Reaching common ground:A patient-family-based conceptual framework of quality EOL care

Improvement in the quality of end-of-life (EOL) care is a priority health care issue since serious deficiencies in quality of care have been reported across care settings. Increasing pressure is now focused on Canadian health care organizations to be accountable for the quality of palliative and EOL care delivered. Numerous domains of quality EOL care upon which to create accountability frameworks are now published, with some derived from the patient/family perspective. There is a need to reach common ground on the domains of quality EOL care valued by patients and families in order to develop consistent performance measures and set priorities for health care improvement. This paper describes a meta-synthesis study to develop a common conceptual framework of quality EOL care integrating attributes of quality valued by patients and their families. © 2005 Centre for Bioethics, IRCM.

Turing’s Menagerie: Talking Lions, Virtual Bats, Electric Sheep and Analogical Peacocks: Common Ground and Common Interest are Necessary Components of Engagement

This theoretical paper attempts to define some of the key components and challenges required to create embodied conversational agents that can be genuinely interesting conversational partners. Wittgenstein’s argument concerning talking lions emphasizes the importance of having a shared common ground as a basis for conversational interactions. Virtual bats suggests that–for some people at least–it is important that there be a feeling of authenticity concerning a subjectively experiencing entity that can convey what it is like to be that entity. Electric sheep reminds us of the importance of empathy in human conversational interaction and that we should provide a full communicative repertoire of both verbal and non-verbal components if we are to create genuinely engaging interactions. Also we may be making the task more difficult rather than easy if we leave out non-verbal aspects of communication. Finally, analogical peacocks highlights the importance of between minds alignment and establishes a longer term goal of being interesting, creative, and humorous if an embodied conversational is to be truly an engaging conversational partner. Some potential directions and solutions to addressing these issues are suggested.

Turing's menagerie:Talking lions, virtual bats, electric sheep and analogical peacocks: Common ground and common interest are necessary components of engagement

This theoretical paper attempts to define some of the key components and challenges required to create embodied conversational agents that can be genuinely interesting conversational partners. Wittgenstein's argument concerning talking lions emphasizes the importance of having a shared common ground as a basis for conversational interactions. Virtual bats suggests that-for some people at least-it is important that there be a feeling of authenticity concerning a subjectively experiencing entity that can convey what it is like to be that entity. Electric sheep reminds us of the importance of empathy in human conversational interaction and that we should provide a full communicative repertoire of both verbal and non-verbal components if we are to create genuinely engaging interactions. Also we may be making the task more difficult rather than easy if we leave out non-verbal aspects of communication. Finally, analogical peacocks highlights the importance of between minds alignment and establishes a longer term goal of being interesting, creative, and humorous if an embodied conversational agent is to be truly an engaging conversational partner. Some potential directions and solutions to addressing these issues are suggested.

Shifting Ground:Beyond National Architecture

The Irish Pavilion at the Venice Architecture Biennale 2012 charts a position for Irish architecture in a global culture where the modes of production of architecture are radically altered. Ireland is one of the most globalised countries in the world, yet it has developed a national culture of architecture derived from local place as a material construct. We now have to evolve our understanding in the light of the globalised nature of economic processes and architectural production which is largely dependent on internationally networked flows of products, data, and knowledge. We have just begun to represent this situation to ourselves and others. How should a global architecture be grounded culturally and philosophically? How does it position itself outside of shared national reference points?
heneghan peng architects were selected as participants because they are working across three continents on a range of competition-winning projects. Several of these are in sensitive and/or symbolic sites that include three UNESCO World Heritage sites, including the Grand Egyptian Museum in Cairo, the Giants Causeway Visitor Centre in Northern Ireland, and the new Rhine Bridge near Lorelei.
Our dialogue led us to discussing the universal languages of projective geometry and number are been shared by architects and related professionals. In the work of heneghan peng, the specific embodiment of these geometries is carefully calibrated by the choice of materials and the detailed design of their physical performance on site. The stone facade of the Giant’s Causeway Visitor Centre takes precise measure of the properties of the volcanic basalt seams from which it is hewn. The extraction of the stone is the subject of the pavilion wall drawings which record the cutting of stones to create the façade of the causeway centre.
We also identified water as an element which is shared across the different sites. Venice is a perfect place to take measure of this element which suggests links to another site – the Nile Valley which was enriched by the annual flooding of the River Nile. An ancient Egyptian rod for measuring the water level of the Nile inspired the design of the Nilometre - a responsive oscillating bench that invites visitors to balance their respective weights. This action embodies the ways of thinking that are evolving to operate in the globalised world, where the autonomous architectural object is dissolving into an expanded field of conceptual rules and systems. The bench constitutes a shifting ground located in the unstable field of Venice. It is about measurement and calibration of the weight of the body in relation to other bodies; in relation to the site of the installation; and in relation to water. The exhibit is located in the Artiglierie section of the Arsenale. Its level is calibrated against the mark of the acqua alta in the adjacent brickwork of the building which embodies a liminal moment in the fluctuating level of the lagoon.
The weights of bodies, the level of water, changes over time, are constant aspects of design across cultures and collectively they constitute a common ground for architecture - a ground shared with other design professionals. The movement of the bench required complex engineering design and active collaboration between the architects, engineers and fabricators. It is a kind of prototype – a physical object produced from digital data that explores the mathematics at play – the see-saw motion invites the observer to become a participant, to give it a test drive. It shows how a simple principle can generate complex effects that are difficult to predict and invites visitors to experiment and play with them.

