Mathematics for Everyday Life

The latest ERCIM News is available and since the last issue highlighted on W2tQ I've been looking forward to this one. The copy covers Everyday Maths with articles on health and the human body pp.12-18, society pp.31-36 and much more. I was tantalised by The Continuum Hypothesis: A Mystery of Mathematics, p.37, which had me thinking - surely that is a mystery of the social sciences? ;-)

Something to contemplate in retirement that - reliving the pain of mathematical encounters as a youngster. I do plan to go back to school (online even) for maths - if granted the time. ...

What would it be like to see the world with true mathematical vision?
I wonder....?

P.S. Don't miss p.26 listed under Water and Weather 'Maths Improves Quality of Life: An Early-Warning System for Environmental Effects on Public Health'.

ERCIM: European Research Consortium for Informatics and Mathematics

Where the heck am I (and where are you on Hodges' model)?

A combination of nursing experience and informatics knowledge and skills have meant that for a long time I have been able to sit on the fence and listen appreciatively to two sides of an ongoing saga. I am sure the ending will be a happy one, if not for the reason that there is no such thing as a 'finished' (nursing) information system. There is however a need for targets, deadlines, plans for a series of software releases and all the activities that accompany 'IT' projects. In short - project management. There is then a constant need for people to sit on the fence.

While the ability to sit on the fence may be something of an advantageous position, there are times when it becomes a source of anxiety and dissonance. Off the fence as a nurse without an informatics role (without i-portfolio), you feel left out of things. Literally chomping at the bit to contribute to the developments taking place - elsewhere.

Also off the fence, but alternately wearing the informatics shoes you have a sense that those soft, fuzzy caring, psychobabble skills are slowly yet inexorably melting away. How credible can you be if you have not 'nursed', that is - seen a client, managed your case load for 1, 2 or 3 years? Whatever your field, you can lose your touch.

Reading Michel Serres and his use of Harlequin as a trope really caught my imagination and breath (as lots of things do). Here's some background to Harlequin (and Hermes):

Two figures, then, inform Serres's oeuvre: Hermes and the Harlequin. Hermes the traveller and the medium allows for the movement in and between diverse regions of social life. The Harlequin is a multicolored clown standing in the place of the chaos of life. Two regions of particular interest to the voyager in knowledge are those of the natural sciences and the humanities. Should science really be opened up to poetry and art, or is this simply an idiosyncrasy on Serres's part? Is this his gimmick? The answer is that Serres firmly believes that the very viability and vitality of science depends on the degree to which it is open to its poetical other. Science only moves on if it receives an infusion of something out of the blue, something unpredictable and miraculous. The poetic impulse is the life-blood of natural science, not its nemesis. Poetry is the way of the voyager open to the unexpected and always prepared to make unexpected links between places and things. The form that these links take is of course influenced by technological developments; information technology transforms the senses, for example. Source: Dr.Vicente Forés López

This short quote hopefully illustrates the attraction of Serres to me as I study Hodges' model and informatics. Discovering Serres really creased me up. I say creased because that is where I am, trapped between two worlds. Stuck in that line between HUMANISTIC and MECHANISTIC realms. If I run the gauntlet there, the only other avenue open to me is that afforded by the INDIVIDUAL and GROUP axis.

Now I'm clearly not the only one able to sit on the fence and take in the views and perspectives of two frequently disparate worlds. On informatics secondment and at events such as HC2008 (HC2009) as a nurse - informatician you have to see lost opportunities looking at the speaker line-up and number of nurses present and able to take the messages home.

As a fact of life change will happen.

How much better though is change borne of
dialogue and engagement?

Like Harlequin those of us with clinical AND informatics insights must mix things up. There is a need to constantly enquire, challenge, influence and direct at times. A need also to pass the baton and let others experience the dual perspectives from the fence (and the splinters too).
Image sources: http://commons.wikimedia.org/wiki/User:Malene
and http://www.qosmiq.com/cdiadrone/ghis/pfolio/characters/index.htm

Hodges' model and care domain dependencies

Analysis and Synthesis: pretty powerful tools.

Looking at Hodges' model the other day I've thought of the model as a foundation upon which learners and experts alike can build. Looking at the model afresh I've realised that (whatever we all may or may not believe) outside of the model there is the 5th spiritual domain. After this and for some people because of this 5th domain time, energy, matter and love came into being.

So now to Hodges' model itself: we could not have health, social AND pastoral care systems if it were not for the SOCIAL and POLITICAL domains. These two group domains underpin and support the individual domains. There has always been talk of the golden age. These two domains provide the scaffolding for our lives and we would do well to remember this in these burnt umber times.


