National religion and the prayer book controversy

Kirjallisuusarvostelu

Expertise and decision making among clinicians in investigations of alleged child sexual abuse

The purpose of the present thesis was to explore different aspects of decision making and expertise in investigations of child sexual abuse (CSA) and subsequently shed some light on the reasons for shortcomings in the investigation processes. Clinicians’ subjective attitudes as well as scientifically based knowledge concerning CSA, CSA investigation and interviewing were explored. Furthermore the clinicians’ own view on their expertise and what enhances this expertise was investigated. Also, the effects of scientific knowledge, experience and attitudes on the decision making in a case of CSA were explored. Finally, the effects of different kinds of feedback as well as experience on the ability to evaluate CSA in the light of children’s behavior and base rates were investigated. Both explorative and experimental methods were used. The purpose of Study I was to investigate whether clinicians investigating child sexual abuse (CSA) rely more on scientific knowledge or on clinical experience when evaluating their own expertise. Another goal was to check what kind of beliefs the clinicians held. The connections between these different factors were investigated. A questionnaire covering items concerning demographic data, experience, knowledge about CSA, selfevaluated expertise and beliefs about CSA was given to social workers, child psychiatrists and psychologists working with children. The results showed that the clinicians relied more on their clinical experience than on scientific knowledge when evaluating their expertise as investigators of CSA. Furthermore, social workers possessed stronger attitudes in favor of children than the other groups, while child psychiatrists had more negative attitudes towards the criminal justice system. Male participants held less strong beliefs than female participants. The findings indicate that the education of CSA investigators should focus more on theoretical knowledge and decision making processes as well as the role of beliefs In Study II school and family counseling psychologists completed a Child Sexual Abuse Attitude and Belief Scale. Four CSA related attitude and belief subscales were identified: 1. The Disclosure subscale reflecting favoring a disclosure at any cost, 2. The Pro-Child subscale reflecting unconditional belief in children's reports, 3. The Intuition subscale reflecting favoring an intuitive approach to CSA investigations, and 4. The Anti Criminal Justice System subscale reflecting negative attitudes towards the legal system. Beliefs that were erroneous according to empirical research were analyzed separately. The results suggest that some psychologists hold extreme attitudes and many erroneous beliefs related to CSA. Some misconceptions are common. Female participants tended to hold stronger attitudes than male participants. The more training in interviewing children the participants have, the more erroneous beliefs and stronger attitudes they hold. Experience did not affect attitudes and beliefs. In Study III mental health professionals’ sensitivity to suggestive interviewing in CSA cases was explored. Furthermore, the effects of attitudes and beliefs related to CSA and experience with CSA investigations on the sensitivity to suggestive influences in the interview were investigated. Also, the effect of base rate estimates of CSA on decisions was examined. A questionnaire covering items concerning demographic data, different aspects of clinical experience, self-evaluated expertise, beliefs and knowledge about CSA and a set of ambiguous material based on real trial documents concerning an alleged CSA case was given to child mental health professionals. The experiment was based on a 2 x 2 x 2 x 2 (leading questions: yes vs no) x (stereotype induction: yes vs no) x (emotional tone: pressure to respond vs no pressure to respond) x (threats and rewards: yes vs no) between-subjects factorial design, in which the suggestiveness of the methods with which the responses of the child were obtained were varied. There was an additional condition in which the material did not contain any interview transcripts. The results showed that clinicians are sensitive only to the presence of leading questions but not to the presence of other suggestive techniques. Furthermore, the clinicians were not sensitive to the possibility that suggestive techniques could have been used when no interview transcripts had been included in the trial material. Experience had an effect on the sensitivity of the clinicians only regarding leading questions. Strong beliefs related to CSA lessened the sensitivity to leading questions. Those showing strong beliefs on the belief scales used in this study were even more prone to prosecute than other participants when other suggestive influences than leading questions were present. Controversy exists regarding effects of experience and feedback on clinical decision making. In Study IV the impact of the number of handled cases and of feedback on the decisions in cases of alleged CSA was investigated. One-hundred vignettes describing cases of suspected CSA were given to students with no experience with investigating CSA. The vignettes were based on statistical data about symptoms and prevalence of CSA. According to the theoretical likelihood of CSA the children described were categorized as abused or not abused. The participants were asked to decide whether abuse had occurred. They were divided into 4 groups: one received feedback on whether their decision was right or wrong, one received information about cognitive processes involved in decision making, one received both, and one did not receive feedback at all. The results showed that participants who received feedback on their performance made more correct positive decisions and participants who got information about decision making processes made more correct negative decisions. Feedback and information combined decreased the number of correct positive decisions but increased the number of correct negative decisions. The number of read cases had in itself a positive effect on correct positive decision.

