Developing Practice in Healthcare: The Contribution of Bildung to Negotiating the Tensions among Practical, Professional and Organisational Knowing

"Action research provides a framework for developing practice in healthcare. While developing practice typically implies a combination of patient centeredness, quality improvement and change, conflicts arise in how concepts such as patient centredness are defined. Developing practice invites attention to positionality and engagement with policy directives, trends in clinical care, and other disciplines each with their own language stratification reflecting particular sets of values and beliefs. Our process of engagement is value-based, requiring attention to different and often conflicting languages or worldviews. We understand practice development as responding to different calls from the system, our individual disciplines, patients and changing discourses in healthcare, each exerting different pressures at different times. This paper describes an action research project aimed at developing nursing practice through engaging with two conflicting philosophies of care. We illustrate the contribution made by a particular understanding of Bildung to engaging with positionality, different voices in healthcare and the context of care in a complex environment. Bildung, as self-cultivation, invites engagement with other as an underpinning for developing practice beginning with first person inquiry. The idea of Bildung drew attention to the local moral world of nursing and the experience of dual citizenship. Dual citizenship reflected engagement with conflicting care philosophies and notions of evidence." (author's abstract

Measured and Calculated Dynamic Response of Rock-Fill Dam

The U.S. Army Corps of Engineers recently completed a seismic stability assessment of the Ririe Darn and Reservoir Project located near Idaho Falls, Idaho. Ririe Darn is an earth- and rockfill darn with a central impervious core constructed between 1966 and 1975 in a narrow canyon of Willow Creek. A geologic and seismologic study indicated that the controlling maximum credible earthquake (MCE} is a Magnitude 7.5 earthquake at a distance of 8 km from the darn. The seismic stability analysis included a dynamic response analysis of the darn using two-dimensional finite element procedures. Empirical relations derived from the observed response and analyses of other darns in narrow canyons were used to develop adjustment factors to correct natural frequencies, dynamic shear stresses, and peak accelerations for three-dimensional (3-D} effects. The October 28, 1983 Mt. Borah Earthquake triggered five strong-motion instruments installed at the crest, left abutment, downstream toe, and outlet tower of Ririe Darn. The epicentral distance to the darn was 179 km. The peak horizontal accelerations recorded at the crest and at the abutment were 0.05 g and 0.02 g, respectively. The accelerogram recorded by the instrument station at the abutment was used to calculate the dynamic response of the darn during the earthquake. From this analysis, the finite element model and the soil parameters were calibrated to best represent the 3-D dynamic response of the darn. After consideration of 3-D effects, the calculated response of the darn using soil properties derived from in-situ and laboratory measurements was in good agreement with the measured response during the 1983 Mt. Borah earthquake. These results indicate that when properly applied, currently available methods to determine soil properties for the dynamic response analysis of embankment darns including in-situ measurements, can provide properties in good agreement with those back-calculated from the observed response of darns

Evaluation: Programme to Support Palliative and Hospice Care in the Republic of Ireland, Final Report

Investment in end-of-life care has made Ireland a world leader in advancing palliative and hospice care but regional inequities persist, according to an evaluation by Professor Mary McCarron and colleagues at Trinity College Dublin.This evaluation examined The Atlantic Philanthropies' End of Life programme -- which aimed to improve the care and quality of life for patients dying from an incurable illness and to ensure they and their families received excellent end-of-life care and services. From its first grant in 2004 through its final grant in 2010, Atlantic invested 25 million in the programme

Measuring GHG Emissions Across the Agri‐Food Sector Value Chain: The Development of a Bioeconomy Input‐Output Model

Increasing food production to meet rising global demand while minimising negative environmental impacts such as agricultural greenhouse gas (GHG) emissions is one of the greatest challenges facing the agri‐food sector. Sustainable food production relates not only to primary production, but also has wider value chain implications. Aninput‐output (IO) model is a modelling framework which contains information on the flow of goods and services across a value chain at a regional or national economy level. This paper provides a detailed description of the development of a Bioeconomy IO (BIO) model which is disaggregated across the subs‐sectors of the agri‐food valuechain and environmentally extended (EE) to examine environmental outputs, including GHG emissions, We focus on Ireland, where emissions from agriculture comprise 33% of national GHG emissions and where there has been a major expansion and transformation in agriculture supported by national and EU policy. In a substantial Annex to this paper, we describe the modelling assumptions made in developing the BIO model. Breaking up the value chain into components, we find that most value is generated at the processing stage of the value chain, with greaterprocessing value in more sophisticated value chains such as dairy processing. On the other hand, emissions are in general highest in primary production, albeit emissions from purchased animal feed are higher for poultry than for other value chains, given the lower animal based emissions from poultry than from cows or sheep. The level ofdisaggregation also shows that the sub‐sectors are themselves discrete value chains. The analysis highlights that emissions per unit of output are much higher for beef and sheep meat value chains than for pig and poultry. The analysis facilitated by the BIO model also allows for the mapping of emissions along the agri‐food value chain using the adapted IO EE approach. Such analysis is valuable in identifying emissions ‘hot‐spots’ along the value chains and analysing potential avenues for emission efficiencies