muslim dialogue, its nature, aims, and methods and its different dimensions, which include doctrinal, ethical, and social dimensions. On the basis of the analysis, the four thinkers contributions for promoting constructive dialogue are evaluated. The persons studied are two religious authorities, the Shiite Great Ayatollah Muhammad Husayn Fadlallah (b. 1935) and the Eastern Orthodox Metropolitan of Mount Lebanon, Georges Khodr (b. 1923), and two academic scholars, Doctor Mahmoud Ayoub (b. 1935) and Doctor, Father Mouchir Aoun (b. 1964), from the Shiite and Greek Catholic communities, respectively. The method of the study is systematic analysis. The sources consist of the four thinkers writings on Christian-Muslim relations, the most of which have been published in Lebanon in the 1990s and 2000s in the Arabic language. In their general guidelines for Christian-Muslim dialogue, the four authors do not offer any novel or unusual insights. However, their dialogue visions are multi-faceted, motivating interreligious encounter both on religious and practical grounds and clarifying the theological grounds and socio-political conditions of this endeavour. The major challenge appears to be the tension between loyalty to one s own convictions and taking into account the particular self-understanding of the other. While this tension may be ultimately unsolvable, it is obvious that linking dialogue tightly to missionary motivations or certain theological agenda imposed on the others is not conducive for better mutual understanding. As for how diverse theologies of religions affect interreligious dialogue, narrow exclusivism hardly promotes mutual knowledge and appreciation, but also inclusive and pluralistic positions have their particular dilemmas. In the end, dialogue is possible from diverse positions on theology of religions. All the authors discuss the theological themes of divine revelation, concept of God, and human condition and ultimate destiny. The two religions particular views on these issues cannot be reconciled, but the authors offer diverse means to facilitate mutual understanding on them, such as increasing mutual knowledge, questioning certain traditional condemnations, showing theological parallels between the two religions, and transcending doctrinal disagreements by stressing common religious experience or ethical concerns. Among the theological themes, especially the concept of God seems to offer possibilities for better understanding than has traditionally been the case. Significantly, all the four authors maintain that Christians and Muslims share the faith in the one God, irrespective of their disagreements about the nature of his oneness. Basic ethical principles are not discussed as widely by the four authors as might be expected, which may reflect the shared cultural background and common ethical values of the Lebanese Muslims and Christians. On this level, Christians alienation from the Islamic law appears as the most significant challenge to mutual understanding, while neighbourly love and the golden rule of ethics offer a fruitful basis for further dialogue. As for the issue of political power-sharing in Lebanon, it is clear that the proposal of an Islamic state is problematic in a country with a sizable Christian minority and a heterogeneous Muslim population. Some form of democracy seems more viable for a multireligious country, but the question remains how to retain religion as a vital force in society, which is felt to be important by all the four Lebanese authors.