Infective Endocarditis in a Finnish Teaching Hospital. 25 Years of Experience of Adult Patients

Infektiivinen endokardiitti yliopistollisessa keskussairaalassa vuosina 1980-2004 hoidetuilla aikuispotilailla Tausta: Infektiivinen endokardiitti on edelleen vakava sairaus. Huolimatta siitä, että taudin diagnostiikka ja hoito ovat kehittyneet, siihen liittyy edelleen merkittävää sairastuvuutta ja kuolleisuutta. Endokardiitin taudinkuvassa on viime vuosina tapahtunut muutoksia monissa maissa. Tavoitteet: Tutkia endokardiitin kliinista kuvaa ja ennustetta suomalaisessa yliopistosairaalassa vuosina 1980-2004 endokardiitin vuoksi hoidetuilla aikuispotilailla. Aineisto: Osatyössä I endokardiitin todennäköisyyttä analysoitiin 222:lla vuosina 1980-1995 endokardiittiepäilyn vuoksi hoidetulla potilaalla käyttäen apuna sekä Duken että von Reyn diagnostisia kriteereitä. Osatyössä II tutkittiin endokardiittiin liittyviä neurologisia komplikaatioita 218 varmassa tai mahdollisessa endokardiittiepisodissa. Osatyössä III tutkittiin seerumin C-reaktiivisen proteiinin (CRP) käyttökelpoisuutta hoitovasteen arvioinnissa 134:ssä varmaksi luokitellussa endokardiittiepisodissa. Osatyössä IV tutkittiin yleisbakteeri-PCRmenetelmän käyttökelpoisuutta etiologisessa diagnostiikassa 56:lla endokardiittiepäilyn vuoksi leikatulla potilaalla. Osatöissä V ja VI analysoitiin kaikki vuosina 1980-2004 hoidetut 303 endokardiittipotilasta lyhytaikais- ja 1-vuotisennusteen suhteen sekä tutkittiin endokardiitin taudinkuvassa tapahtuneita muutoksia sairaalassamme. Tulokset: Duken kriteerit osoittautuivat von Reyn kriteereitä herkemmiksi endokardiitin diagnostiikassa: 243 tutkitusta episodista 114 luokiteltiin varmoiksi endokardiiteiksi Duken kriteereillä, kun vastaavasti ainoastaan 64 luoteltiin varmoiksi von Reyn kriteereillä (p<0.001). Lisäksi peräti 115 episodissa endokardiitin diagnoosi hylättiin von Reyn kriteereillä, kun diagnoosi hylättiin Duken kriteereillä ainoastaan 37 episodissa (p<0.001). Neurologinen komplikaatio ilmeni ennen mikrobilääkehoidon aloittamista 76 %:ssa episodeja ollen ensimmäinen oire 47 %:ssa. Kuolema oli merkitsevästi yhteydessä neurologisiin komplikaatioihin. Hoitovastetta seurattaessa seerumin CRP:n lasku oli merkitsevästi nopeampaa komplikaatioitta toipuvilla potilailla kuin niillä, joille kehittyi komplikaatioita tai jotka menehtyivät tautiinsa. PCR-tutkimus poistetusta läpästä antoi ainoana menetelmänä etiologisen diagnoosin neljässä tapauksessa (2 stafylokokkilajia, 1 Streptococcus bovis,1 Bartonella quintana), joissa kaikissa mikrobilääkehoito oli ollut käytössä ennen näytteiden ottamista. Koko aineistossa kahden läpän infektio tai neurologisten komplikaatioiden, perifeeristen embolioiden tai sydämen vajaatoiminnan kehittyminen ennustivat sekä sairaalakuolleisuutta että 1-vuotiskuolleisuutta, kun taas ≥65 vuoden ikä ja sydämen ultraäänitutkimuksessa todettu vegetaatio tai Duken luokittelun mukainen pääkriteeri ennustivat kuolemaa vuoden sisällä. Korkea CRP-taso sairaalaan tullessa ennusti sekä sairaalakuolleisuutta että 1-vuotiskuolleisuutta. Huumeiden käyttäjien endokardiitit lisääntyivät tutkimusaikana merkitsevästi (p<0.001). Päätelmät: Tässä työssä vahvistetaan Duken kriteerien käyttökelpoisuus endokardiitin diagnostiikassa. Lisäksi vahvistui käsitys, että nopea diagnoosi ja mikrobilääkehoidon aloittaminen ovat parhaat keinot ehkäistä neurologisia komplikaatioita ja parantaa endokardiittipotilaiden ennustetta. CRP:n normalisoituminen on endokardiittipotilailla hyvän ennusteen merkki. Suoraan läppäkudoksesta tehty PCR-tutkimus on hyödyllinen, kun taudin aiheuttaja on kasvuominaisuuksiltaan vaativa tai potilas on saanut mikrobilääkehoitoa ennen viljelynäytteiden ottamista. Muutamat aiemmissa tutkimuksissa todetut huonon ennusteen merkit ennustavat huonoa ennustetta myös tämän tutkimuksen potilailla. Uutena löydöksenä ilmeni, että korkea CRP-arvo sairaalaan tullessa merkitsee sekä huonoa lyhyt- että pitkäaikaisennustetta. Huumeiden käyttäjien endokardiittien ilmaantuminen on tärkein epidemiologinen muutos 25 vuoden tutkimusaikana.

