Gardenfors' book - a quote and can that be, surely not ...h2cm?

The title of Peter Gardenfors' book Conceptual Spaces is enough to switch the four lights on in this house. In chapter 1 the conclusion includes -

So what kind of theory is the theory of conceptual spaces? Is it an empirical, normative, computational, psychological, neuroscientific, or linguistic theory? The answer is that the theory of conceptual spaces is used in two ways in this book. On a general level, it is a framework for cognitive representations. .... On a more specific level, the framework of conceptual spaces can then be turned into empirically testable theories or constructive models by filling in specific dimensions with certain geometrical structures, specific measurement, specific connections to other empirical phenomena, and so forth. p.30.

Chapter 5: Semantics gives us figure 5.9 (p.173):

Spatial relations between some abstract lexemes

EXISTENCE LOCATION
POSSESSION OWNERSHIP

Here below is h2cm. I'll leave the explanatory connections to you:

intrapers. sciences
sociology politics

Since 1986 or thereabouts I've been teased by quadtrees, Voronoi tesselations, facet analytic theory, clustering methods et al. and set to believe there's something here that we can use....

On the website I started to explore some of the assumptions that underpin the structure and (what might contribute to) a theory of Hodges' model. The next 'paper' will assume that the reader is familiar with Hodges' model. The focus will be h2cm as a candidate conceptual space with Gardenfors' text as a key and initial source.

The domains, distances, dimensions, data^# it's all there: bar the door....

Many thanks everyone for passing this way - we are now at 10,000+ visitors
^#P.S. I'm actually not sure about the data - that is a real challenge.

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

Soft thinking: Care Ideals & Real World Constraints

It would be marvellous to be able to practice comprehensive care in terms of assessment, planning, intervention and evaluation (apie). In reality of course the world at large conspires to upset the best laid plans. Let's call them constraints it sounds better.

Away from the theory there are so many constraints in practice that maybe they should be reflected in software applications or e-learning on Hodges' model? Now if you are looking for rocket science then please read no further, since what follows does not even qualify as a plastic bottle rocket project.

Let's imagine we are creating a data entry form for Hodges' model. Users of the form can specify a care domain and enter a care problem. The first constraint and a true reflection of the real care world is that the number of problems 'allowed' is limited; it might be 3 per domain, or something like this:

intra-INTERPERSONAL = 3
SCIENCES = 5
SOCIOLOGY = 3
POLITICAL = 4

So there's an essay for you: What would your total be? What if the fifteen possible problems can be allocated with the further constraint that a domain cannot exceed five in total? Does there need to be a minimum of at least one problem in a domain? What year is it? Are 'problems' a bit old hat? What about the individual's strengths?

If on completion (whenever that may be) the patient (plus carer...) has defined a set proportion of the problems, then there is one measure of holistic care. A further holistic measure could be the number of ticks for those four stages of care - apie. It does not take much when painting with care constraints and numbers to find complexity. And this does not even touch the surface.

DSL examples - thrills and spills: "Data lend me your ear!"

The final chapters of Olsen's book Design Patterns in Ruby made my lips dry. I hadn't checked ahead, but Olsen mentions mid-text what's to follow. In getting there and reading about the Interpreter pattern and DSLs, I do hope this does not prove a one-off date. Olsen's book IS brilliant (and besides Ruby looks so dynamic across the dance floor), but the examples used were tinged with anti-climax and prompted a reality check.

Olsen's examples DO illustrate the principles, like most things worthwhile they need deliberate reading, but they DO deliver. So what's up? Well, the examples presented are taken from the world of IT (file backup). Yes, I know... well what do you expect! I had hoped for a DSL from a less technical domain; something left-of-centre, something that traverses the HUMANISTIC - MECHANISTIC divide. This is where the definitions of domain, DSL and the craft of caring and programming can (possibly) provide some useful insights.

For decades the literature and projects have focussed upon nursing languages. Communication relies on language of course. Even the absence of messages - verbal, non-verbal or other - tells us something. In health and other professions great emphasis is placed upon communication skills. We have to listen actively. How we listen - the constraints, what we deem as significant, and what is subsequently recorded and retained defines our care domains.