Growth Coalitions and Rural Development Police in the EU and the US

A recent issue of EuroChoices (7:1) was devoted to a discussion of comparative US-EU rural development policies. This article discusses the concept of growth coalitions, well developed in urban literature but less so in rural literature. Some light is shed on the different positions of rural and environmental issues in EU and US policies. The agricultural lobby is the dominant actor in agricultural growth coalitions because it perceives land in terms of its exchange value. Environmental and rural development actors perceive land in terms of its use value and its contributions to quality of life: they form a rural development coalition, seeing the need to balance growth with quality of life, but they have less political power than the agricultural growth coalition. In the European context, rural and environmental agendas are linked to a multi-functional agricultural agenda allowing common ground between these two coalitions and greater visibility in the policy arena. In the US, rural interests and environmental groups are more often in opposition to agriculture. This reduces their political visibility and clout. The challenge is how to link the power of the agricultural growth coalitions with rural development coalitions to achieve a broader balance of concerns and a more effective rural development policy.

Moments of Recognition:The Four Semester Studio in QUB

It is a legitimate assertion that the common ground of work of worth in architecture, whether theoretical or built comes from a firmly held position on the part of the author. In addition to delivery key competencies architectural education should act to support the formation of such a position in the student, or to make students aware of the possibility of holding such a position.

It is with this in mind perhaps that intensive unit-based diploma and masters structures are increasingly becoming the standard structure for for schools of architecture across the UK. The strengths of such a structure are most evident when the school, either by virtue of financial strength or geographic location is able to attract a diverse range of contrasting positions to bear in the formation of these units. In effect the offering to the student is a short, intensive immersion into a clear line of thought based on the position of those running the unit. Research is channeled by those running the unit to the work of the students. A single cohort of students therefore is able to observe and understand a wide range of ways of thinking about the subject whether or not they are participants in a unit or not. It is axiomatic that where this structure is applied in the absence of these resources the result can be less helpful, individual units are differentiated not to reflect the interests of those running the unit but for the sake of difference as its own end.

In structuring the M.Arch programme in Queens University Belfast the reality of our somewhat peripheral location was placed at the forefront of our considerations. A single 4 semester studio is offered. The first three semesters are carefully structured to offer a range of directed and self directed projects to the students. By interrogation of these projects, and work undertaken at undergraduate level the aim is to assist the students to identify a personal position on architecture, which is then developed in the thesis in semester four. Research and design outputs are emergent from the interest of the student body, cultivated by staff who have the time over the four semesters to get to know all aspects of a students interests.

This paper will lay out this structure and some of the projects run within it. Now having delivered two graduating years the successes and challenges of the system will be laid out by reference to several case studies of individual student experiences of the structure.

Negative Silence: The unspoken future of Northern Ireland

The premise for finding common ground between unionism and nationalism in Northern Ireland in the 1998 Agreement centred on an accepted compromise regarding what the future of the province might be: continued union within the UK was assured but could be changed if unity with the Republic of Ireland was the will of the majority. In this way, Northern Ireland was suspended as if on a see-saw between the ‘two traditions’. As a consequence, the very success of power-sharing has made it difficult for parties to articulate a shared vision of Northern Ireland’s future. This paper identifies a ‘negative silence’ regarding the outlook for Northern Ireland and seeks to uncover some of its implications by analysing three of its constitutive elements. First, how the aspirational discourse of the four largest political parties has remained largely entrenched in oppositional gullies. Second, how the debate around the Shared Future framework and Cohesion, Sharing and Integration programme ironically embodies deep differences in political visions of a ‘shared’ future for Northern Ireland. Finally, interview-based reflections on how an inability to articulate a future for Northern Ireland affects the young ‘Agreement generation’ and their (dis)empowerment as citizens. The paper concludes that the thicker the fog of silence grows over the subject of Northern Ireland’s future, the bleaker this future is likely to be

Deliberative Democracy in Northern Ireland: Opportunities and challenges for consensus in a consociational system

The 1998 Multiparty Agreement established a consociational system that contains within it an explicit dualism: unionist/nationalist, north and south of Ireland, and British and Irish. But although this formula has facilitated relatively stable and devolved governance, it is based on a distorted representation of a society in which there are much more complex divisions and, indeed, many common problems. Citizen-led efforts towards deliberative democracy since the 1980s have demonstrated both the will and the capacity for alternative, consensual political expressions. This chapter examines the challenges and opportunities facing these citizen-led initiatives in a political environment which, despite the significant decline in violence and terror, seems stubbornly resistant to the idea of broadening the various means of democratic participation.

