Benzodiazepines and Cognitive Functioning in Older Adults. With Emphasis on Long-Term Use and Withdrawal

Benzodiazepines (BZD) and benzodiazepine related drugs (RD) are the most commonly used psychotropics among the aged. The use of other psychotropics taken concomitantly with BZD/ RD or their cognitive effects with BZD/RD have not been studied frequently. The aim of this academic thesis was to describe and analyse relationships between the use of BZD/RD alone or concomitantly with antipsychotics, antidepressants, opioids, antiepileptics, opioids and anticholinergics in the aged and their health. Especially, the relationships between long-term use of BZD/RD and cognitive decline were studied. Additionally, the effect of melatonin on BZD/RD withdrawal and the cognitive effects of BZD/RD withdrawal were studied. This study used multiple data sets: the first study (I) was based on clinical data containing aged patients (≥65 years; N=164) admitted to Pori City Hospital due to acute disease. The second data set (Studies II and III) was based on population-based data from the Lieto Study, a clinico-epidemiological longitudinal study carried out among the aged (≥65 years) in the municipality of Lieto. Follow-up data was formed by combining the cohort data collected in 1990-1991 (N=1283) and in 1998-1999 (N=1596) from those who participated in both cohorts (N=617). The third data set (Studies IV and V) was based on the Satauni Study’s data. This study was performed in the City of Pori in 2009-2010. In the RCT part of the Satauni Study, ninety-two long-term users of BZD/RD were withdrawn from their drugs using melatonin against placebo. The change of their cognitive abilities was measured during and after BZD/ RD withdrawal. BZD/RD use was related to worse cognitive and functional abilities, and their use may predict worse cognitive outcomes compared with BZD/RD non-users. Hypnotic use of BZD/RD could be withdrawn with psychosocial support in motivated participants, but melatonin did not improve the withdrawal results compared to those with placebo. Cognitive abilities in psychomotor tests did not show, or showed only modest, improvements for up to six months after BZD/RD withdrawal. This suggests that the cognitive effects of BZD/RD may be longlasting or permanent.

Modularity in Health and Social Services: Perspectives on Organization and Management

Organizations that provide health and social services operate in a complex and constantly changing environment. Changes occur, for example, in ageing, technology and biotechnology, and customers’ expectations, as well as the global economic situation. Organizations typically aim to adapt the changes by introducing new organizational structures and managerial practices, such as process and lean management. Only recently has there been an interest in evaluating whether organizations providing health and social services could apply modularity in order to respond to some of the changes. The concept of modularity originates from manufacturing, but is applied in many other disciplines, such as information technology and logistics. However, thus far, the literature concerning modularity in health and social services is scarce. Therefore the purpose of this thesis is to increase understanding concerning modularity and the possibilities to apply modularity in the health and social services context. In addition, the purpose is to shed light on the viewpoints that are worth taking into account when considering the application of modularity in the health and social services context. The aim of the thesis is to analyze the way in which the modular structures are applied in the health and social services context and to analyze what advantages and possible barriers, as well as managerial concerns, might occur if modularity is applied in the health and social services context. The thesis is conducted by using multiple methods in order to provide a broad aspect to the topic. A systematic literature review provided solid ground for pre-understanding the topic and supported the formulation of the research questions. Theoretical reasoning provided a general overview of the special characteristics of the health and social services context and their effect on application of modularity. Empirical studies concentrated on managerial concerns of modularity particularly from the perspective of health and social services for the elderly. Results of the thesis reveal that structures in products, services, processes, and organizations are rather modular in health and social services. They can be decomposed in small independent units, while the challenges seem to occur especially in the compatibility of the services. It seems that health and social services managers have recognized this problem and they are increasingly paying attention to this challenge in order to enhance the flexible compatibility of services. Advantages and possible barriers of modularity are explored in this thesis, and from the theoretical perspective it could be argued that modularity seems to be beneficial in the context of health and social services. In fact, it has the potential to alleviate several of the challenges that the health and social services context is confronting. For example, modular structures could support organizations in their challenging task to respond to customers’ increasing demand for heterogeneous services. However, special characteristics of the health and social services context create barriers and provide significant challenges in application of modularity. For example, asymmetry of information, negative externalities, uncertainty of demand, and rigid regulation prevent managers from extensively drawing benefits from modularity. Results also reveal that modularity has managerial implications in health and social service. Modularity has the potential to promote and support new service development and outsourcing. Results also provide insights into network management and increases managerial understanding of different network management strategies. Standardization in health and social services is extensive due to legislation and recommendations. Modularity provides alternative paths to take an advantage of standardization while still ensuring the quality of the services. Based on this thesis, it can be concluded, both from a theoretical perspective and from empirical results concerning modularity in health and social services, that modularity might fit well and be beneficial. However, the special characteristics of the health and social services context prevent some of the benefits of modularity and complicate its application. This thesis contributes to the academic literature on the organization and management of health and social services by describing modularity as an alternative way for organizing and managing health and social services. In addition, it contributes to the literature of modularity by exploring the applicability of modularity in the context of health and social services. It also provides practical contribution to health and social services managers by evaluating the pros and cons of modularity when applied to health and social services.