Reading Michel Serres and other authors you realise that the SCIENCE and intra-INTERPERSONAL care domains depend on the continued support and sustenance of the SOCIAL contract and the POLITICAL contract. I have not written 'social AND political contracts' purposefully as this suggests far greater similarity than I can argue for.

As we look and consider the relationships at work, what else can you see?

Well, we can see the distance between our collective understanding of science AND the distance between many individuals and the political process. Depicted in this way the fragility of things so often taken for granted - research, health care, individual choice, technologically enhanced and aspirational life styles becomes starkly apparent. The things that are granted do rely on contracts. Now though these two contracts themselves depend on the formulation and enactment of a natural contract between the Earth and its inhabitants (Serres, 1990).

Serres, M. The Natural Contract, trans. Elizabeth MacArthur and William Paulson, University of Michigan Press; 1995.

Original image source: http://www.leader-lift.com/sca.html

Listening and Seeing: The Next Generation

On the latest Sky At Night Sir Patrick Moore brought the most welcome news that Jodrell Bank is not to close due to a recent science funding cock-up. This is a great relief as in addition to seeing - we need to listen too. The Hubble Space Telescope will have its final servicing mission in August:



This will prolong the life of Hubble a true wonder with the images it has sent home to Earth and a fitting last flight for Space Shuttle Atlantis.

As we look forward even further to the Next Generation Telescope now called the James Webb Space Telescope astronomy is not only cool but it's hot and heavy too. Here is a discipline that ensures it samples all the available data streams open to it in order to test, verify, learn and progress. Out on the leading edge of astronomical data windows such as gravity waves, it is a case of discovering just how to listen and see. Diagnostic medicine benefits enormously from existing and new ways to investigate anatomy, physiology and pathological processes.

Astronomers need dishes the size of Jodrell Bank and bigger - such as Arecibo and arrays. People come equipped with telescopes and dishes of their own. As multidisciplinary (multi-eared) research teams develop proposals to take advantage of major initiatives such as the Towards Next-Generation Healthcare programme, let's hope the young stars are able to listen to and connect with the older stars.

Mindsets and Desksets

Trying to pick up the programming handle again (literally in the case of Ruby) has reminded me that it isn't just a matter of mindset, an effective working environment is essential too. At work I noticed how the systems developers frequently use two monitors. The penny has dropped recently as I've realised; on the old BBC micro I actually used two monitors, one of them was a 12inch Philips mono that was really clear for all its limited palette. The other screen was a Grundig portable TV. The BBC micro was brilliant with its varied graphic modes including teletext. Funny that trying to identify what graphic mode you needed to achieve the learning (program) objective, which in turn affected the amount of RAM. Happy virtual juggling times.

Watching the display technology evolve at the Which Computer Show in Birmingham, I could never afford a Microvitek proper jobbie. Now though if I feel given some 'progress' I can justify another monitor and reconfig the desk space - then change will follow.

As for mindsets it was in the 1980s that I last painted in oils - the cottage in Padstow, Cornwall.
I wonder...?

Holistic Bandwidth [II] 16, 180, breadth, depth and thoughts initial

If we were able to put the care record into an appropriate text analysis program is there a measure of the conceptual span - the holistic bandwidth of care - somewhere in there? Could there be a disciplinary or task-based mesh, a tag cloud that could be superimposed on Hodges' model to represent care as holistic bandwidth?

Very early on in the web site's history a page was added on the multicontextual nature of health (and social care). This contexts page like the others has not been properly researched, which I recognise is a risk for readers in terms of 'evidence based sources' and a risk for me since of course the Web is a rather public arena to air initial thoughts.

Since the site and this blog are a call for research in this area, I'm sure a search would reveal a literature, but without recourse to said literature I'm not sure how explicitly - my incomplete - notion of holistic bandwidth has been studied in care contexts. On the context page I included several basic diagrams to indicate how Hodges' model might be used as a 'measure'. This page plus the others need revising with a bin (icon) close to hand, in the meantime how can we measure holistic bandwidth?

We could add the problems identified in each care domains, e.g.:

INTRA-interPERSONAL = 3
POLITICAL = 2
SOCIOLOGY = 5
SCIENCES = 6
= 16

Continuing in a fit of numerics we could throw in some multiplication - 3*2*5*6 = 180 ?
'180' is much more impressive than a paltry '16'.

What next...? Could the domain scores be weighted in some way? Is it valid to assign a primary domain? And while we are at it where does self-care fall (intra-interpersonal surely)? Wither the literary heavyweights of severity, chronicity, strengths, recovery and well-being. ...? Oops - how could I forget - dependency measures are nothing new; but the literature bearers are not the issue.