Health-related quality of life in school children: validation of instrument, child self assessment, parent-proxy assessment and school nursing documentation of health check-ups

The aims of this study were to validate an international Health-Related Quality of Life (HRQL) instrument, to describe child self and parent-proxy assessed HRQL at child age 10 to 12 and to compare child self assessments with parent-proxy assessments and school nursing documentation. The study is part of the Schools on the Move –research project. In phase one, a cross-cultural translation and validation process was performed to develop a Finnish version of Pediatric Quality of Life Inventory™ 4.0 (PedsQL™ 4.0). The process included a two-way translation, cognitive interviews (children n=7, parents n=5) and a survey (children n=1097, parents n=999). In phase two, baseline and follow-up surveys (children n=986, parents n=710) were conducted to describe and compare the child self and parent-proxy assessed HRQL in school children between the ages 10 and 12. Phase three included two separate data, school nurse documented patient records (children n=270) and a survey (children n=986). The relation between child self assessed HRQL and school nursing documentation was evaluated. Validity and reliability of the Finnish version of PedsQL™ 4.0 was good (Child Self Report α=0.91, Parent-Proxy Report α=0.88). Children reported lower HRQL scores at the emotional (mean 76/80) than the physical (mean 85/89) health domains and significantly lower scores at the age of 10 than 12 (dMean=4, p=<0.001). Agreement between child self and parent-proxy assessment was fragile (r=0,4, p=<0.001) but increased as the child grew from age 10 to 12 years. At health check-ups, school nurses documented frequently children’s physical health, such as growth (97%) and posture (98/99%) but seldom emotional issues, such as mood (2/7%). The PedsQLTM 4.0 is a valid instrument to assess HRQL in Finnish school children although future research is recommended. Children’s emotional wellbeing needs future attention. HRQL scores increase during ages between childhood and adolescence. Concordance between child self and parent-proxy assessed HRQL is low. School nursing documentation, related to child health check-ups, is not in line with child self assessed HRQL and emotional issues need more attention.