”Käsitteitä tarpeen mukaan". Kirjallisuustieteelliset käsitteet lukion kirjallisuudenopetuksessa

Tavoitteeni tässä tutkimuksessa oli selvittää, miten kirjallisuustieteellisiä proosa-anayysin käsitteitä opetetaan opetussuunnitelman mukaisissa lukion äidinkielen ja kirjallisuuden oppikirjoissa ja miten hyvin kokelaat hallitsivat kertoja-käsitteen tekstitaidon ylioppilaskokeessa keväällä 2007. Samalla pohdin, minkälainen kirjallisuustieteellinen käsitteistö palvelisi tekstianalyysin opetusta koulussa, koska Lukion opetussuunnitelman perusteet 2003 ja äidinkielen ylioppilaskoe edellyttävät äidinkielen ja kirjallisuuden opetukselta ja oppilailta käsitteiden käyttöä. Tutkimusaineistonani olivat kaikki kuusi käytössä olevaa lukion äidinkielen ja kirjallisuuden oppikirjaa ja 440 kpl kevään 2007 äidinkielen tekstitaidon ylioppilaskokeen vastaustekstiä. Oppikirjoja tarkastelin soveltamalla niiden arviointiin Lev S. Vygotskin ajatuksia arkikäsitteiden ja tieteellisten käsitteiden opettamisesta ja Hans Aeblin esittämiä teoreettisia malleja käsitteiden opettamisesta ja oppimisesta. Tutkimukseni osoittaa, että opetussuunnitelmassa mainittujen proosa-analyysin käsitteiden kertoja, näkökulma, motiivi, aihe ja teema opetus on epätäsmällistä. Oppikirjoissa ei ole otettu huomioon sitä, että käsitteenoppiminen on monivaiheinen prosessi. Myöskään problematiikkaa, joka aiheutuu kyseisten käsitteiden määrittelyn kirjavuudesta ja käytöstä sekä arkikielen käsitteinä että tieteellisinä käsitteinä, ei oppikirjoissa käsitellä. Sama näkyy ylioppilaskoeaineistossa: oppilaat eivät hallitse käsitettä kertoja tieteellisenä käsitteenä. Tietoisuus kirjallisuustieteellisten käsitteiden määrittelyn problematiikasta ja arkikäsitteiden ja tieteellisten käsitteiden ontologisista kategorioista on onnistuneen käsitteenoppimisen edellytys. Kirjallisuustieteelliset käsitteet ovat metakäsitteitä, jotka edellyttävät oppilaiden metakäsitteellisen tietoisuuden ja motivaation hyödyntämistä opetuksessa, jossa olisi sovellettava monipuolisesti eri oppimiskäsitysten parhaita puolia hyödyntäviä lähestymistapoja, erilaisia pedagogisia diskursseja. Koulujen kirjallisuudenopetusta suunniteltaessa ja kirjallisuustieteellisiä käsitteitä opetettaessa on otettava huomioon niin kirjallisuustieteen kuin kasvatustieteen näkökulma. Opetussuunnitelman ja ylioppilaskokeen asettama vaatimus käsitteiden käytöstä on kohtuuton, mikäli ei sovita, miten käsitteet määritellään ja mitä käsitteitä kokelaiden oletetaan ylioppilaskokeessa hallitsevan. Kirjallisuustieteellisten käsitteiden puutteellisen opetuksen oppikirjoissa ja niiden epämääräisen käytön ylioppilaskokeen tehtävänannoissa ja arvioinnissa voi kärjistyneimmillään nähdä oppilaan oikeusturvakysymyksenä