If we still frequently fail to deliver holistic care, then what is holistic bandwidth (actually measuring)? Is it -

• The scope of care [in one or all of - assessment, planning, intervention, evaluation, outcome]?
• Simplicity [breadth]?
• Complexity [breadth and depth]?
• (Rapid) care integration [time, connectedness]?
• Concordance: clinical problems + patient (carer) problems + outcome set?
  
• ....?

Holistic Bandwidth [I] - Where's the brush?

Apart from those intervals and instances (times!) when emergency intervention is needed, holistic care is seen as a primary goal in health and social care theory, practice and policy.

IF care is not holistic THEN it could be argued that there is care dissonance.

The high quality non-critical, general efforts in the PHYSICAL [SCIENCES] care domain -

fluids, diet, warmth, pressure sore care, comfort, security, infection control ....

can be compromised by lack of attention to the EMOTIONAL [Intra-INTERPERSONAL] care domain -

respect, empathy, unconditional +ve regard, non-judgemental attitude, time, space, attention ....

- what the patient (carers and others*) expect to follow does not occur.

Rather like cognitive dissonance acute discomfort results when care of the required high quality (holistic, timely, person-centred...) is not applied across the board (h2cm).

(In being human) everyone recognises the BASICs of CARE (discuss?):

It is the remembering that is the problem.

Remembering demands an assured space in the organisational memory - such that staff in those other spaces - wards, clinics, patient's homes, residential homes are able to fulfil the holistic spectrum of care needs.

Dissonance encourages game playing with beliefs [1-n players].

It is very easy and a fairly well understood human trait for us to become pre-occupied with what we do. (As you will have noticed I have a problem with brackets and italics...) When at work (i.e. not day-dreaming) "It is what we do that counts."; but care variances bound to professional disciplines and particular clinical settings should not be wielded as a foil.

So, perhaps this dissonance can be represented as distance:

• patients and carers may not articulate their discomfort - at the time

(and hence is perceived of less consequence to the service - at the time);

• as the distance between concepts and their meanings.

Could this distance provide a measure of holistic bandwidth? No doubt, it already has somewhere in the literature? The first holistic bandwidth metric suggested above is acknowledged in policies around the response to complaints, which stress the need to deal with the complaint there and then if possible. Is this enough and what about the distances between concepts and meanings?

more to follow....

I Googled 'organisational dementia' and found the following reference:
‘Sustaining New Industrial Relations in the Public Sector: The politics of trust and co-operation in the context of organisational dementia and disarticulation’ (with M. Martinez Lucio), in P. Dibben, P. James, I. Roper, and G. Wood (eds.) Modernising Work in Public Services London: Macmillan. 2007.

*Of course there is a major cost on staff morale here also.

Holistic care striking a balance: Dance halls and the steps we take

I was reminded recently of these research related terms:

NOMOTHETIC -

Of or relating to the study or discovery of general scientific laws.

IDIOGRAPHIC -

Concerned with establishing the uniqueness of a phenomenon:
an individual, a place, or a region, for example.

These words struck me due to the way that Hodges' model can encompass them courtesy of the INDIVIDUAL-GROUP and HUMANISTIC-MECHANISTIC axes.

You know those arcade and now home based interactive dance games where the player dances on a pad?: well if Hodges' model is a dance hall and the concepts we use (the semantic web) comprise the dance steps; then if we focus on one side only (self?) we would essentially be standing on one foot - dancing with one half of our body or may be even a quarter.

Come on.
Yes of course - "at your own risk".
Stand up, move the chair out of the way and do your groove thing!

Try it!

Do you feel a bit silly?

OK, OK, it's no use,

Alright!

I confess!

While I try to be holistic, that's how I dance...

Image source adapted from:
http://www.uniqlo.jp/mixplay/

DOE’s SciDAC Visualization and Analytics Center for Enabling Technologies -

Even though the datasets involved are way beyond my day-to-day (clinical) work in mental health and an understanding of the techniques involved, I'm a sucker for the images and knowledge that scientific visualization opens up.

At Cyberinfrastructure Technology Watch the article -

DOE’s SciDAC Visualization and Analytics Center for Enabling Technologies - Strategy for Petascale Visual Data Analysis Success

- includes on page 2 discussion of survival of the data tsunami and refers to following figure:


For quite a while I've been thinking about individual health and social care and the point at which things become complex. You come to realise the role scalability plays in these things. And when you do - complexity is never far away. Just how far away are these esoteric datasets?

At VACET the body behind this work it speaks volumes that 'visualization' is not alone. It's not just about (and never was I'm sure!) pretty pictures: ANALYSIS figures large too (great to see enabling in there too!).