The effects of ICT on school: teachers’ and students’ perspectives

The purpose of this study was to investigate the effects of information and communication technology (ICT) on school from teachers’ and students’ perspectives. The focus was on three main subject matters: on ICT use and competence, on teacher and school community, and on learning environment and teaching practices. The study is closely connected to the national educational policy which has aimed strongly at supporting the implementation of ICT in pedagogical practices at all institutional levels. The phenomena were investigated using a mixed methods approach. The qualitative data from three cases studies and the quantitative data from three statistical studies were combined. In this study, mixed methods were used to investigate the complex phenomena from various stakeholders’ points of view, and to support validation by combining different perspectives in order to give a fuller and more complete picture of the phenomena. The data were used in a complementary manner. The results indicate that the technical resources for using ICT both at school and at homes are very good. In general, students are capable and motivated users of new technology; these skills and attitudes are mainly based on home resources and leisuretime use. Students have the skills to use new kinds of applications and new forms of technology, and their ICT skills are wide, although not necessarily adequate; the working habits might be ineffective and even wrong. Some students have a special kind of ICT-related adaptive expertise which develops in a beneficial interaction between school guidance and challenges, and individual interest and activity. Teachers’ skills are more heterogeneous. The large majority of teachers have sufficient skills for everyday and routine working practices, but many of them still have difficulties in finding a meaningful pedagogical use for technology. The intensive case study indicated that for the majority of teachers the intensive ICT projects offer a possibility for learning new skills and competences intertwined in the work, often also supported by external experts and a collaborative teacher community; a possibility that “ordinary” teachers usually do not have. Further, teachers’ good ICT competence help them to adopt new pedagogical practices and integrate ICT in a meaningful way. The genders differ in their use of and skills in ICT: males show better skills especially in purely technical issues also in schools and classrooms, whereas female students and younger female teachers use ICT in their ordinary practices quite naturally. With time, the technology has become less technical and its communication and creation affordances have become stronger, easier to use, more popular and motivating, all of which has increased female interest in the technology. There is a generation gap in ICT use and competence between teachers and students. This is apparent especially in the ICT-related pedagogical practices in the majority of schools. The new digital affordances not only replace some previous practices; the new functionalities change many of our existing conceptions, values, attitudes and practices. The very different conceptions that generations have about technology leads, in the worst case, to a digital gap in education; the technology used in school is boring and ineffective compared to the ICT use outside school, and it does not provide the competence needed for using advanced technology in learning. The results indicate that in schools which have special ICT projects (“ICT pilot schools”) for improving pedagogy, these have led to true changes in teaching practices. Many teachers adopted student-centred and collaborative, inquiry-oriented teaching practices as well as practices that supported students' authentic activities, independent work, knowledge building, and students' responsibility. This is, indeed, strongly dependent on the ICT-related pedagogical competence of the teacher. However, the daily practices of some teachers still reflected a rather traditional teacher-centred approach. As a matter of fact, very few teachers ever represented solely, e.g. the knowledge building approach; teachers used various approaches or mixed them, based on the situation, teaching and learning goals, and on their pedagogical and technical competence. In general, changes towards pedagogical improvements even in wellorganised developmental projects are slow. As a result, there are two kinds of ICT stories: successful “ICT pilot schools” with pedagogical innovations related to ICT and with school community level agreement about the visions and aims, and “ordinary schools”, which have no particular interest in or external support for using ICT for improvement, and in which ICT is used in a more routine way, and as a tool for individual teachers, not for the school community.

Conceptions of mathematics teacher education : thoughts among teacher educators in Tanzania

This study addresses the question of teacher educators’ conceptions of mathematics teacher education (MTE) in teacher colleges in Tanzania, and their thoughts on how to further develop it. The tension between exponents of content as opposed to pedagogy has continued to cause challenging conceptual differences, which also influences what teacher educators conceive as desirable in the development of this domain. This tension is connected to the dissatisfaction of parents and teachers with the failure of school mathematics. From this point of view, the overall aim was to identify and describe teacher educators’ various conceptions of MTE. Inspired by the debate among teacher educators about what the balance should be between subject matter and pedagogical knowledge, it was important to look at the theoretical faces of MTE. The theoretical background involved the review of what is visible in MTE, what is yet to be known and the challenges within the practice. This task revealed meanings, perspectives in MTE, professional development and assessment. To do this, two questions were asked, to which no clear solutions satisfactorily existed. The questions to guide the investigation were, firstly, what are teacher educators’ conceptions of MTE, and secondly, what are teacher educators’ thoughts on the development of MTE? The two questions led to the choice of phenomenography as the methodological approach. Against the guiding questions, 27 mathematics teacher educators were interviewed in relation to the first question, while 32 responded to an open-ended questionnaire regarding question two. The interview statements as well as the questionnaire responses were coded and analysed (classified). The process of classification generated patterns of qualitatively different ways of seeing MTE. The results indicate that MTE is conceived as a process of learning through investigation, fostering inspiration, an approach to learning with an emphasis on problem solving, and a focus on pedagogical knowledge and skills in the process of teaching and learning. In addition, the teaching and learning of mathematics is seen as subject didactics with a focus on subject matter and as an organized integration of subject matter, pedagogical knowledge and some school practice; and also as academic content knowledge in which assessment is inherent. The respondents also saw the need to build learner-educator relationships. Finally, they emphasized taking advantage of teacher educators’ neighbourhood learning groups, networking and collaboration as sustainable knowledge and skills sharing strategies in professional development. Regarding desirable development, teacher educators’ thoughts emphasised enhancing pedagogical knowledge and subject matter, and to be determined by them as opposed to conventional top-down seminars and workshops. This study has revealed various conceptions and thoughts about MTE based on teacher educators´ diverse history of professional development in mathematics. It has been reasonably substantiated that some teacher educators teach school mathematics in the name of MTE, hardly distinguishing between the role and purpose of the two in developing a mathematics teacher. What teacher educators conceive as MTE and what they do regarding the education of teachers of mathematics revealed variations in terms of seeing the phenomenon of interest. Within limits, desirable thoughts shed light on solutions to phobias, and in the same way low self-esteem and stigmatization call for the building of teacher educator-student teacher relationships.

