Social work in a hospital emergency department

This paper describes how a Hospital Social Work Department's Emergency Team has attempted to provide a crisis and out-of-hours service to its Emergency Department. Through a staffing commitment to extensive evening and weekend cover, the Emergency Team's social worker is able to provide an immediate intervention and assessment service to problems. This has resulted in early detection and treatment of the non-medical aspects of a patient's problem and appropriate referral to other agencies for longer-term follow-up.

Medicalising Prohibition : Harm reduction in Finnish and International Drug Policy

The increase in drug use and related harms in the late 1990s in Finland has come to be referred to as the second drug wave. In addition to using criminal justice as a basis of drug policy, new kinds of drug regulation were introduced. Some of the new regulation strategies were referred to as "harm reduction". The most widely known practices of harm reduction include needle and syringe exchange programmes for intravenous drug users and medicinal substitution and maintenance treatment programmes for opiate users. The purpose of the study is to examine the change of drug policy in Finland and particularly the political struggle surrounding harm reduction in the context of this change. The aim is, first, to analyse the content of harm reduction policy and the dynamics of its emergence and, second, to assess to what extent harm reduction undermines or threatens traditional drug policy. The concept of harm reduction is typically associated with a drug policy strategy that employs the public health approach and where the principal focus of regulation is on drug-related health harms and risks. On the other hand, harm reduction policy has also been given other interpretations, relating, in particular, to human rights and social equality. In Finland, harm reduction can also be seen to have its roots in criminal policy. The general conclusion of the study is that rather than posing a threat to a prohibitionist drug policy, harm reduction has come to form part of it. The implementation of harm reduction by setting up health counselling centres for drug users with the main focus on needle exchange and by extending substitution treatment has implied the creation of specialised services based on medical expertise and an increasing involvement of the medical profession in addressing drug problems. At the same time the criminal justice control of drug use has been intensified. Accordingly, harm reduction has not entailed a shift to a more liberal drug policy nor has it undermined the traditional policy with its emphasis on total drug prohibition. Instead, harm reduction in combination with a prohibitionist penal policy constitutes a new dual-track drug policy paradigm. The study draws on the constructionist tradition of research on social problems and movements, where the analysis centres on claims made about social problems, claim-makers, ways of making claims and related social mobilisation. The research material mainly consists of administrative documents and interviews with key stakeholders. The doctoral study consists of five original articles and a summary article. The first article gives an overview of the strained process of change of drug policy and policy trends around the turn of the millennium. The second article focuses on the concept of harm reduction and the international organisations and groupings involved in defining it. The third article describes the process that in 1996 97 led to the creation of the first Finnish national drug policy strategy by reconciling mutually contradictory views of addressing the drug problem, at the same as the way was paved for harm reduction measures. The fourth article seeks to explain the relatively rapid diffusion of needle exchange programmes after 1996. The fifth article assesses substitution treatment as a harm reduction measure from the viewpoint of the associations of opioid users and their family members.

Elämän tiede : Tutkimus lääketieteellisestä teknologiasta, vanhemmuudesta ja perimän hallinnasta

Doctoral dissertation work in sociology examines how human heredity became a scientific, political and a personal issue in the 20th century Finland. The study focuses on the institutionalisation of rationales and technologies concerning heredity, in the context of Finnish medicine and health care. The analysis concentrates specifically on the introduction and development of prenatal screening within maternity care. The data comprises of medical articles, policy documents and committee reports, as well as popular guidebooks and health magazines. The study commences with an analysis on the early 20th century discussions on racial hygiene. It ends with an analysis on the choices given to pregnant mothers and families at present. Freedom to choose, considered by geneticists and many others as a guarantee of the ethicality of medical applications, is presented in this study as a historically, politically and scientifically constructed issue. New medical testing methods have generated new possibilities of governing life itself. However, they have also created new ethical problems. Leaning on recent historical data, the study illustrates how medical risk rationales on heredity have been asserted by the medical profession into Finnish health care. It also depicts medical professions ambivalence between maintaining the patients autonomy and utilizing for example prenatal testing according to health policy interests. Personalized risk is discussed as a result of the empirical analysis. It is indicated that increasing risk awareness amongst the public, as well as offering choices, have had unintended consequences. According to doctors, present day parents often want to control risks more than what is considered justified or acceptable. People s hopes to anticipate the health and normality of their future children have exceeded the limits offered by medicine. Individualization of the government of heredity is closely linked to a process that is termed as depolitization. The concept refers to disembedding of medical genetics from its social contexts. Prenatal screening is regarded to be based on individual choice facilitated by neutral medical knowledge. However, prenatal screening within maternity care also has its basis in health policy aims and economical calculations. Methodological basis of the study lies in Michel Foucault s writings on the history of thought, as well as in science and technology studies.