The domains that are the subject of DSL are specific, which explains how they can be implemented in some 50-70 lines of code (this also says something about Ruby). In contrast, within Hodges' model those four domains may as well be galactic quadrants they are so broad. Regardless of this (non-trivial) issue, standing at the nexus of h2cm the question needs to be asked (and is constantly being asked by health & informatics communities):

How good a listener can the MECHANISTIC ear be?

Domain Specific Languages [II] + a Ruby mixin

Last year in one of those pick-it-up:put-it-down cycles, I surfed into this article on DSLs and Ruby c/o:

Ruby Code & Style Creating DSLs with Ruby
by Jim Freeze, March 16, 2006

Although as mentioned the other week, I'd read - and keep reading! - Chris Pine's intro Ruby book and the Thomas's Pickaxe, much of the code is hard to follow for a beginner - here's a snippet (from page 3 of 4):

[n.b. Some lines below are incomplete due to Blogger's interpretation of the characters]

Again, we update the require statement in dsl-loader.rb to load the mydsl4.rb file and run the loader:

% ruby dsl-loader.rb params.dsl
#
["@parameter", "@name"]

This is all well and good, but what if we don’t know the parameter names in advance? Depending on the use cases for the DSL, parameter names may be generated by the user. Never fear. With Ruby, we have the power of method_missing. A two-line method added to MyDSL will define a DSL attribute with dsl_accessor on demand. That is, if a value is to be assigned to a (thus far) non-existent parameter, method_missing will define the getters and setters and assign the value to the parameter.

% cat mydsl5.rb
require 'dslhelper'

class MyDSL
def method_missing(sym, *args)
self.class.dsl_accessor sym
send(sym, *args)
end

def self.load(filename)
# ... Same as before
end
end

% head -1 dsl-loader.rb
require 'mydsl5'

% ruby dsl-loader.rb params.dsl
#
["@parameter", "@name"]

Once again Olsen's - Design Patterns in Ruby has really helped me out describing the use (and limitations) of method-missing (p.184). I swear I heard some clanks as the pieces re-arranged themselves and one or two fell (almost) in place. Having copied Freeze's code into Ruby, it would not run. At least now the code is not as complex looking at it was and reading it through now it makes a lot more sense. I'm really looking forward to trying this again in Eclipse. On that first exposure I had a vague notion of the principle of method-missing, but reading Olsen's book I've a better grasp and may be able to keep hold of this and other Ruby concepts. Believe me that helps in my pick-it-up:put-it-down world.

more to follow ....

Domain Specific Languages [I]

Even after a brief acquaintance with the h2cm web site and W2tQ, you'll appreciate the word domain is both hard and soft-wired into my consciousness. On first discovering Hodges' model, the four quadrants were clearly recognisable as knowledge domains.

As the website evolved(?) 'Care Domains' was added to the model's title (which has also paid some dividends in search engine terms).

In the early days of hobbyist programming a major project would be to write a compiler. I'm sure I can recall several magazine articles on this (Practical Computing?); step-by-step of course.

Searching on 'domains' as I frequently do, it was inevitable I would come across DSLs or Domain Specific Languages, which instantly caught my attention. Here are some intros -

http://martinfowler.com/bliki/DomainSpecificLanguage.html

http://homepages.cwi.nl/~arie/papers/dslbib/

http://www.infoq.com/presentations/domain-specific-languages

- more to follow, but please don't wait for a compiler ;-)

Website & Content Review: Inter - Intrapersonal

While grappling with Drupal is an opportunity to learn new skills and put the website on a more professional and potentially dynamic-database-driven footing that is just one step. The other step is the need to evaluate the content and have a right sort out!

One thing that has bugged me for a long time is the name of the top left care domain - this junction of the HUMANISTIC - INDIVIDUAL axes. Being focussed on the individual - the label should read INTRAPERSONAL not INTERPERSONAL as reflected in the following definitions:

INTRAPERSONAL: Existing or occurring within the individual self or mind.

INTERPERSONAL:

1. Of or relating to the interactions between individuals: interpersonal skills.
2. Existing or occurring between individuals: interpersonal communication or conflict.