Suomenkielisen maantiedon kouluopetuksen alkuvaiheet

Allan Tiitta

Exposure to Tobacco Smoke and Markers of Subclinical Atherosclerosis in Children and Adolescents. The STRIP Study.

Background: Measurement of serum cotinine, a major metabolite of nicotine, provides a valid marker for quantifying exposure to tobacco smoke. Exposure to tobacco smoke causes vascular damage by multiple mechanisms, and it has been acknowledged as a risk factor for atherosclerosis. Multifactorial atherosclerosis begins in childhood, but the relationship between exposure to tobacco smoke and arterial changes related to early atherosclerosis have not been studied in children. Aims: The aim of the present study was to evaluate exposure to tobacco smoke with a biomarker, serum cotinine concentration, and its associations with markers of subclinical atherosclerosis and lipid profile in school-aged children and adolescents. Subjects and Methods: Serum cotinine concentration was measured using a gas chromatographic method annually between the ages 8 and 13 years in 538-625 children participating since infancy in a randomized, prospective atherosclerosis prevention trial STRIP (Special Turku coronary Risk factor Intervention Project). Conventional atherosclerosis risk factors were measured repeatedly. Vascular ultrasound studies were performed among 402 healthy 11-year-old children and among 494 adolescents aged 13 years. Results: According to serum cotinine measurements, a notable number of the school aged children and adolescents were exposed to tobacco smoke, but the exposure levels were only moderate. Exposure to tobacco smoke was associated with decreased endothelial function as measured with flow-mediated dilation of the brachial artery, decreased elasticity of the aorta, and increased carotid and aortic intima-media thickness. Longitudinal exposure to tobacco smoke was also related with increased apolipoprotein B and triglyceride levels in 13-year-old adolescents, whose body mass index and nutrient intakes did not differ. Conclusions: These findings suggest that exposure to tobacco smoke in childhood may play a significant role in the development of early atherosclerosis. Key Words: arterial elasticity, atherosclerosis, children, cotinine, endothelial function, environmental tobacco smoke, intima-media thickness, risk factors, ultrasound

Opintojaksopalautejärjestelmän kehittäminen ammattikorkeakoululle

Koulutusorganisaatio on nykypäivänä samanlaisten haasteiden edessä kuin liike-elämä. Se joutuu kilpailemaan julkisista resursseista ja hyvistä opiskelijoista. Menestyäkseen tässä kilpailussa organisaation on kehitettävä toimintansa laatua jatkuvasti. Tärkein koulussa tapahtuva toiminto on oppiminen ja oppimisen laatu perustuu koulutusorganisaation laatuun. Tämän diplomityön tavoitteena oli kehittää toimiva opintojaksopalautejärjestelmä Saimaan ammattikorkeakoululle. Palautejärjestelmä on tärkeä osa oppivan organisaation laatujärjestelmää. Työssä tutkittiin aluksi millainen on oppiva organisaatio, miten se oppii ja millaisia vaatimuksia palautejärjestelmään kohdistuu oppivan organisaation ja laatujärjestelmän näkö-kulmasta. Empiirisessä osassa selvitettiin aluksi teemahaastattelujen avulla opiskelijoiden ja opetushenkilöstön näkemyksiä nykyisistä menettelytavoista ja toiveista uuden järjestelmän suhteen. Haastattelujen, kohdeorganisaation nykytilan ja vertailujärjestelmien analysoinnin perusteella suunniteltiin uusi yhteinen palautejärjestelmä nykyisten vaihtelevien palautekäytäntöjen tilalle. Johdon hyväksymä palautejärjestelmä otettiin käyttöön suunnistellusti vuoden 2008 lopulla. Palaute ja seuranta palvelevat organisaation oppimista silloin, kun sekä oppimisesta että opettamisesta kerätään palautetta, palautetta saadaan kattavasti, se viedään toimenpiteiden tasolle ja kaikesta tästä tiedotetaan asianosaisille.