Bell jars and bell curves

To those who do not know Mathematics it is difficult to get across a real feeling as to the beauty,
the deepest beauty of nature. ... If you want to learn about nature, to appreciate nature,
it is necessary to understand the language that she speaks in.
Richard Feynman. 1918-1988. American physicist.

As those of us who can - work through school, college and those who are gifted (in both senses) take the university detour we identify, refine and utilise our intellectual strengths. This entails that we must also come to recognise our limitations. Looking heaven wards the day dawns that the "way of the astronaut" is a step too far, that's OK others can fly for me. ... At some point and usually much too early in academic careers specific aptitudes, intelligence and abilities crystallise into that form of diamond known as yea or nay. Statistics have it that there are many average scholars out there. Some people are average in maths AND English (languages), a smaller proportion excel in one or the other. So, how is your essay writing? Or should I ask how is your number theory?

The bell curve has its say, but having that bell jar placed over you is just the start of the story. Minds should be constantly enquiring. The result is coming across things you cannot fully comprehend and yet you have this real sense - you know - that "there is a tool here I could use - if only...."

At work we will naturally share many abilities with our peers - including befuddlement when it comes to maths. The nursing literature includes an ongoing parade of titles dedicated to explaining maths and stats to the numerically challenged.

In the mid 80s the dichotomy between the SCIENCES and HUMANITIES was illustrated for me in a working paper from the school of geography at University of Leeds. I still have it, saving it for a rainy day:
Macgill, S.M. (1984). Structural Analysis of Social Data, A Guide to Ho's Galois Lattice Approach and A Partial Re-Specification of QAnalysis, Working Paper 416, School of Geography, University of Leeds.
Abstract 1985

I came across this like a moth to a flame (thankfully I found an egg-carton to hide under). I began to work through the paper and had a puncture before even leaving the lay-by. My '84 A5 copy is rather basic in terms of print quality. Showing it to a few people at the time they thought perhaps there were some printing errors. They may well be right although may be they were also being kind. It wasn't just a 'NO ENTRY' sign, it was a brick wall I had met before. Some teachers reinforced this wall; while there were many others who did their level best to help me find a way through, or around. The truth is my cognitive wiring just ain't up to it. Referencing a paper is one thing, plumbing its depths and applying it is another.

So the obvious conclusion from this mathematical close encounter (more like a distant approach really) is that I'm challenged when it comes to maths. I've worked my may through SPSS descriptive stats and some 'real' stats; implemented BASIC search algorithms. But away from the lecture-IT room the knowledge quickly evaporates. I'm utterly fascinated looking at the world-universe within and around me, but I'm knee deep in a river and dying of thirst. There are millions of people haunted by the spectre of their ineptitude with numbers.

This is one of the main points of Macgill's text. The paper highlights an approach of great potential to social science researchers (including health and social care?) and yet the people most in need of such methods are frequently disadvantaged being unable to fully understand, grasp and apply these tools.

So tantalising, so frustrating - the glass is very frosted for this 'average student' (lifelong learner!).

Is it just about opportunities or opportunities to break the frosted glass?

Lonely model seeks ...

Lonely model seeks caring companion in mind and body. Open minded and adventurous (so make that companions!). Seeking at minimum a life-long relationship. Wise head on young shoulders. Outgoing: ready to travel anywhere. Enjoy milling around hospitals guessing the illnesses of out-patients. Will consider alternate scene. VERY flexible. Minimal baggage (will help YOU to carry yours). Interests span sciences and arts, ICT, global health, human ecology, the world of ideas and ideologies, analysis and synthesis: but never before breakfast in bed. Bag-ladies and excluded others please do apply. If you are into boxes or out of them get in TOUCH asap! Reply PO Box h2cm-4 (or is that 5?)
Image source with thanks to Ellis Nadler.
Ack: http://www.ananova.com/news/story/sm_2057296.html

Blog Action Day: h2cm around the water whole

Today is Blog Action Day when bloggers unite, posting on the key theme of the environment:

+

It is often said that the planet 'Earth' should be renamed such is the surface area covered by water. Water has long been the reason for life to congregate.

H20: the planet-wide religion of life.

For people water means settlement, hence the fear that in future it is water resources that will drive conflicts.

As we try to get to grips with the environmental issues and their solutions conceptual frameworks like h2cm can help bring everyone and everything together.

Think of Hodges' model as a watering hole.

People, communities, nations arrive there. Peering into the water we see ourselves and our neighbours.

TI:ME to share, if not barefoot TI:ME to kick off the shoes, touch the Earth and reflect:

ONE & MANY
MANY & ONE

From the four corners of the compass some of Earth's travellers arrive together. Others approach alone. Yet others will claim their arrival is spiritual. Whichever knowledge domain is the point of arrival, this provides the primary context.