Boundary value problems for third-order nonlinear ordinary differential equations

In this paper, we describe how to analyze boundary value problems for third-order nonlinear ordinary differential equations over an infinite interval. Several physical problems of interest are governed by such systems. The seminumerical schemes described here offer some advantages over solutions obtained by using traditional methods such as finite differences, shooting method, etc. These techniques also reveal the analytic structure of the solution function. For illustrative purposes, several physical problems, mainly drawn from fluid mechanics, are considered; they clearly demonstrate the efficiency of the techniques presented here.

On the ignition and extinction problems in forced convection systems

In this paper the problem of ignition and extinction has been formulated for the flow of a compressible fluid with Prandtl and Schmidt numbers taken as unity. In particular, the problems of (i) a jet impinging on a wall of combustible material and (ii) the opposed jet diffusion flame have been studied. In the wall jet case, three approximations in the momentum equation namely, (i) potential flow, (ii) viscous flow, (ii) viscous incompressible with k = 1 and (iii) Lees' approximation (taking pressure gradient terms zero) are studied. It is shown that the predictions of the mass flow rates at extinction are not very sensitive to the approximations made in the momentum equation. The effects of varying the wall temperature in the case (i) and the jet temperature in the case (ii) on the extinction speeds have been studied. The effects of varying the activation energy and the free stream oxidant concentration in case (ii), have also been investigated.

A semi-experimental approach to plane problems in elasticity

A semi-experimental approach to solve two-dimensional problems in elasticity is given. The method has been applied to two problems, (i) a square deep beam, and (ii) a bridge pier with a sloping boundary. For the first problem sufficient analytical results are available and hence the accuracy of the method can be verified. Then the method has been extended to the second problem for which sufficient results are not available.

Estimation of the critical viscous sublayer in heat transfer problems

Imagining a disturbance made on a compressible boundary layer with the help of a heat source, the critical viscous sublayer, through which the skin friction at any point on a surface is connected with the heat transferred from a heated element embedded in it, has been estimated. Under similar conditions of external flow (Ray1)) the ratio of the critical viscous sublayer to the undisturbed boundary layer thickness is about one-tenth in the laminar case and one hundredth in the turbulent case. These results are similar to those (cf.1)) found in shock wave boundary layer interaction problems.

A particle filtering approach for structural system identification in vehicle–structure interaction problems

The problem of identification of parameters of a beam-moving oscillator system based on measurement of time histories of beam strains and displacements is considered. The governing equations of motion here have time varying coefficients. The parameters to be identified are however time invariant and consist of mass, stiffness and damping characteristics of the beam and oscillator subsystems. A strategy based on dynamic state estimation method, that employs particle filtering algorithms, is proposed to tackle the identification problem. The method can take into account measurement noise, guideway unevenness, spatially incomplete measurements, finite element models for supporting structure and moving vehicle, and imperfections in the formulation of the mathematical models. Numerical illustrations based on synthetic data on beam-oscillator system are presented to demonstrate the satisfactory performance of the proposed procedure.

Breathing, swallowing and voice in laryngeal disorsers

The aim of this work was to examine how breathing, swallowing and voicing are affected in different laryngeal disorders. For this purpose, we examined four different patient groups: patients who had undergone total laryngectomy, anterior cervical decompression (ACD), or injection laryngoplasty with autologous fascia (ILAF), and patients with dyspnea during exercise. We studied the problems and benefits related to the automatic speech valve used for the rehabilitation of speech in laryngectomized patients. The device was given to 14 total laryngectomized patients who used the traditional valve especially well. The usefulness of voice and intelligibility of speech were assessed by speech pathologists. The results demonstrated better performance with the traditional valve in both dimensions. Most of the patients considered the automatic valve a helpful additional device but because of heavier breathing and the greater work needed for speech production, it was not suitable as a sole device in speech rehabilitation. Dysphonia and dysphagia are known complications of ACD. These symptoms are caused due to the stretching of tissue needed during the surgery, but the extent and the recovery from them was not well known before our study. We studied two patient groups, an early group with 50 patients who were examined immediately before and after the surgery and a late group with 64 patients who were examined 3 9 months postoperatively. Altogether, 60% reported dysphonia and 69% dysphagia immediately after the operation. Even though dysphagia and dysphonia often appeared after surgery, permanent problems seldom occurred. Six (12 %) cases of transient and two (3 %) permanent vocal cord paresis were detected. In our third study, the long-term results of ILAF in 43 patients with unilateral vocal cord paralysis were examined. The mean follow-up was 5.8 years (range 3 10). Perceptual evaluation demonstrated improved results for voice quality, and videostroboscopy revealed complete or partial glottal closure in 83% of the patients. Fascia showed to be a stable injection material with good vocal results. In our final study we developed a new diagnostic method for exertional laryngeal dyspnea by combining a cardiovascular exercise test with simultaneous fiberoptic observation of the larynx. With this method, it is possible to visualize paradoxal closure of the vocal cords during inspiration, which is a diagnostic criterion for vocal cord dysfunction (VCD). We examined 30 patients referred to our hospital because of suspicion of exercise-induced vocal cord dysfunction (EIVCD). Twenty seven out of thirty patients were able to perform the test. Dyspnea was induced in 15 patients, and of them five had EIVCD and four high suspicion of EIVCD. With our test it is possible to set an accurate diagnosis for exertional laryngeal dyspnea. Moreover, the often seen unnecessary use of asthma drugs among these patients can be avoided.