Source: Answers.com

This is not a mistake as such, it merely serves to highlight the way Hodges' model relies on the underlying continua. This domain from a health, social care and family perspective can readily incorporate INTRA-INTERPERSONAL. Today when I sat down with my clients and their carers it was not exactly SOCIAL, the emphasis was on INTRA - INTERPERSONAL interactions (situations).

So, from now on I will refer to both INTRA & INTER in any new content to follow.

Speaking of future content: the 1st NW England Drupal user group meeting on Wednesday night in Manchester is at the Cornerhouse. Eight attendees so far including myself, with six people 'watching' and yet to decide - I can't wait. Don't think we'll manage the Apple store too - another ti:me.

If you have any pointers regards future content please get in touch - h2cmng AT yahoo.co.uk.

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.

SOCIOLOGY links: Holistic Bliss or Tristram Shandy ... IV

I've introduced the rationale behind the content of the INTERPERSONAL and POLITICAL links pages. Let's now look at SOCIOLOGY: Although the ticking of the clock has a mechano-quantum constancy, people are collectively nudged forward through the 7 AGES that characterise our personal and social lives. These two lives beg a question in terms of Hodges' model and its four care (knowledge) domains. From what I've already said chronological age is mechanistic; but if that is the case in which domain does pathological age reside? Perhaps it is not just one domain, but a matter of span ;-). If for you this means or includes traversing the SCIENCE and SOCIOLOGY domains; that is quite a journey, so better prepare...

Following this on the SOCIOLOGY links page - can that be HEALTH PROTECTION & PROMOTION? Again!

Well yes it is and this is not a mistake. Just an effort to emphasise the need to direct our attention and resources at health promotion and prevention at a community AND individual level. Visiting Assen in the Netherlands last month you hear of the Dutch love of bicycling. Seeing is believing though and all ages were out and about. Marvellous to behold.

If health and communities are about support then there are a multitude of groups and networks dedicated to the task for PATIENTS and CARERS. The emphasis now is also to engage the public in service and policy development. They also need to be INVOLVED in public health, health and social care research and not just as 'subjects'.

In terms of Hodges' model contrast this journey - SOCIO-POLITICAL with the SOCIO-SCIENTIFIC referred to above. Another post perhaps....?

Similarly, there are PROFESSIONAL and other associations across all disciplines. This includes the notion of integrated services, still a long way to go. These professional groups are 'political' in the [ORGANISATIONAL] sense, but I wanted to reflect the social - socialisation - aspect. (What! You've done one row! Come on Jones hurry up!)

The phrase COMPUTER SUPPORTED COLLABORATIVE WORKING (CSCW) is not used as widely these days, but it captures a key purpose in HEALTH, SOCIAL & COMMUNITY INFORMATICS whether at an international, national or local level. Although I have placed it on the INTERPERSONAL page EDUCATION is all about 'socialisation' and an ongoing debate.

SOCIOLOGY I & II speak for themselves and in there you should find medical sociology and narrative medicine. Surely, the SOCIOLOGY listings should have pride of place here? The position of SOCIOLOGY on this links page is not intended to reflect examples of various socio-political concepts such as demotion, loss of status, alienation... It is true, these can reach over the INDIVIDUAL-GROUP axis and pummel the individual; but -

No. As with the other links pages SOCIOLOGY sits on the 2nd row due to the needs of health and social care learners (ALL staff!), patients and carers (the Public) to have speedy access to the relevant links.

QUALITATIVE RESEARCH is next and the ongoing quest for more effective methods and tools to help unravel the phenomenological world. As with QUANTITATIVE RESEARCH in the SCIENCES listing, I've included some examples of software tools.

The final row presents ANTHROPOLOGY in which medicine and SCIENCE will find their earliest roots. Fittingly then HISTORY is right alongside. Two listings are devoted to ART, CULTURE, MEDIA and TECHNOLOGY; a realm I could really get lost in if I had the chance. I've tried to include some of the best examples of various genres, but they change so quickly. Please let me know (through the website) if you've a gem or two.... to share - or if you notice any broken / outdated links. I use tools to check, but they are digital and of course on this [HUMANISTIC] side of h2cm everything we touch is 'analogue'(?).