The 21st century is the century of context: SITUATION

Flora + Fauna = 1

Flora + Fauna + Earth = 1

h2cm is not the starting point. We must bring experience, birth and death and all that is in-between to help solve our problems: transform attitudes. While we may be reaching for the stars there is nowhere to run.

Gaia taps our shoulder with increasing insistence. Who will turn and look her in the eye? The dare increases in magnitude moment by year. Avoidance of Nature’s gaze will not serve to protect, because we are already turning to shades of grey.

Comets were cast in the role of Hermes, the harbingers of tomorrow. Today, the appearance of contrails near the horizon is striking, so comet like; especially as they buzz the sun. In addition to finding h2cm there, what other messages are writ large in the sky? When will we once again see the stars reflected in the water hole?

Image sources with thanks:
http://www.fabricandart.com/HTML_files/Fabrics/australian_fabric_page.html
http://nightpath.org/gaia/

SCIENCES links: Holistic Bliss or Tristram Shandy ... V

Finally: what of the content of the SCIENCES links page? Firstly, a little background -

Hodges' model has a key role to play in engagement. In health this means helping people to help themselves. Assist them to use the knowledge and experience they have of their illnesses. When necessary educate them - patients, carers and the general public. Use the latest research to further health promotion and preventive measures. These efforts, these messages though must compete with an awful cacophony of noise - political and cultural in the media - that is frequently itself awful dross.

Little wonder then that the science, educational and political communities are so concerned about the public switch-off, with citizens ill-equipped to critique and engage in debate on key SCIENCE issues - biotechnology, nanotech, astronautics - funding!

Engagement is not for everyone of course, but surely we can do better this?

Over on this right-hand MECHANISTIC side of h2cm what should political expectations (aspirations!) be regards the holistic bandwidth of a given citizenry? What does the 21st C. curriculum for the citizen look like? Is it as taught, the written, the learned, DIY, the 'take away', the media delivered or the hidden, ...?

Back to the task at hand: Like all the links pages SCIENCES also places health related subjects uppermost for ready access together with selected conferences. Not surprisingly ANATOMY & PHYS are first on the top row, followed by selected NURSING AND CARE THEORIES. If the h2cm website has any roots as a project it started here and spread.

The media in general and IT commentators in particular stress information overload. The relentless increase in the volume of information year-on-year has a prime contributor amongst the research community in medicine.

When we speak of General Practitioner (family physician) it seems increasingly difficult to determine what is general? There are so many branches of medicine even before specialised directions must be taken. The costs and risks associated with 21st C. medicine mean that filtering the research literature to find the treatment pearls is crucial to effective practice, outcomes, management and policy. So, EVIDENCE BASED PRACTICE (EBP) that utilises e-libraries and electronic databases is the tool of our times and with QUANTITATIVE RESEARCH completes the top row.

Before moving down a peg (if digression sensitive turn away now).

If you look at Hodges' model and its quadrants with a nurse's eye, you know for intramuscular injections the dorsogluteal - the upper-outer quadrant of the buttock - has been cited as a preferred site. How fitting then that the upper-right quadrant in h2cm is the SCIENCES. Problem is of course upper-outer translates as upper-right AND upper-left and sticking needles in people is a pretty invasive and mechanistic task. That upper-outer LEFT quadrant in h2cm translates to the humanistic [INTERPERSONAL] domain, so sticking needles there may be anatomically correct, but epistemologically speaking where are the talking therapies? (The model also at this point invites dialogue and debate on addiction.)

Recently, I've been researching a paper on socio-technical structures (which will also attempt to explain the hyphen), this project-making or -breaking conjunction of the social and technical for me begs the question of the locus of INFORMATICS. There are many schools of informatics in addition to HEALTH INFORMATICS I & II. If it is sensible to ask of these informatics fields, which h2cm domains would they claim as their primary home? [COMMUNITY INFORMATICS is listed in the political domain.] The great and ongoing efforts in CLINICAL CODING AND CLASSIFICATION within medicine are also listed here.

I've often wondered about how much duplication there is in the various electronic databases that are available? What metrics would you use? There's a major Phd study for someone there if not already completed or under way? We see rationalisation in other industries, business sectors until then (or the semantic web) the plethora of available resources in INFO SOURCES further extends EBP. In artificial intelligence pruning the search is an essential strategy. Is the internet tree still growing or shrinking? I understand it is actually shrinking - rationalisation has begun?

The next three categories represent a key personal interest of mine. IMHO graphics, diagrams and visualization can help conjoin health, informatics, h2cm and the wider world; hence DIAGRAMS and VISUALIZATION I & II. Is there a role for DIAGRAMmatic reasoning in health and social care?