Parallella, dynamiska representationer i gymnasiefysiken : implementering av ett interaktivt datorverktyg i didaktiska situationer och uppfattning av effektivt lärande

The computer is a useful tool in the teaching of upper secondary school physics, and should not have a subordinate role in students' learning process. However, computers and computer-based tools are often not available when they could serve their purpose best in the ongoing teaching. Another problem is the fact that commercially available tools are not usable in the way the teacher wants. The aim of this thesis was to try out a novel teaching scenario in a complicated subject in physics, electrodynamics. The didactic engineering of the thesis consisted of developing a computer-based simulation and training material, implementing the tool in physics teaching and investigating its effectiveness in the learning process. The design-based research method, didactic engineering (Artigue, 1994), which is based on the theoryof didactical situations (Brousseau, 1997), was used as a frame of reference for the design of this type of teaching product. In designing the simulation tool a general spreadsheet program was used. The design was based on parallel, dynamic representations of the physics behind the function of an AC series circuit in both graphical and numerical form. The tool, which was furnished with possibilities to control the representations in an interactive way, was hypothesized to activate the students and promote the effectiveness of their learning. An effect variable was constructed in order to measure the students' and teachers' conceptions of learning effectiveness. The empirical study was twofold. Twelve physics students, who attended a course in electrodynamics in an upper secondary school, participated in a class experiment with the computer-based tool implemented in three modes of didactical situations: practice, concept introduction and assessment. The main goal of the didactical situations was to have students solve problems and study the function of AC series circuits, taking responsibility for theirown learning process. In the teacher study eighteen Swedish speaking physics teachers evaluated the didactic potential of the computer-based tool and the accompanying paper-based material without using them in their physics teaching. Quantitative and qualitative data were collected using questionnaires, observations and interviews. The result of the studies showed that both the group of students and the teachers had generally positive conceptions of learning effectiveness. The students' conceptions were more positive in the practice situation than in the concept introduction situation, a setting that was more explorative. However, it turned out that the students' conceptions were also positive in the more complex assessment situation. This had not been hypothesized. A deeper analysis of data from observations and interviews showed that one of the students in each pair was more active than the other, taking more initiative and more responsibilityfor the student-student and student-computer interaction. These active studentshad strong, positive conceptions of learning effectiveness in each of the threedidactical situations. The group of less active students had a weak but positive conception in the first iv two situations, but a negative conception in the assessment situation, thus corroborating the hypothesis ad hoc. The teacher study revealed that computers were seldom used in physics teaching and that computer programs were in short supply. The use of a computer was considered time-consuming. As long as physics teaching with computer-based tools has to take place in special computer rooms, the use of such tools will remain limited. The affordance is enhanced when the physical dimensions as well as the performance of the computer are optimised. As a consequence, the computer then becomes a real learning tool for each pair of students, smoothly integrated into the ongoing teaching in the same space where teaching normally takes place. With more interactive support from the teacher, the computer-based parallel, dynamic representations will be efficient in promoting the learning process of the students with focus on qualitative reasoning - an often neglected part of the learning process of the students in upper secondary school physics.

