Evaluation of driving ability of the disabled persons in the context of the psychological activity theory

In the future the number of the disabled drivers requiring a special evaluation of their driving ability will increase due to the ageing population, as well as the progress of adaptive technology. This places pressure on the development of the driving evaluation system. Despite quite intensive research there is still no consensus concerning what is the factual situation in a driver evaluation (methodology), which measures should be included in an evaluation (methods), and how an evaluation has to be carried out (practise). In order to find answers to these questions we carried out empirical studies, and simultaneously elaborated upon a conceptual model for driving and a driving evaluation. The findings of empirical studies can be condensed into the following points: 1) A driving ability defined by the on-road driving test is associated with different laboratory measures depending on the study groups. Faults in the laboratory tests predicted faults in the on-road driving test in the novice group, whereas slowness in the laboratory predicted driving faults in the experienced drivers group. 2) The Parkinson study clearly showed that even an experienced clinician cannot reliably accomplish an evaluation of a disabled person’s driving ability without collaboration with other specialists. 3) The main finding of the stroke study was that the use of a multidisciplinary team as a source of information harmonises the specialists’ evaluations. 4) The patient studies demonstrated that the disabled persons themselves, as well as their spouses, are as a rule not reliable evaluators. 5) From the safety point of view, perceptible operations with the control devices are not crucial, but correct mental actions which the driver carries out with the help of the control devices are of greatest importance. 6) Personality factors including higher-order needs and motives, attitudes and a degree of self-awareness, particularly a sense of illness, are decisive when evaluating a disabled person’s driving ability. Personality is also the main source of resources concerning compensations for lower-order physical deficiencies and restrictions. From work with the conceptual model we drew the following methodological conclusions: First, the driver has to be considered as a holistic subject of the activity, as a multilevel hierarchically organised system of an organism, a temperament, an individuality, and a personality where the personality is the leading subsystem from the standpoint of safety. Second, driving as a human form of a sociopractical activity, is also a hierarchically organised dynamic system. Third, in an evaluation of driving ability it is a question of matching these two hierarchically organised structures: a subject of an activity and a proper activity. Fourth, an evaluation has to be person centred but not disease-, function- or method centred. On the basis of our study a multidisciplinary team (practitioner, driving school teacher, psychologist, occupational therapist) is recommended for use in demanding driver evaluations. Primary in a driver’s evaluations is a coherent conceptual model while concrete methods of evaluations may vary. However, the on-road test must always be performed if possible.

Exhaled nitric oxide : Variability and association with bronchial hyperresponsiveness and atopy

Airway inflammation is a key feature of bronchial asthma. In asthma management, according to international guidelines, the gold standard is anti-inflammatory treatment. Currently, only conventional procedures (i.e., symptoms, use of rescue medication, PEF-variability, and lung function tests) were used to both diagnose and evaluate the results of treatment with anti-inflammatory drugs. New methods for evaluation of degree of airway inflammation are required. Nitric oxide (NO) is a gas which is produced in the airways of healthy subjects and especially produced in asthmatic airways. Measurement of NO from the airways is possible, and NO can be measured from exhaled air. Fractional exhaled NO (FENO) is increased in asthma, and the highest concentrations are measured in asthmatic patients not treated with inhaled corticosteroids (ICS). Steroid-treated patients with asthma had levels of FENO similar to those of healthy controls. Atopic asthmatics had higher levels of FENO than did nonatopic asthmatics, indicating that level of atopy affected FENO level. Associations between FENO and bronchial hyperresponsiveness (BHR) occur in asthma. The present study demonstrated that measurement of FENO had good reproducibility, and the FENO variability was reasonable both short- and long-term in both healthy subjects and patients with respiratory symptoms or asthma. We demonstrated the upper normal limit for healthy subjects, which was 12 ppb calculated from two different healthy study populations. We showed that patients with respiratory symptoms who did not fulfil the diagnostic criteria of asthma had FENO values significantly higher than in healthy subjects, but significantly lower than in asthma patients. These findings suggest that BHR to histamine is a sensitive indicator of the effect of ICS and a valuable tool for adjustment of corticosteroid treatment in mild asthma. The findings further suggest that intermittent treatment periods of a few weeks’ duration are insufficient to provide long-term control of BHR in patients with mild persistent asthma. Moreover, during the treatment with ICS changes in BHR and changes in FENO were associated. FENO level was associated with BHR measured by a direct (histamine challenge) or indirect method (exercise challenge) in steroid-naïve symptomatic, non-smoking asthmatics. Although these associations could be found only in atopics, FENO level in nonatopic asthma was also increased. It can thus be concluded that assessment of airway inflammation by measuring FENO can be useful for clinical purposes. The methodology of FENO measurements is now validated. Especially in those patients with respiratory symptoms who did not fulfil the diagnostic criteria of asthma, FENO measurement can aid in treatment decisions. Serial measurement of FENO during treatment with ICS can be a complementary or an alternative method for evaluation in patients with asthma.