It could be argued (and has been) that visual literacy is yet another educational milestone.

PROGRAMMING is great fun - if you are not concerned with hydraulic control systems, air traffic control software, or clinical systems. MARKUP LANGUAGES variations of XML have proved revolutionary. In reading about and my initial tinkering with Drupal, XML is in there (and so much more). In education and nursing theory much is written about the need to bridge the theory-practice gap. Perhaps the gap is necessary: a velodrome has to have a centre. XML is a software technology that can bridge gaps in transforming data, information and knowledge.

As in other domains I wondered where to place ENVIRONMENT & ECOLOGY? In the four introductions to the website, I've stressed the relationship (dependency) between green issues, health and our quality of life. ENVIRONMENT & ECOLOGY should ideally reside in each of the domains, or at the centre the 5th domain - the spiritual - made up of all four.

Our VIRTUAL creations and worlds are presented next. IF you want to conjoin data sources, users, and present information & engage users, THEN use the senses that are available. Health and social care records can benefit from visualization as tantalisingly glimpsed in early work on visualization in the social sciences. (I'll see if I can switch these around a bit.)

Next: ASTRONOMY: Orion - you started this journey from my bedroom window. Rising in Winter standing tall then giving way to Spring. We need to give the real stars back to the people:

Turn off the light,
take a deep breath and relax

[Engima - Mea Culpa]

SCIENCE could comprise so much more space permitting just one scratch of this surface - pharmacology, chemistry, physics the new disciplines all deserve listings of their own.

SCIENCE is most clearly evinced in MATHS & LOGIC that provide the basis for ENGINEERING. The final two categories return to programming. Compared with the others this final row is smaller. I have to contain this pantological journey. The H2CM links pages are big enough: I know my limits.

The final category RUBY [TOOLSET] is perhaps poetic justice since programming is oft described as SCIENCE and ART. One thing that Hodges' model is about -

folding time and space.

Help Wanted: Arts, Media and Health Studies Students

It’s a regular student's dilemma: with assignment in hand find a worthy project that truly matches the brief and your creative talents.

For arts students a project that is in the form of a commission is highly desirable, reflecting the real world and future artist-client relationships. If there are any tutors reading, I (or h2cm) can provide several commissions, although I'm afraid without financial reimbursement. ...

The h2cm site would benefit from the attention of an artistic eye.

• A banner is still needed for the blog, preferably something that changes dynamically.

Here's one idea I worked up, but it's not exactly subtle?


• There are numerous images on the website that need a refresh of more than a coat of paint.

• Photoshop, Illustrator and other applications are often used to create montages. Hodges' model may at first appear blanc, but within the care domains lie hidden layers. A complex montage of ideas and concepts awaiting release and expression.

• If none of the above appeal, h2cm can help inspire and support any brief – being a regular smorgasbord for creative types.

Lecturers/tutors: if your students use Hodges' model from the outset, do they get extra marks if they include their 'working out - calculations'?

• I’ve often wondered about the model’s two axes being represented as a place.

What would it be like to take a walk along these streets illustrated using cut-outs of health and social care problems, solutions and issues like so many shop-fronts?

Over to you and as the (Northern) academic year closes - have a great holiday....

Ecotherapy: Hey Surf's Up - Better grab your sunbed

Having an eye for 'therapy-this' and 'that-therapy', a report on ecotherapy has appeared on the MIND website, blogs and other media. It's not new really, although the researched approach is very welcome. The mental health benefits of volunteering and the great outdoors have been recognised for countless years.

This summer - August in fact, there's an opportunity to do something different that also has an outdoor theme. It means putting that surf board down and getting the sun bed out: after midnight. Now is the time to do some networking and planning - at that time of night of course you must be safe and this is an experience to share with people you know and trust.

This is 'astrotherapy' which is connected to ecotherapy because venturing out you realise how light it is at night - where is the night sky!

Why go out and find dark skies? It's the PERSEID meteor shower and this summer with maximum the 12-13 August there is no full moon.

You can also check on whether the International Space Station (AND Space Shuttle on this occasion!) will pass within sight for your location.

When you can and do look at the stars it's quite a trip. If you are feeling depressed or lacking in self-esteem, if you let the view work its magic - it sure can make you feel insignificant and yet so very special. Gifted: to look the infinite in the eye...