As you may have noticed this SOCIOLOGY domain is the smallest with just 12 listings. Perhaps here with the POLITICAL domain in the lower half-group hemisphere of Hodges model more (people) really does mean less? Yet, another post perhaps...?

Although ARCHITECTURE seems to epitomise -

• the physical world with its presence (whether loved or abhorred);
• the notion of artefact on a grand and detailed scale
• the mix of mechanism and material
• ....
  

Architecture is also associated with the human spirit, the ephemeral. I have wondered about including the subject here. It is a truly colossal micro-macro subject and also a profound factor in the health and well-being of all of us.

Like health it touches all the knowledge domains....

Next! Last but not least SCIENCES...

INTERPERSONAL links: Holistic Bliss or Tristram Shandy ... III

The INTERPERSONAL domain links are to my mind (no pun intended) fairly obvious, at least that first row complements the SCIENCES top row opposite.

Basically, who needs a talking therapy and who needs a drug therapy?

The two uppermost care domains are intended to represent the INDIVIDUAL axis, so just as the SCIENCES [ANATOMY & PHYS] domain covers physical care; so the INTERPERSONAL domain encompasses emotional and mental health care.

Hodges' model is comprised of four care domains, but it is these two [INTERPERSONAL : SCIENCES] applied to the individual that even today we struggle to balance in theory and practice.

A key factor in Brian Hodges' early nursing career (and mine) has been the role of institutions, organisations and the formal policies and structures they represent. This can be depicted as:

EMOTIONAL HEALTH : PHYSICAL HEALTH (both 'individual')
OTHERS family, society : INSTITUTIONS (both 'group')

As to the INTERPERSONAL links themselves - I arrived at mental health through reading a psychology text on Wundt and introspection, then James..... PSYCHOLOGY being of central importance in this domain has two listings, with MENTAL HEALTH and closely related THERAPIES also sharing the top row. I may swap these around: PSYCH-OLOGY as a cognitive science should be placed rightmost, while MENTAL HEALTH and THERAPIES should be further to the left being more 'humanistic'. What do you think?

Do the sciences have to be corralled in the SCIENCES domain? I think I remember Bryan Magee and John Searle in conversation noting that many disciplines with science in their title are probably not sciences - in that upper right hand quadrant sense. Maybe it is just that -

cognitive science : "SCIENCE" (physics, biology, chemistry)
social science : political science

- are still running wild out there, untamed and as yet unbroken? Cognitive science has however, clearly come of age and the 21st century will undoubtedly be the century of the brain when anatomy, physiology and genetics are linked to thought and individual (and even social) behaviour.

Already the content here highlights cognition (thought). The inclusion of other link categories in this upper-left set can be explained with recourse to cogitation. After PSYCHOLOGY, PHILOSOPHY (with ETHICS) is the rather obvious 'ology'.

For better or for worse our culture is driven more by IDEAS and ideology than philosophy. Call it the informal philosophical engine that drives CREATIVITY.

COMMUNICATION lies at the heart of all things human-e. Given the millennia that the patient-physician relationship has been around, you might expect it to be perfected by now. Well health and social care workers and the public they serve are still trying to reach empathic nirvana (although that may be to take communication a bit too far).

Hodges' model has a role to play supporting reflection for all.

IDEAS, COMMUNICATION lead us to belief and a central component in psychological therapies. Belief is also a thread can be used by one individual to lead others positively or to subvert other individual's capacity to think critically. It is in this INTERPERSONAL domain that good and evil are so proximal they create heat, fanned by a culturally driven winds of history and media from the South. Be-life indeed. Here then - THEOLOGY is purposefully placed with TRANSDISCIPLINARITY. If it is to serve humanity Religion must be bound and integrated into the corpus of knowledge and that includes reconciliation with the SCIENCES. We cannot deny myth and yet myth cannot deny evidence - a debate that will go on......