Asiakassuunnitelma asiakaslähtöistä auttamista tavoitteellistamassa : Kohteen rakentumisen moniääninen menetelmä

The research focuses on client plan in the field of health care and social work on families with children. The purpose of the plan is to create objectives for helping the client and to assist in coordinating the ever-increasing multi-professional work. In general, the plan is understood in terms of assignments and as a contract specifying what to do in client cases. Taking this into consideration, the plan is outsourced into a written document. Instead of understanding the plan as a tool that stabilizes the objectives of action, documents it and facilitates evaluation, the client plan is conceptualized in this study as a practice. This kind of practice mediates client work as being itself also a process of action that focuses on an object whose gradual emergence and definition is the central question in multi-professional collaboration with a client. The plan is examined empirically in a non-stabilized state which leads to the research methodology being based on the dynamics between stabilization and emerging, non-stabilized entities the co-creation and formulation of practice and context. The theoretical approach of the research is the micro analytic approach of activity theory (Engeström R. 1999b). Grounding on this, the research develops a method of qualitative analysis which follows an emerging object with multiple voices. The research data is composed of the videotaped sessions from client meetings with three families, the interviews with the client and the workers as well as client documents that are used to follow up on client processes for at least one year. The research questions are as follows: 1) How is the client plan constructed between the client and different professional agents? 2) How are meanings constructed in a client-centred plan? 3) What are the elements of client-employee relationships that support the co-configuration necessitated by the changes in the client s everyday life? The study shows that the setting of objectives were limited by the palette of institutional services, which caused that the clients interpretations and acts of giving meaning to the kinds of help that was required were left out of the plan. Conceptually, the distinctions between client-centred and client-specific ways of working as well as an action-based working method are addressed. Central to this action-based approach is construing the everyday life of the client, recognizing different meanings and analyzing them together with the client as well as focusing attention on developing the prerequisites for social agency of the clients. The research portrays the elements for creating an action-based client plan. Key words: client plan, user perspective, multi-voiced meaning, multi-professional social work with children and families, agency

Food biotechnologies in Italy: a social psychological study

This dissertation presents an analysis of the representations of food biotechnologies in Italy. The thesis uses the analysis of discourse to illustrate the articulated ways in which representations are instantiated in different contexts. The theoretical thrust of the work resides in its discussion of the basic tenets of both Social Representations Theory and Discursive Psychology. The thesis offers a detailed description of the two frameworks; affinities and difference are highlighted, and a serious effort is made to develop an integrated set of theoretical resources to answer the research questions. The thesis proposes to combine a discursive methodology with Social Representations Theory. After a description of the relevant legislative framework follows an illustration of the categories used for the textual analysis. The study proposes the textual analysis of the following data: the first declaration issued by a small Italian council rejecting biotechnologies; four texts which focus on positions taken by the Catholic Church in the matter of food biotechnologies; several transcripts from a public debate in a small community of the north west of Italy. The latter study, which included an ethnographic dimension, focuses on recordings from interviews, a focus group, a public meeting and newspaper articles. Particular attention is paid to ideological representations and to the relevance of citizenship and governance to debates about food biotechnologies.