Mind - Go green to beat the blues - Executive Summary

Some obvious tips: If travelling somewhere even with others check the site during the day. If needed: get permission - tell someone; take extra clothes and a hat - midges, mozzies. If you've a torch cover it with a transparent red film (red hanky even) so it doesn't mess your (and others!) night vision as much. Support your neck properly, you can't stand and crane your neck for hours - besides you'll look daft the next day walking into work - hey I know. If you are in the back garden and see a meteor don't shout out. The buckets of water will fly. Give yourself a good 10-15 minutes to light-dark adapt. Don't forget the flask! Be patient and I'm sure you'll be rewarded...

Holistic Bandwidth: All or Nothing

Quite a few years ago (Jones, 2004), I took the term bandwidth from the information and communication technology (ICT) world and applied it to health and social care. We seem to have been trying to achieve holistic and integrated care for decades. When care assessment, planning, intervention and evaluation is limited in scope this creates a narrowing of perspective, a bottleneck. Just as bandwidth problems used to affect the quality of on-line experience, so the bandwidth in health and social services ultimately affects the quality of care.

There's nothing wrong with perspective.

It's essential to making sense of the world. And after all, that railway line travels all the way to the vanishing point and it doesn't stop there. Road or railway - there's enough space reading between the lines to launch a whole film and literary genre.

I've said it before – but it really is ironic that many of the constraints in ICT have been overcome through broadband, memory costs/capacity and multi-core processors; while health services still struggle, still need to change:

From DISEASE - TREATMENT to PREVENTION - ENABLING ...

Single-track thinking is no longer sufficient, even if it is reassuring being able to see where you came from.

There’s an interesting non-trivial aside that follows from this bandwidth notion. The old conundrum of quality versus quantity.

Quality and quantity are the ties that bind, the Gordian knot. Cut this one at your peril!

Failure to focus on priorities, to take in that single, that utmost life-threatening perspective could result in disaster. Intensive care is the obvious example. Failure to attend to the physical priorities because of what seem new-age, airy-fairy ideas will quickly get you noticed.

There’s probably a paper out there on quality, quantity and appeals to holistic care. Returning to bandwidth I have wondered about how to measure this? Integrated care pathways and variance might be one approach, serious incident reports may be another revelatory approach? If it’s a care concept and moves ((uses energy) has currency) measure it!

There are a raft of measures for all sorts of things including, mood, behaviour, nursing care related, quality, risk and dependency. If you know of any that might measure holistic bandwidth, please let me know and add a comment here.

In the meantime I’ll ramble on - travelling h2cm's tracks…



Jones, P. (2004). Viewpoint: Can Informatics And Holistic Multidisciplinary Care Be Harmonised? British Journal of Healthcare Computing & Information Management, 21, 6, 17-18.

Gordian knot image c/o Bernice Steinbaum Gallery.

"Where are we?" Take Two, Three, F.... (witheringcare?)

In Five Senses, Serres does not overtly discuss mortality, loss, depletion and omission (Connor, 1999). Management consultants advise that to succeed ‘think outside the box’, but the population pyramid is casting an ever larger shadow, highlighting an ageing population and the box is frequently found full and yet empty? Plaques disconnect, disable the memory; the critical biological box no longer registers and connects. The noise that counts, the background bioelectrical hum is disrupted or absent. Memories once ready to roll downhill, surfing the wave of potential are inaccessible, if marshalled at all. Wither the neural crossroads; the informatique mote in Hermes’ eye?

Our older people, those not yet ephemeral have become peripheral, their personal space an adjunct to furniture. New quantities in life, beg questions of quality, especially quality of care and what it means to care. The concept of self, person-hood is a prime distinguishing factor in terms of describing the attitudes of cultures and communities to older adults and memory loss. In the developed nations the debate continues: is this the price of a long life, or a way of life? In a search for the locus of informatics: the sign on this door reads deep informatics. Listen carefully, as inside the seniors are cared for at home (touched*) remotely courtesy of telecare solutions. The values here of course extend from inappropriate use of informatics to lack of access to such services (Barlow et al., 2006). ...




*For Serres touch is the interface.




We must ensure remote care is not a total substitute for face-to-face interaction.

Barlow, J., Bayer, S., Curry, R. (2006). Implementing Complex Innovations in Fluid Multi-Stakeholder Environments: Experiences of ‘Telecare’, Technovation, 26, 3, pp.396-406.

Connor, S. (1999). Michel Serres’ Five Senses.
Retrieved May 19, 2007, from http://www.bbk.ac.uk/english/skc/5senses.htm

From submitted chapter: Exploring Serres’ Atlas, Hodges’ Knowledge Domains and the Fusion of Informatics and Cultural Horizons - forthcoming...

P.S. Sorry about the two posts today - trying to figure some things out...