Education in the halls : students' perspectives on cultural expression and resistance

This research is a qualitative study of cultural reproduction and resistance from students' perspectives. Thirteen teenagers (eight in attendance in regular high schools and five drop-outs) were recruited to take part and were involved to varying degrees through interviews, journal writing, and group interactive sessions. A purposive sampling design was used initially to recruit individuals known to the researcher through contacts in an alternate education setting. Other participants were recruited throughout the research phase. The theoretical aspects are premised on the work of Paul Willis, Michel Foucault, and Pierre Bourdieu. The reflexive praxeology of Bourdieu reflects the position taken as one way of understanding how students construct and respond to the situations of cultural dominance they experience in schools. The same reflexivity is offered for suggestions as to how teachers can respond to their own position in the education system.

Employer Perspectives on Secondary School Cooperative Education in a Southern Ontario City in Canada

Despite 2 Ontario Ministry of Education policy documents which mandate that regular program effectiveness surveys be completed in secondary school co-op programs, research was either not occurring or data were not being made available. A lack of co-op research also existed at the postsecondary level. The primary reason for this study was to determine the perspectives of current secondary school co-op employers in the Hamilton-Wentworth District School Board (HWDSB) and to identify any program strengths as well as any areas in which improvement can be made. A secondary aim of the study was to discover the reasons that some employers decline to participate in the co-op program, and why other employers decide to discontinue their co-op partnerships. An online survey was utilized with 2 Likert scales and open-ended questions to solicit responses from the 100 participants. The findings from this study strongly supported previous secondary and postsecondary co-op research. Overall, the HWDSB co-op program was found to be very strong, and employer satisfaction very high. There were, however, areas in which improvement could be made. Although most employers felt supported by institutions and felt that expectations were clearly communicated and were reasonable, there was evidence that many employers perceived a lack of institutional support which included factors such as communication, student placement and fit, and institutional responsiveness. In addition, some employers felt that students were underprepared for the workplace and lacked basic employability skills such as dependability and responsibility.

Male and Female Perspectives on Female Principals in South Africa

In South Africa, women are at a high risk of discrimination and opposition to authority when they obtain leadership positions, especially in education (Gouws & Kotze, 2007). The purpose of this study was to inquire into 10 secondary school educators’ perceptions of female principals’ effectiveness in two South African schools. Qualitative case study research methodology included interviews, as well as participant observations and semi-structured interviews. These interviews were conducted within two school settings in South Africa. The participants were teachers, department heads, and deputy principals. When the data were analyzed, it was found that all participants wanted a leader who was transformational and there was a strong preference for those who had feminine traits. This research showed the strong desire for transformational leaders as well as how feminine characteristics are not only starting to become more accepted, but also are now becoming preferred.

Two School Administrators’ Perspectives on How Intercultural Education is Promoted in Their Elementary Schools

This study examined the perspectives of 2 elementary school administrators (1 principal of a faith based school, and 1 vice-principal of a public school) towards intercultural education and how it was implemented in their schools. A generic qualitative research methodology guided this study. Face-to-face interviews that used a guide with open-ended questions were used to collect data. Participants were administrators in their respective schools, had been involved in intercultural activities at their school, and were professional acquaintances of the researcher. The interviews were digitally recorded and the interview transcripts were reviewed by participants to ensure accuracy. The administrators’ understanding of intercultural education tended to be limited to learning and celebration of various cultures. The intercultural education strategies used in the respective schools focussed on developing a knowledge base and provided limited intercultural interaction. The public school had greater resources available than the private faith-based school. However, the resources were not always used to facilitate intercultural education. Teachers and administrators were provided with very few professional development opportunities focussed on intercultural education.