The economic emphasis placed currently on creativity is quite remarkable, not just at a national level (cue ramble...). Cities recognise that their future development, sustainability and very survival depends on the generation and flow of ideas. Some things do not change. In myth a special place has been reserved for the isolated thinker, the one individual who takes themselves away for weeks-months, to be touched by the spiritual realm, to return to the community delivering insight, creative sustenance. Now creative individuals are needed more than ever. The isolation is virtual, the community potentially global. The energies of individuals are directed at solving problems concerning more mundane matters of cost, risk, flexibility and growth. Those creative outputs are distilled through team work and although they are then diluted they remain invaluable - such is the scale of the problems to be solved. Just as the great rivers that feed our cities have their sources - often remote and isolated in the high mountains, so ideas and creativity begin with one individual. That flow of personal knowledge now finally enters the ocean of KNOWLEDGE MANAGEMENT - EXPERT SYSTEMS (decision support systems).

I have a little mantra that I share with students. It's not perfect as there is much overlap; but I figure that what aptitude is to engineering so attitude is to caring.

HEALTH PROTECTION and PROMOTION, SELF CARE are all about attitude. Of course, money in the form of departmental budgets (those institutions do matter) and family income can make a huge difference, but if the right attitudes are not present then you may as well - "go fish!".

In light of the above STUDY SKILLS and EDUCATION and TRAINING speak for themselves - on this occasion at least. One of the original purposes of Hodges' model was to facilitate reflective practice (more to follow). We are familiar with the mechanical tools in use everyday to the extent they are taken for granted. Now the focus of training is more likely on the software tools that translate IDEAS into art, artefacts and conceptual frameworks.... ;-) These graphical and design tools must be learnt and the HUMAN-COMPUTER INTERFACE and its ACCESSIBILITY 'quotient' can prove to be either a brick wall or a leg-up for the individual user (even if networked or a collaborative tool - see SOCIOLOGY links).

If the SOCIAL domain reflects the worlds of the others, then the last INTERPERSONAL row REST & RECREATION reflects something of me and my family.

"Next!" - the SOCIOLOGY domain links....

POLITICAL links: Holistic Bliss or Tristram Shandy ... II

Having mentioned the other day that health and social care related subjects are placed at the top of the links pages, of course the POLITICAL page - as awkward a cuss as ever - differs. The political topflight is missing some obvious candidates. Although there are related links in there somewhere amongst the four links pages I have not explicitly listed:

• mental health law
• (patient - carer, long-term) advocacy
• consent and capacity
• confidentiality
• professional (and other) codes of conduct
• health and safety
• or global health

Perhaps I should list these or other missing political categories? If we stop and think about it though - what do you need before you can deliver coherent health and social care? That top row are the critical determinants: the starting blocks. If DEMOCRACY, JUSTICE and LAW are absent or taken away where is care? Why in so many developing countries is health care so poor - native/ethnic medicine practices can only go so far?

In promoting 'DEMOCRACY' this in itself is a challenge of our (Western) times, given the apathy that exists in local and national politics. No surprise then that CITIZENRY & LEADERSHIP (C&L) are not far behind with their hands raised. There's a chicken and egg here: should C&L be on the front row? Then the people would have the Government they deserve on the second row. Can they be side-by-side?

HUMAN RIGHTS should be on that top row; however, HUMAN RIGHTS are surely dependent upon DEVELOPMENT to overcome POVERTY and effective LEGISLATION?

We need cognitive capacity to boot-load our person-al operating system first thing in the morning, although in terms of HUMAN RIGHTS and an individual and family's capacity to exercise choices ECONOMICS is where the buck stops. While vital money is not enough: International STANDARDS make the world go around from paper size, device operation to INFORMATION STANDARDS. I like this word GOVERNANCE because it does not have to be central, it can be peripheral - grassroots - as well and takes many forms: national, corporate, financial, clinical, information, civil, and green. Sometimes political change needs to start on the edge, that's where others can get on-board.