News exclusive: Mind mapper is visited by guardian angel of Hodges' model

On the web I found an interesting comment item from the Educational Guardian 2006 by Philip Beadle "Mind maps: rubbish in theory, but handy in practice". Being an educational piece Mr Beadle is concerned with mind mapping in the context of children, although that's quite an age range in reality. As the title suggests, the piece as a whole does not rubbish mind mapping completely, but the start got my goat.... You see I thought of the first impressions and assumptions that people may form coming to Hodges' cognitive x-roads. Do they turn back or cross the divide?

Beadle apparently mind mapped the article and asks the reader if they notice a rise in quantity. I don't know if it's a typo, but quality should be the factor here. He made several points:

• Mind-mapping is easy
• Send people to search for coloured pencils
• Sharpen them - and again - and again
• DO NOT use a felt pen

These instructions are c/o the books by Tony Buzan the mind mapping guru. Beadle declares them wrong - and continues:

• Draw something in the middle (right dead bang, no less) of the paper
• Stay away from the sides - radiant thinkers need space
• Draw six multicoloured lines from the centre and a picture at the end of each
• Lines should be curly - no room for rulers in this realm
• Write key words in UPPER and lower case and voilà! A basic mind map is born

I realise you can read, but suffice to add that Beadle explains the claims that are made for mind mapping and the issue of 'bad science'.

Hodges' model has a problem here. It is not scientific - not evidence based. Not for the last time I'll say that the website and this blog are a (faltering?) call for research.

In many subjects the concepts of locus and control is important, in psychology and therapy for example. In mind mapping what determines that initial centre-stage drawing? True it could be person-centred, situated and problem centred.

As described above, though the space (page) in mind mapping is blanc*, virginal, neutral and crucially - unstructured.

Actually, there's some grief and annoyance in store for the mind mapper coming to Hodges' model.

There they are coloured pencils in hand, tongue protruding seeking airborne creative inspiration...

And then, it happens "Sh-t! Who the hell has graffitied on my page!"

Then suddenly, a voice booms out from overhead:

"Greetings, mild-mannered mind-mapper. Here is an announcement: the centre of this page has been rendered a no-go-zone. It is now a hyper-dimensional nexus, the point of fusion between four disciplines, five even (how could I forget). It is Complexity and Chaos. You can venture as near as you wish. Now please do not fret; I have it on good authority that aesthetically many things look better slightly off-centre."

The point I want to make - is the central importance of:

• Hodges' axes and knowledge domains - just where is the 'map'?
  
• How these influence the locus of control and association
• The concepts are already 'on' the page implicitly
  
• The user makes them explicit (in mind-mapping the space is aconceptual)
  

There are other critical dependencies:

• The knowledge, skills, attitudes and aptitudes of the user (are they a novice or expert#?)
• Whether they are novice or expert, Hodges' model provides a common conceptual substrate
• Finally (though I could go on!) quality in health and social care - and without - is the real issue. There are times when silence is golden...
  

There are many visualization (with apologies to those with voluminous datasets to swing) and mind mapping tools out there, but with the semantic web and Web 2.0-3.0... then Hodges' model will come of age....

Take care out there and if I seem tied in knots please help!

Ack: *Michel Serres; #Benner, et al..

Holistic Care No. 1

If you’ve checked the main website and some of the references you’ll have noticed the recurring theme of ‘holism’ and the assumed lack of progress in achieving “holistic care”. It has been talked about for decades, but how would we know even if holistic care was delivered into our midst? We need to know where to look and how to recognise holistic care. In which direction do we look – primary care, secondary care, or social care, or maybe all of these? The word 'achieved' also suggests measurement of some sort. So three points then:

1. Definition – to recognise
2. Criteria – to define and measure
3. Location – to seek

Over several posts we’ll explore these points and see where we end up....

Hodges' model and the art of seeing

On paper and as presented to date Hodges' model suggests that the paths to holistic and integrated care merely requires consideration and recording of care concepts ordinarily 'out of scope'. Oh, if life were that simple! Looking at h2cm you can see why this assumption follows.

Two interests which I have not pursued for many years are astronomy and oil painting. The first time you look through a telescope at the moon or Jupiter, what do you see? We tend to think that what is there in the field of view is what we see, but even after a brief time at the eyepiece you learn to see. The last time I picked up a brush it felt good, but the buzz was missing. It helps to paint regularly, if time permitted joining an art club would definitely re-light the fuse. You have to be in the right frame of mind, ideally with a space permanently set-up with your table/easel and paints.

Hodges model can provide a space and using that space can help bring about *a change in the way of seeing that means a change in what is seen.

*Bortoft, H. (1996) The Wholeness of Nature: Goethe's Way of Science (Paperback), Floris Books.


This book could feature on the h2cm reading list!