Triangulation of rights, balancing of interests : exploring the tensions between freedom of conscience and freedom of religion in comparative constitutional law

La liberté de religion, souvent reconnue comme étant la « première liberté » dans de nombreuses traditions juridiques, reflète également les différentes conceptions de la place de l’individu et de la communauté dans la société. Notre étude analysera les modèles constitutionnels canadien, américain et européen de liberté de religion et conscience. Dans un premier chapitre, nous examinerons les conceptions théoriques de la religion dans les sciences sociales ainsi les approches juridiques afin de mieux cerner comment la religion est conçue et de plus, comprendre les diverses influences sur sa conceptualisation. Dans un second et troisième chapitre, nous tenterons d’une part, de qualifier la relation entre la liberté de conscience et la liberté de religion au Canada en nous livrant à une analyse approfondie des deux libertés et d’autre part, d’identifier les questions qui demeurent irrésolues. Dans le chapitre final, nous observerons comment la liberté de conscience a été interprétée dans les contextes américain et dans l’Union Européenne, par le biais de la Cour Européenne des droits de l’Homme. Notre hypothèse est que l’on peut arriver à une meilleure compréhension de la relation entre les libertés de conscience et religion en clarifiant les conceptions théoriques de la religion et de la conscience en droit constitutionnel comparé.

Equality of Opportunity in Public Employment : Judicial Perspectives on Backwardness

This thesis is a study of -Equality of Opportunity in Public Employment : Judicial Perspectives on Backwardness. This study is an attempt to evaluate the concept of backwardness and equality of opportunity in employment and to assess the judicial perspectives in relation to them. The study reveals that the recent review petition of the Constitution Bench did not assess the decision of Chakradhar and its import. The study reveals that the Indian judiciary could successfully locate and apply the above principles. It was-Justice Subba Rao's nascent attempt in Devadasan which marked the starting point of such a jurisprudential enquiry. Later Thomas developed the thoughts by a reading new meaning and content to equality provisions of the Constitution which included the elimination of inequalities as the positive content of Articles 14 and 16(1) and elevated reservation provision to the same status of equality principles under the Constitution. Soshit, Vasanth Kumar and Mandal supplemented further to the jurisprudential contents. In this process, the courts were guided by the theories of John Rawls, David Miller, Ronald Dworkin, Max Weber and Roscoe Pound. Thus there was a slow and steady process of transformation of the reservation provision. From an anti-meritarian, unenforceable and enabling provision, it reached a stage of equally relevant and explanatory part of fundamental right to equality. Mandal viewed it as a part of sharing of State power. Though this can be seen by rereading and re-joining thoughts of judges in this regard, the judicial approach lacks coherence and concerted efforts in evolving a jurisprudential basis for protective discrimination. The deliberations of the framers of the Constitution reveals that there was much confusion and indeterminacy with regard to the concept of Backwardness. The study shows that the judiciary has been keeping intact the framers’ expectation of having a reasonable quantum of reservation, preventing the undeserved sections from enjoying the benefit, avoiding its abuse and evolving a new criteria and rejecting the old ones.

Normative and cognitive influences on female entrepreneurial reluctance at the base of the pyramid - an explorative study of cleaning ladies in Istanbul

Previous research has considered entrepreneurship as a way out of poverty and as a chance to foster economic growth. Moreover, specifically start-ups headed by women have played an important role in the economic development and it has been argued that gender-related issues, amongst others, play a significant role for the performance of a country or region. Against this background, this qualitative study explores desires, reluctances and constraints toward entrepreneurial activities of a comparably homogenous group of potential (poor) entrepreneurs in an emerging economy—cleaning ladies in Istanbul. We focus on this particular context as still rather little is known on reasons why women do not start a business (in Turkey). We believe exploring the reasons why certain individuals choose not to become entrepreneurs is at least as telling as investigating why they do so. We draw upon the social dimensions of entrepreneurship by Shapero and Sokol (1982) alongside Institutional Theory and posit that normative and cognitive forces may shape individual decisions on entrepreneurship. We identified two basic clusters of women and discuss possible hindrance factors undermining entrepreneurial desires and limitations for entrepreneurship as well as possible avenues for policy makers (and MNCs) to foster entrepreneurship in the given community.

Perspectives on academic writing in european higher education : genres, practices, and competences

Resumen basado en el de la publicación