Communities are social entities, nebulous things as I still recall from an old course essay: Community care means whatever you want it to mean: discuss? So if community is social, then why is COMMUNITY INFORMATICS [CI] in the political links domain? Well, CI very broadly speaking seeks to promote and assure the study and use of informatics developments, specifically communications and information technologies for groups within a population who may otherwise remain disadvantaged, and so find themselves on the wrong side of the so-called digital divide. Whether your arrival is positively or negative framed in terms of social inclusion or social exclusion you must pass through Customs and Excise:

c/o the political domain.

NEWS is quite a strange thing or these days a many splendoured-multimedia-mobile kind of thing. You see the messenger is always transformed into a bizarre beast: a POLITICAL animal. The animal has long been on the endangered list, it is rarely sighted and the SCIENTISTs next door call it a 'Trust'. Because its appearance is so remarkable children are wary; so in a poll they elected to call the creature a 'can-U-really'.

Who 'owns' the news, controls it, governs the media - what difference does it make? What is news these days? The quality of health care information and news and overall what counts as news is at issue. Big brother once the epitome of totalitarianism is now equated with total trash.

Connected to the news is the global family's and a Nation's ability to SEARCH the web without censorship?

Finally then what categories are missing here politically? It's true war & peace, mass marketing, weapons of mass depletion, crime and punishment, crimes against Earth, plus management have gone AWOL.

ORGANISATIONS are in there, but personnel and human resources are not. Should they be? What do you think? What's in your political set?

"NEXT!" INTERPERSONAL links
(speaking of which - checkout Doc Walker, Driving with the Brakes On - great song!)

Holistic Bliss or Tristram Shandy and the Web Hydra I

Building the h2cm website a decade ago the links pages -

INTERPERSONAL : SCIENCES
SOCIOLOGY : POLITICAL

- were planned as a feature from early on. They started as TWO pages but have become FOUR and far more general in nature than originally planned. I first envisaged a core h2cm nursing set into which students - life-long learners could all dive.

Perhaps there's a project there for students: Specify what you consider to be a core set of links resources and justify your answer in terms of either one of the following or a combination of - models of care, health-social care policy, self-care, multidisciplinary teams? .....

Like many potential h2cm developments (XML templates, ...) which I've shared with contacts over the years the core h2cm links set never saw the light of an HTML page. The main target audience for the links pages remains as the health and social care community (although given h2cm's universal scope I'm jumping around on this (sadly) cold-tin-roof shouting: "Hey everyone - oveeerrrr here!").

If you look at the four links pages and the model's axes INDIVIDUAL-GROUP & HUMANISTIC-MECHANISTIC you might conclude that a re-organisation is needed. So as the other potential developments are still outstanding (Drupal, ...) maybe this deserves some explanation?

Why? Well, there is too much there and many visitors may be put off? I navigate these links spaces quite readily (which as author is not surprising I suppose), but being critical the pages do represent a management overhead, a distraction from other tasks. Seeking a positive side maybe this generic set of links have emerged out of a human attempt (most searches/links resources are of course now machine-based) to push the 'holistic frontiers' and our conception(s) of what it is to care?

You'll notice on several links pages that the first row of links acknowledges the intended audience. I do not want students to have to scroll for the health and social care related resources. So, these are placed near the 'top'.

Although a domain links page is presented as a single 4-column table, it is valuable to take the main headings and view the four care or knowledge domains links together. This is listed below, if the formatting holds! (Probably need a graphic for this...)

Over several posts we'll explore the links pages one by one. Already a few things stand out...

What's there. What isn't and whether there's a why: initial observations welcome....

P.S. Shame about the weather last w/e in NW England.

Psychology I II Mental Health Therapies Anat&Phys Care T&P Evidence BP Research

Philosophy ---- Ideas Communication Theology Health Inform. II Info Sources Diagrams

Health Promotion Study Skills Education DSS Visualiz. II MarkupLangs Ajax & XML

HCI Accessibility Creativity Graphics Environment Virtual Reality Science Astronomy

------------------Rest & Rec----------------- Maths, Logic Engineering Programming [Toolset]

7 Ages Health Prom Patients Practitioners Development Democracy Economics Policy

CSCW ------ Sociology I II Qual Research Activism Citizenry Employment Human Rights

Anthropology History Art & Culture I --- II Info. Gov Standards Open Source Comm. Inform.