Att förstå det stora i det lilla : byskolan som pedagogik, kultur och struktur

I det lilla sammanhanget synliggörs de stora frågorna om både pedagogik, kultur och struktur och om samverkan mellan dem. Studiet av de minsta enheterna i den finländska utbildningen ger kunskap om det viktiga i pedagogiska relationer och i skolgemenskaper, men synliggör också samhällsskeendets inbyggda konflikter om mål och värderingar. Det övergripande syftet med studien är att fördjupa kunskapen om de små skolornas pedagogiska, kulturella och strukturella innebörd och betingelser. Genom djupintervjuer med 12 finlandssvenska lärare i byskolor med färre än 30 elever, analys av skolindragningsdebatt och utbildningspolitiska styrdokument, samt genom teoretiskt förankrade reflektioner skapas en förståelse av såväl lärares arbete och pedagogiska tänkande som skolans funktion i samhället. Avhandlingen byggs upp enligt ett hermeneutiskt och narrativt tänkande. I studien framkommer att byskollärares pedagogiska tänkande syftar till det enskilda barnets optimala och balanserade helhetsutveckling i en gemenskap, där det är centralt att finna den pedagogiska balansen och möjligheten inom kontinuum mellan bl.a. elevbemyndigande och beledsagande. De pedagogiska intentionerna bär syftet att ge rötter och vingar, samhörighet och frihet. I lärarnas beskrivningar uttrycks en sammanvävning mellan deras pedagogiska intentioner och de kontextuella möjligheterna att realisera dessa. Byskollärarna är bärare av en pedagogisk professionalitet som utvecklas i relation till arbetets betingelser. Det praktiska yrkeskunnandet innefattar en balansgång mellan å ena sidan systematik och organisering och å andra sidan flexibilitet och frihet. Att samma lärare handhar eleverna en lång tid är en pedagogisk möjlighet och utmaning. I lärarnas berättelser aktualiseras vad balansgången i en god pedagogisk relation innebär. Både lärare och elever fostras in i en särskild skolkultur och undervisningskultur, i en växelverkan. Yrkeskulturen präglas av olika former av samverkan, både med skolans hela personal som ett teamarbete och med lokalsamhället. Lärarna uttrycker god arbetstrivsel, men friheten och ansvaret i arbetet kan vara både stimulerande och betungande. I en metaanalys skapas teoretiska modeller för vad arbete i närhetens och litenhetens spänningsfält kan innebära och hur det kan påverka lärares professionella utveckling och ork. Den lilla byskolan relaterad till en större samhällskontext öppnar för frågor om vad kvalitet innebär och vilka värderingar som är riktgivande inom utbildningsplanering. Kampen för kontinuiteten i byskolans berättelse tolkas som en kamp för det lokala rummet, för gemenskap, existens, framtid, likvärdighet och trygghet. Kampen för byskolan är ett försvar av både lokal livskvalitet och pedagogisk kvalitet för den enskilde eleven. I det övergripande kulturella sammanhanget synliggörs motsättningar. Det verkar finnas en inbyggd konflikt i utbildningsplaneringens föresatser att samtidigt uppnå jämlikhet, kostnadseffektivitet och kvalitet. En teoretisk modell synliggör hur pedagogik, kultur och struktur samverkar inom utbildning/byskola och påverkar lärares och elevers handlingsutrymme.

Under ytan, vid ytan och ovanför ytan : analys av tanken bakom tre läromedel i slöjd

This thesis is based on the personal experience gained related to the planning and production of three web-based teaching materials for the teaching subject knownas sloyd at the comprehensive school in Finland. After the teaching materials had been produced and published on the Internet at the Finnish textile teachers' website KässäBoxi, the idea for this thesis emanated from the questions: Why do the three teaching materials look the way they do and why do other textile teachers comment that they are different? In earlier sloyd educational research it has been stated that a scientific paradigm affects the individual ideology of a sloyd teacher. The aimfor my doctoral thesis is to continue on the topic. As the area of interest comprises the thought behind three teaching materials in sloyd, the aim of the thesis is to show how teaching and educational ideologies in sloyd appear in the teaching materials at hand. The research approach has parallels to research about another, tangible phenomena, namely the iceberg. In a similar way as an iceberg, a teaching material has a profound base, but the base is not always completely visible to the user of the teaching material. In this thesis I strive to show what there is under the surface, on the surface and above the surface of three teaching materials in sloyd. The research approach is defined as qualitative and phenomenologic-hermeneutic. The analysis results in knowledge about how the producer of a teaching material affects the character of a teaching material by choices concerning for example the form, structure, language and illustrations of the teaching material. The analysis also shows how the producers' individual educational and teaching ideologies within the teaching subject at hand appear by means of traces concerning the view on the pupil and the teacher, and the view on planning and conducting teaching in sloyd. The thesis also results in knowledge about how sloyd educational scientific theories and demands from society, as they are stated in the national core curriculum, appear in the three teaching materials. The application of the sloyd educational scientific theory of individual sloyd activity as a holistic educative system is also widened in the thesis. This thesis contributes to future research on producing teaching materials by information about what aspects a producer of teaching materials needs to consider and how the aspects become visible in the teaching materials. This kind of knowledge is valuable to teacher students in sloyd, to teachers in sloyd who intend to plan and produce teaching materials and to teachers who tutor the planning and production of teaching materials.