Endothelial Function in Hypertension: Victim or Culprit?

Far from simply lining the inner surface of blood vessels, the cellular monolayer that comprises the endothelium is a highly active organ that regulates vascular tone. In health, the endothelium maintains the balance between opposing dilator and constrictor influences, while in disease, it is the common ground on which cardiovascular risk factors act to initiate the atherosclerotic process. As such, it is the site at which cardiovascular disease begins and consequently acts as a barometer of an individual's likely future cardiovascular health. The vascular endothelium is a very active organ responsible for the regulation of vascular tone through the effects of locally synthesized mediators, predominantly nitric oxide (NO), endothelial NO synthase (eNOS), and superoxide. NO is abundantly evident in normally functioning vasculature where it acts as a vasodilator, inhibits inflammation, and has an antiaggregant effect on platelets. Its depletion is both a sign and cause of endothelial dysfunction resulting from reduced activity of eNOS and amplified production of nicotinamide adenine dinucleotide oxidase, which, in turn, results in raised levels of reactive oxygen species. This cascade is the basis for reduced vascular compliance through an imbalanced regulation of tone with a predominance of vasoconstrictive elements. Further, structural changes in the microvasculature are a critical early step in the loss of normal function. This microvascular dysfunction is known to be highly predictive of future macrovascular events and is consequently a very attractive target for intervention in the hypertensive population in order to prevent cardiovascular events.

British Irish Institutional Structures: Towards a New Relationship

Growing institutional cooperation between the Republic of Ireland and the UK,
initially directed explicitly at resolution of the Northern Ireland conflict, has taken the form of three parallel institutional structures. First, an Anglo-Irish (later, British–Irish) Intergovernmental Conference has dealt with matters relating to the government of Northern Ireland in areas to which power is not devolved, and with certain other ‘sovereign’ matters. Second, a British–Irish Council links not just the two sovereign governments but also the devolved institutions in Scotland, Wales and Northern Ireland and the crown dependencies of Jersey, Guernsey and the Isle of Man. Third, a matching British–Irish Parliamentary Assembly provides common ground for representatives of the legislative bodies of the same jurisdictions. The
paper tracks the evolution of these structures, and assesses the significance of the new institutions for the British–Irish relationship.

Exchange potential from the common energy denominator approximation for the Kohn-Sham Green's function: Application to (hyper)polarizabilities of molecular chains

An approximate Kohn-Sham (KS) exchange potential v(xsigma)(CEDA) is developed, based on the common energy denominator approximation (CEDA) for the static orbital Green's function, which preserves the essential structure of the density response function. v(xsigma)(CEDA) is an explicit functional of the occupied KS orbitals, which has the Slater v(Ssigma) and response v(respsigma)(CEDA) potentials as its components. The latter exhibits the characteristic step structure with "diagonal" contributions from the orbital densities \psi(isigma)\(2), as well as "off-diagonal" ones from the occupied-occupied orbital products psi(isigma)psi(j(not equal1)sigma). Comparison of the results of atomic and molecular ground-state CEDA calculations with those of the Krieger-Li-Iafrate (KLI), exact exchange (EXX), and Hartree-Fock (HF) methods show, that both KLI and CEDA potentials can be considered as very good analytical "closure approximations" to the exact KS exchange potential. The total CEDA and KLI energies nearly coincide with the EXX ones and the corresponding orbital energies epsilon(isigma) are rather close to each other for the light atoms and small molecules considered. The CEDA, KLI, EXX-epsilon(isigma) values provide the qualitatively correct order of ionizations and they give an estimate of VIPs comparable to that of the HF Koopmans' theorem. However, the additional off-diagonal orbital structure of v(xsigma)(CEDA) appears to be essential for the calculated response properties of molecular chains. KLI already considerably improves the calculated (hyper)polarizabilities of the prototype hydrogen chains H-n over local density approximation (LDA) and standard generalized gradient approximations (GGAs), while the CEDA results are definitely an improvement over the KLI ones. The reasons of this success are the specific orbital structures of the CEDA and KLI response potentials, which produce in an external field an ultranonlocal field-counteracting exchange potential. (C) 2002 American Institute of Physics.