Only Connect?: Aspects of Intertextuality in Zadie Smith's On Beauty

Tutkielma käsittelee intertekstuaalisuuden eri muotoja Zadie Smithin romaanissa On Beauty (suom. Kauneudesta). Tutkimuksen tarkoitus on osoittaa kuinka oleellisesti intertekstuaalisuuden teoria on vaikuttanut kirjallisuustieteen metodeihin ja postmoderniin kirjallisuuskäsitykseen, sekä käsitellä sen soveltuvuutta nykykirjallisuuden tutkimiseen analysoimalla teorian sisäistä monimuotoisuutta ja ristiriitoja. Tutkimusmateriaalina käytetään Smithin romaanin lisäksi E. M. Forsterin romaania Howards End (suom. Talo jalavan varjossa), johon On Beauty tietoisesti viittaa. Teoreettisena viitekehyksenä tutkielmassa toimii Gérard Genetten teoksessa Palimpsests sekä Roland Barthesin esseessä Tekijän kuolema esille tuodut kirjallisuusteoreettiset käsitykset. Valittu metodologia antaa mahdollisuuden hahmottaa intertekstuaalisuus kahdella eri tavalla: Genetten strukturalistinen lähestymistapa soveltuu teosten välisten viittaussuhteiden tutkimiseen, kun taas Barthesin jälkistrukturalistinen diskurssi auttaa ymmärtämään tekstienvälisyyden osana merkityksen jatkuvaa epävakautta. Tutkielman ensimmäinen osio keskittyy analysoimaan lähiluvun keinoin romaanien On Beauty ja Howards End välistä strukturalistista suhdetta vertailemalla teosten eroja ja yhtäläisyyksiä Genetten intertekstuaalisuusteorian valossa. Vertailussa kiinnetetään erityisesti huomiota teosten juoneen, rakenteeseen, aikaan ja paikkaan, sekä uudelleenkirjoitusten yleiseen tendenssiin päivittää alkuperäistä tarinaa kohdeyleisölle paremmin sopivaksi. Toisessa osiossa tutkimusta esille nousee jälkistrukturalistinen näkemys intertekstuaalisuudesta osana lukijan tuottaman merkityksen tulkinnanvaraisuutta. Osiossa käsitellään Rembrandtin taideteosten roolia Smithin romaanissa ja analysoidaan hahmojen tulkintoja sekä suhtautumista Rembrandtin tuotantoon Barthesin teoreettisten käsitteiden kautta. Keskeiseksi analyysin kohteeksi nousee lukija sekä lukijan tuottamat tulkinnat ja niiden merkitys Smithin romaanin tematiikassa. Tutkielmassa osoitetaan kuinka intertekstuaalisuus ei ole niin yksinkertainen termi kuin sen laaja käyttö niin kirjallisuustieteessä kuin mediassakin antaa ymmärtää, sekä selvitetään intertekstuaalisuuden teorian kehitystä 60-luvulta nykypäivään. Vaikka strukturalistisessa muodossa käsite soveltuu etenkin kahden toisiinsa kytkeytyneen teoksen tutkimiseen, vertaileva analyysi kuitenkin osoittaa, että On Beauty ei ole pelkkä uudelleenkirjoitus, vaan romaanin tulkintaan tarvitaan myös jälkistrukturalistisen dekonstruktion käsitteitä, jotta laajemmat tekstuaalisuuden verkostot aukeavat lukijalle. Romaanissa esiintyvä taitelijakuva myös osoittaa, että Smith itse on hyvin tietoinen kirjallisuusteoreettisesta keskustelusta.