Musikaliska möten man minns : om musikundervisningen i årskurserna sju till nio som en arena för starka musikpplevelser

Earlier research has shown that strong experiences related to music (SEM) can occur in very different contexts and take on many different forms. Experiences like these seem significant and have among other things reportedly had an affect on the individual's continuing relationship towards music, which makes them interesting from a pedagogical point of view. Formal teaching situations, though, are under-represented in studies where people have been asked to describe strong experiences that they have had in connection with music. The purpose of my thesis is to investigate what SEM may mean to pupils and teachers in lower secondary school (grades 7-9), and to inquire more deeply into the potential "space" for such experiences within school music education. On a comprehensive level my ambition is to deepen the understanding for SEM as a possible element in pedagogical situations. Three empirical perspectives are employed: pupil-, teacher- and curriculum perspectives. The pupil perspective involved an analysis of written accounts of 166 fifteen-year-olds, describing own strong experiences. The teacher perspective involved studying 28 music teachers' conceptions of the purpose of teaching music in school as well as their understanding about strong music experiences in school context. Further, the teachers' descriptions of SEM that they have had themselves were analysed. The curriculum perspective is reflected through a study of how music experience was represented in 24 local and 2 national curriculum texts for music. Grounded in a phenomenological-hermeneutical perspective the material have been analyzed both qualitatively and quantitatively. The result points towards the fact that the music education in school has the potential to become an arena for SEM and that this can happen in relation to a multitude of activities and genres and take on many different expressions. Only one pupil referred to a musical encounter in the classroom environment; all other experiences that occurred inside the frame of school activity had taken place in other arenas (the school hall, public concert halls, and so on). However, more than 98 % of the descriptions concerned musical encounters in leisure time contexts. The significance of SEM is further clarified by narrative constructions. SEM as a conception does not occur on the curriculum level; however the analyze revealed a number of interesting "openings" which are illustrated. Even though all teachers displayed a fundamentally positive attitude towards the idea of regarding SEM as a feature of formal musical learning, it became clear that many teachers never had approached this theme from a pedagogical point of view before. Still, they proved to have an evident "familiarity" towards the phenomenon based on their own experiences of receptive and performative musical encounter. The possible space for strong musical experiences within school music education is specified through a detailed illustration of six specific themes derived from the reasoning of the teachers. Furthermore, this is described through a mapping of the potential experiencing zone, constructed from the teachers descriptions of educational aims.

Objective Evaluation of Nasal Dimensions in Children with Acoustic Rhinometry

Aims: This study was carried out to investigate the usefulness of acoustic rhinometry in the evaluation of intranasal dimensions in children. The aim was to define reference values for school children. In addition, the role of the VAS scale in the subjective evaluation of nasal obstruction in children was studied. Materials and methods: Measurements were done with Acoustic Rhinometry A1. The values of special interest were the minimal cross-sectional area (MCA) and the anterior volume of the nose (VOL). The data for reference values included 124 voluntary school children with no permanent nasal symptoms, aged between 7 and 14 years. Data were collected at baseline and after decongestion of the nose; the VAS scale was filled in before measurements. The subjects in the follow-up study (n=74, age between 1 and 12 years) were receiving intranasal spray of insulin or placebo. The nasal symptoms were recorded and acoustic rhinometry was measured at each control visit. Results: In school children, the mean total MCA was 0.752 cm2 (SD 0.165), and the mean total VOL was 4.00 cm3 (SD 0.63) at baseline. After decongestion, a significant increase in the mean TMCA and in the mean TVOL was found. A correlation was found between TMCA and age, and between TVOL and height of a child. There was no difference between boys and girls. A correlation was found between unilateral acoustic values and VAS at baseline, but not after decongestion. No difference wasfound in acoustic values or symptoms between the insulin and placebo group in the follow-up study of two years. Conclusions: Acoustic rhinometry is a suitable objective method to examine intranasal dimensions in children. It is easy to perform and well tolerated. Reference values for children between 7 and 14 years were established.