Cultural differences and postmerger problems: Misconceptions and cognitive simplifications.

Researchers and practitioners have increasingly explained post-merger organizational problems with cultural differences, especially in the context of cross-border mergers and acquisitions. It is suggested here that cultural differences have great explanatory power in the context of post-merger change processes. There are, however, problems with a number of superficial cultural conceptions that are common in research in this area and in managerial rhetoric. This critical article provocatively delineates misconceptions widely held by researchers and practitioners in this field, which not only disregard cultural differentiation, fragmentation, inconsistencies and ambiguities, but further, illustrate a lack of understanding of cultural permeability and embeddedness in the environment, an overemphasis on abstract values and lack of attention to organizational practices, an overemphasis on initial structural differences and lack of attention to the new cultural layer, a lack of recognition of the political dimensions and a failure to recognize cultural differences as sources of value and learning. In this article, the theoretical problems associated with these misconceptions are examined and new conceptual perspectives suggested. The risks at stake for decision makers are also discussed.

On the Benefits and Problems of the Object-Oriented Paradigm including a Finnish Study

Several researchers are of the opinion that there are many benefits in using the object-oriented paradigm in information systems development. If the object-oriented paradigm is used, the development of information systems may, for example, be faster and more efficient. On the other hand, there are also several problems with the paradigm. For example, it is often considered complex, it is often difficult to make use of the reuse concept and it is still immature in some areas. Although there are several interesting features in the object-oriented paradigm, there is still little comprehensive knowledge of the benefits and problems associated with it. The objective of the following study was to investigate and to gain more understanding of the benefits and problems of the object-oriented paradigm. A review of previous studies was made and twelve benefits and twelve problems were established. These benefits and problems were then analysed, studied and discussed. Further a survey and some case studies were made in order to get some knowledge on what benefits and problems with the object-oriented paradigm Finnish software companies had experienced. One hundred and four companies answered the survey that was sent to all Finnish software companies with five or more employees. The case studies were made with six large Finnish software companies. The major finding was that Finnish software companies were exceptionally positive towards the object-oriented information systems development and had experienced very few of the proposed problems. Finally two models for further research were developed. The first model presents connections between benefits and the second between problems.

Technology-related peso problems in stock returns

Although empirical evidence suggests the contrary, many asset pricing models assume stock returns to be symmetrically distributed. In this paper it is argued that the occurrence of negative jumps in a firm's future earnings and, consequently, in its stock price, is positively related to the level of network externalities in the firm's product market. If the ex post frequency of these negative jumps in a sample does not equal the ex ante assessed probability of occurrence, the sample is subject to a peso problem. The hypothesis is tested for by regressing the skewness coefficient of a firm’s realised stock return distribution on the firm’s R&D intensity, i.e. the ratio of the firm’s research and development expenditure to its net sales. The empirical results support the technology-related peso problem hypothesis. In samples subject to such a peso problem, the returns are biased up and the variance is biased down.

CFD tools in engineering design studies and medical sciences

In the recent time CFD tools have become increasingly useful in the engineering design studies especially in the area of aerospace vehicles. This is largely due to the advent of high speed computing platforms in addition to the development of new efficient algorithms. The algorithms based on kinetic schemes have been shown to be very robust and further meshless methods offer certain advantages over the other methods. Preliminary investigations of blood flow visualization through artery using CFD tool have shown encouraging results which further needs to be verified and validated.