--------------------------------------------------- News ------ Soft-Hardware --- Search -------- Org

--------------------------------------------------- ---------------------- Commercial ---------------

Four knowledge domains = four audiences?

I don't know if there is any sense in this, but people look for 'signs' all the time - don't we? With the last front-end revision of the website (early 2005) I had twigged that there are at least four audiences that an introduction to Hodges' model needs to address.

Looking at the care domains the following seemed to fall just right:

Patients and Carers : Students - Lifelong Learners

Public [Citizens] : Policy makers, Managers

These may be lost to many visitors (but not you!) given the surfing attention span. If people do access and digest the first page above, which acts as a general introduction, they may not reach the second audience specific page.

Should I swap these around?

What is provided on the first page of each, is a basic h2cm graphic showing some relevant concepts for that particular domain. (It's this representation that trivialises h2cm).

The introductions do need revising and updating. I found some typos on the student - sciences piece, so not the best effort.

I think overall though this approach works - it was a sign to me.

What do you think, any suggestions?

Ecotherapy to follow...

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..

What is a 'domain'? II

Last week I referred to a definition of domain that included mention of:

1. A territory over which rule or control is exercised.
2. A sphere of activity, concern, or function; a field: the domain of history. See synonyms at field.
3. Physics. Any of numerous contiguous regions in a ferromagnetic material in which the direction of spontaneous magnetization is uniform and different from that in neighboring regions.
4. Law.
a) The land of one with paramount title and absolute ownership.
b) Public domain.

The remaining definitions -

5. Mathematics.
a) The set of all possible values of an independent variable of a function.
b) An open connected set that contains at least one point.
6. Biology. Any of three primary divisions of living systems, consisting of the eukaryotes, bacteria, and archaea, that rank above a kingdom in taxonomic systems that are based on similarities of DNA sequences.
7. Computer Science. A group of networked computers that share a common communications address.
[Source: Answers.com]

- I suggested were connected by language....

There are some very formal definitions of domain from the world of 5. maths. Pulling other words out of the hat isn't the answer, but the idea of mapping between 'domains' is (I think) very important in Hodges' model; even though any mapping is subjective and - in this instance - not evidence based. Is it possible to be presented by an insurmountable edifice - something that terrifies you and yet fascinates at the same time? Well that's maths for me. I'll return to this another time.

Maths, 6. biology and computer science (to follow) are as noted in the first post domains of study. In health care and especially within medicine 'formal languages' has been and remain a major preoccupation in the form of coding and classification schemes. If you follow the links above you'll see they are listed in the SCIENCES page - since they are formal and structured. In order to report on activity locally and epidemiology at a global level, classification and coding is essential.

The links also include examples of languages of nursing. Nurses spend quite some time writing and computers still choke when it come to analysing and reporting on reams of narrative text. Computers still love codes. Although they are becoming ever more versatile, they still crunch numbers or 'data'.

As for computer science 7: in the 1980s I remember seeing graphs depicting 'languages' from microcode and assembler language at the heart of the machine, through to the fuzzy world of written and spoken language. In between there's quite a spectrum covering logic and a huge range of computer programming languages.

Searching the web I suppose I was bound to come across domain specific languages (DSL)? There's a couple of videos and hey Ruby's in the frame! Funny that, I had noticed in Starbucks how some people like to show off their DSL expertise.

One things for sure this really focuses the mind in terms of defining a domain!

What is a 'domain'?

With visitors to the website confusing the title Hodges' Health Career Model for job careers; the addition of 'Care Domains' was intended to reduce confusion.

I think this has helped, but because the future beckons and this blog plus the website appear to have a multidisciplinary readership more clarity may be of help, especially the use of this word 'domain'.