Endoscopic biliary procedures: studies on cannulation and stenting

Deep cannulation is a prerequisite for successful endoscopic retrograde cholangiopancreatography (ERCP) procedures. Of the biliary procedures, stenting is one of the most common. This study was carried out to investigate current and controversial issues regarding biliary cannulation and stenting. The double guidewire (DGW) technique was studied to analyze its safety and feasibility in biliary cannulation as a single procedure and as a part of the novel three-step cannulation protocol. Female gender was evaluated in regard to difficult cannulation. The use of an angled and a straight tipped guidewire in biliary cannulation was studied in a prospective, randomized trial. Additionally, the patency of the novel antireflux plastic biliary stent was compared to the patency of the conventional plastic biliary stent in a prospective, randomized setting. The DGW method seems safe and feasible as an alternative cannulation technique in biliary cannulation. Female gender was not associated significantly with difficult biliary cannulation in our study, although the cannulation times seemed to be longer and the alternative cannulation techniques seemed to be needed more often in females than males. According to the results of this thesis, an angled tipped guidewire may facilitate biliary cannulation. In controversy to the previous result presented in the literature, the antireflux plastic biliary stent tested herein should not be used, as the patency of the stent was significantly shorter compared to the conventional plastic stent.

The Effects of Estradiol, Androgens and the Selective Estrogen Modulators: Ospemifene, Raloxifene and Tamoxifen on Explant Cultures of Human Breast Tissue

The impact of menopausal hormone therapy (MHT) on increasing the risk for breast cancer (BC) remains controversial. To understand MHT-elicited cellular breast effects and the potential risks, included with using this therapy, a further investigation into this controversy is the subject of this thesis. In this thesis, to study the effects of estrogen, progestin, androgens and selective estrogen receptor modulators (SERMs), a modified tissue explant culture system was used. The different types of human breast tissues (HBTs) used in this study were normal HBTs, obtained from reduction mammoplasties of premenopausal women (prem-HBTs) or postmenopausal (postm-HBTs) women and peritumoral HBTs (peritum-HBTs) which were obtained from surgeries on postmenopausal BC patients. The explants were cultured up to three weeks in the presence or absence of estradiol (E2), medroxyprogesterone acetate (MPA), testosterone (T), dihydrotestosterone (DHT) and SERMs - ospemifene (OSP), raloxifene (RAL) and tamoxifen (TAM). The cultured HBTs maintained morphological integrity and responded to hormonal treatment in vitro. E2, MPA or E2/MPA increased proliferative activity and was associated with increased cyclin-D1 and caused changes in the cell cycle inhibitors p21 and p27, whereas the androgens T and DHT inhibited proliferation and increased apoptosis in HBT epithelia and opposed E2-stimulated proliferation and cell survival. The postm-HBTs were more sensitive to E2 than prem-HBTs. The effects of OSP, RAL and TAM on HBT epithelium were antiproliferative. E2, androgens and SERMs were associated with marked changes in the proportions of epithelial cells expressing steroid hormone receptors: E2 increased ERα expressing cells and decreased androgen receptor (AR) positive cells, whereas T and DHT had opposite effects. The OSP, RAL and TAM, also decreased a proportion of ERα positive cells in HBT epithelium. At 100 nM, these compounds maintained the relative number of AR positive cells, present at control level, which may partly explain proliferative inhibition. In conclusion, the proliferative activity of E2, in the epithelium of postm-HBTs, is opposed by T and DHT, which suggests that the inclusion of androgens in MHT may decrease the risk for developing BC.

The role of due diligence in cross-border acquisitions

Mergers and acquisitions (M&A) have become an important strategy for international expansion, even though numerous acquisitions fail to achieve their financial and strategic objectives. The risk associated with transactions partly depends on the extent to which the insight into the target company actually holds true. Due diligence is performed to eliminate this information asymmetry. Due diligence is an audit conducted prior to the planned transaction. It can be described as a purposeful and systematic investigation of business opportunity and risk during on-going sale negotiations. The importance of due diligence is emphasized widely in the academic literature as well as among M&A practitioners. On the other hand, researches and practitioners have differing views on what and how much is enough for a due diligence audit. Therefore, this study examines the role of due diligence in a cross-border acquisition process. The main objective of the research is fulfilled by examining the reasons for conducting due diligence, recognizing the elements affecting effective due diligence and analyzing the need and opportunities for enhancing the utilization of due diligence. For the empirical part of this qualitative study five expert interviews were conducted among experienced Finnish acquirers and advisors. In addition, five expert interviews conducted for a distinct study were utilized as a secondary source of data. The results of this study present fundamental reasons for conducting due diligence. However, conducting due diligence is not always self-evident. Doubtful attitude towards due diligence exists, though it is exceptional. Carefully planning the focus of due diligence and compiling and managing the team conducting due diligence are identified as the main elements affecting effective due diligence. Altogether, due diligence can have plural roles which in this study are categorized as the confirmatory, preparative, and cross-functional roles of due diligence. The older academic literature tends to emphasize the confirmatory role whereas the current academic discussion also supports the preparative role of due diligence. It can be argued that the roles of due diligence differ among experienced due diligence practitioners based on several factors. In attempt to increase the value of due diligence for acquirers, more than one role of due diligence is likely to exist. As a result of the different approaches and the controversy regarding the concept of due diligence, the demand for a new, wider definition of due diligence can be claimed to exist.

