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This study examines how organizations construct and manage risk objects as a duality of harm–benefit within their normal operations. It moves beyond the existing focus on accidents, disasters and crisis. We study the risk‐transfer processes of 35 insurers where they navigate the tension of retaining risk in their insurance portfolio to increase the benefit of making profit and transferring risk to reinsurance to reduce the harm of paying claims. We show that organizations’ constructions of risk are underpinned by everyday risk management practices of centralizing, calculating and diversifying. Through variation in these practices, not all organizations seek balance and we in turn uncover the sensemaking processes of abstracting and localizing that enable organizations to prioritize harm or benefit. This contributes to the risk literature by illuminating the co‐constitutive relationship between risk sensemaking processes and everyday risk management practices. Following the complex linkages involved in the construction of risk objects as sources of harm–benefit, our analysis also contributes to the literature on dualities. It shows that while immediate trade‐offs between harm–benefit occur, prioritizing one element of the duality is ultimately a means for attaining the other. Thus, while initial imbalance is evident, prioritization can be an enabling approach to navigating duality.  相似文献   
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Problem

Research suggests that the skill and experience of the attendant significantly affect the outcomes of vaginal breech births, yet practitioner experience levels are minimal within many contemporary maternity care systems.

Background

Due to minimal experience and cultural resistance, few practitioners offer vaginal breech birth, and many practice guidelines and training programmes recommend delivery techniques requiring supine maternal position. Fewer practitioners have skills to support physiological breech birth, involving active maternal movement and choice of birthing position, including upright postures such as kneeling, standing, squatting, or on a birth stool. How professionals learn complex skills contrary to those taught in their local practice settings is unclear.

Question

How do professionals develop competence and expertise in physiological breech birth?

Methods

Nine midwives and five obstetricians with experience facilitating upright physiological breech births participated in semi-structured interviews. Data were analysed iteratively using constructivist grounded theory methods to develop an empirical theory of physiological breech skill acquisition.

Results

Among the participants in this research, the deliberate acquisition of competence in physiological breech birth included stages of affinity with physiological birth, critical awareness, intention, identity and responsibility. Expert practitioners operating across local and national boundaries guided less experienced practitioners.

Discussion

The results depict a specialist learning model which could be formalised in sympathetic training programmes, and evaluated. It may also be relevant to developing competence in other specialist/expert roles and innovative practices.

Conclusion

Deliberate development of local communities of practice may support professionals to acquire elusive breech skills in a sustainable way.  相似文献   
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Drawing from ethnographic work carried out between 2005 and 2007, this article considers the ways in which a women’s network has developed strategies to find meaning around the absences of loved ones, killed or ‘disappeared’ during the decades of conflict in Sri Lanka. For most of these women, the fate of their husbands, brothers, sons and fathers is not known and the lack of answers means that they are unable to fully grieve and find closure. In order to survive, they must find ways to deal with the absent bodies and present memories of those who may never be located and accounted for. These strategies include tree-planting ceremonies carried out as a way of not only remembering and mourning loved ones but also asking questions about how one makes sense of loss and what it means to carry the burden of unanswered absences through everyday life and into the future.  相似文献   
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Laud et al. (1993) describe a method for random variate generation from D-distributions. In this paper an alternative method using substitution sampling is given. An algorithm for the random variate generation from SD-distributions is also given.  相似文献   
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