Vertailevan markkinoinnin sääntely kilpailijan näkökulmasta

Tämän tutkielman tarkoituksena on tutkia, miten vertailevaa markkinointia tulee arvioida kilpailevien elinkeinonharjoittajien välisissä riita-asioissa. Kuluttajia koskeva näkökulma rajataan siten tutkimuksen ulkopuolelle. Tutkielmassa käsitellään vertailevaa markkinointia koskevaa sääntelyä ja sen tulkintaa erityisesti markkinaoikeuden ja liiketapalautakunnan ratkaisuissa noudattaen lainopillista tutkimusmenetelmää. Tutkimustulokset osoittavat, ettei yksistään lainsäädännön nojalla voida tehdä päätelmiä siitä, millaisia vertailevaa markkinointia koskevia toimenpiteitä on pidettävä kiellettyinä. Arvioinnissa on siten otettava huomioon kaikki tapauskohtaiset seikat ja tulkittava niitä lainsäädännön, itsesääntelyn sekä oikeuskäytännön perusteella. Etenkin kohderyhmä määrittelee sen, miten vertailevan markkinoinnin sääntelyä tulee yksittäisessä tapauksessa tulkita.

Uusia näkökulmia Melanchthonin ajatteluun ja toimintaan

Kirjallisuusarvostelu

Bariatric and Post-Bariatric Surgery: from Metabolic Surgery to Plastic Surgery Indications

Background: Controversy exists concerning indications and outcomes of major bariatric surgery procedures. Massive weight loss after bariatric surgery leads to excess skin with functional and aesthetic impairments. The aim of this study was to investigate the major bariatric surgery procedures and their outcomes in two specific subgroups of morbidly obese patients, ≥55-year-olds and the superobese. Further aims were to evaluate whether the preoperative weight loss correlates with laparoscopic gastric bypass complications. The prevalence and impact of excess skin and the desire for body contouring after bariatric surgery were also studied. Patients and Methods: Data from patients who underwent Laparoscopic Adjustable Gastric Banding (LAGB) and Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) at Vaasa Central Hospital were collected and postoperative outcomes were evaluated according to the BMI, age and preoperative weight loss. Patients who had undergone bariatric surgery procedures were asked to complete a questionnaire to estimate any impairment due to redundant skin and to analyse each patient’s desire for body contouring by area. Results: No significant difference was found in operative time, hospital stay, or overall early postoperative morbidity between LAGB and LRYGB. Mean excess weight loss percents (EWL%) at 6 and 12 months after LRYGB were significantly higher. A significant difference was found in operative time favouring patients <55 years. Intraoperative complications were significantly more frequent in the group aged >55 years. No significant difference was detected in overall postoperative morbidity rates. A significant difference was found in operative time and hospital stay favouring all patients who lost weight preoperatively. Most patients reported problems with redundant skin, especially on the abdomen, upper arms and rear/buttocks, which impaired daily physical activity in half of them. Excess skin was significantly associated with female gender, weight loss and ΔBMI. Patients with a WL >20 kg, ΔBMI ≥10 kg/m2 and an EWL % > 50 showed a significantly surplus skin discomfort (p < 0.001). Most patients desired body contouring surgery, with high or very high desire for waist/abdomen (62.2%), upper arm (37.6%), chest/breast (28.3%), and rear/buttock (35.6%) contouring. Conclusions: LRYGB is effective and safe in superobese (BMI >50) and elderly (>55 years) patients. A preoperative weight loss >5% is recommended to improve the outcomes and reduce complications. A WL >20 kg, ΔBMI ≥10 kg/m2 and an EWL % > 50 are associated with a higher functional discomfort due to redundant skin and to a stronger desire for body contouring plastic surgery.