The dictionary is a good place to start:

do·main

1. A territory over which rule or control is exercised.
2. A sphere of activity, concern, or function; a field: the domain of history. See synonyms at field.
3. Physics. Any of numerous contiguous regions in a ferromagnetic material in which the direction of spontaneous magnetization is uniform and different from that in neighboring regions.
4. Law.
a) The land of one with paramount title and absolute ownership.
b) Public domain.
5. Mathematics.
a) The set of all possible values of an independent variable of a function.
b) An open connected set that contains at least one point.
6. Biology. Any of three primary divisions of living systems, consisting of the eukaryotes, bacteria, and archaea, that rank above a kingdom in taxonomic systems that are based on similarities of DNA sequences.
7. Computer Science. A group of networked computers that share a common communications address.
[Source: Answers.com]

1. A territory over which rule or control is exercised: can apply in Hodges' model from a theoretic perspective by a curriculum, a scheme of work, and consequently in practice. We refer to the clinical domain, medical domain or social domain. This latter usage overlaps with 2. we often speak of fields of study and practice.

Place (territory) is the vital ingredient here; specific wards, clinics, treatment centres and even community may be described as a domain of care. The way 'domain' is used in day-to-day language may vary markedly. On some occasions the domain in question may be at an even higher level: clinical domain versus management domain.

3. Is interesting because although they are not exactly magnetic, there are several polarities* at work in Hodges' model.

On the borders between Hodges' domains, what is the 'switch' (context, situation, person focus ...) that determines the placement and direction of care concepts: for example - humanistic or mechanistic?

Sticking with physics there are undoubtedly several chaotic attractors within the bounds of Hodges' model. From the behaviour of the heart to the role of psychosocial stress in risk of relapse. If several variables are linked chaotically, what risks are run if one or more domains (however defined) are deemed non-relevant or out of scope?

4. This legalistic definition of 'domain' also applies. Hodges' model is person-centred, but although focused on the individual the model acknowledges the need to reconcile the diametric opposition that is the law that prevails for the one [INTERPERSONAL] and the law, justice and systems of the many [SOCIAL] and [POLITICAL].

Hodges' model is also in the public 'domain' all that is needed is an acknowledgement.

The remaining definitions 5, 6 and 7 - maths, biology and computer science - are all connected.

The connection?

Language?

More to follow.... Hope to return over the weekend...
*Will post about polarities, when I take a certain photo over in Manchester.
Just hope they don't pull it down before I get there! Bye for now...

Hodges model: What is it? [3] The science of sailing...

Thanks Lorraine for your comment on Hodges' model: What is it? [1] - hope to hear more from you.

Like good weather and a pair of familiar lived-in walking boots Hodges' model should encourage exploration, but should it do more than that?

Definitely!

Policy, the health and social care literature and the media often refer to care pathways and the patient journey. A journey imposes cognitive and physical demands on the individuals concerned and involves the interplay of various forces and the expenditure of energy.

Care pathways require negotiation, especially if everyone is truly unique and services and care delivery are person-centred. The patient journey has a start and end point: whatever the outcome. For all travellers there is no such thing as a free-lunch in energy terms.

So far Hodges' model has been described as a house of ideas, a sailing vessel and an interface. What next? Well there's more to sailing than meets the I-skipper!

You see setting sail there are four forces at work...

The FIRST is the wind of time that blows fair and foul, from tranquil, stillness and peace to unpredictable, chaotic and turbulent. Foul winds exact pressure on the rigging, the sails, the whole boat suffers: noise. Relentless pounding. Physical forces act on our bodies and the sails. The winds attempt to heel the boat over. We use SCIENCE to understand this force.

The SECOND force is that of the keel, which seeks to counteract the wind of time. Pushing against the water the keel provides ballast. In health and social care there is a social and POLITICAL contract at work, health and social care services are provided to help those buffeted and battered by the wind. Break this contract and all-aboard are imperilled. Check the charts, take a regular bearing. Reflect. Beware the false lights of the wreckers.

THIRDLY, the wind creates pressure on the sails, high pressure to the windward and low pressure behind. This difference in pressure draws the boat forward. This equates to the combined effects of groups of individuals, carers and volunteers and the wider SOCIAL community whose energies help the patient (and their family) to muster their resources, strengths and progress whatever the context (heading).

The FOURTH force is the friction borne by the yacht's surfaces and the water. Those who sail do so largely because of the interplay of this and other natural forces. Water. Wind. Salt. Friction lets us know we are alive. Friction helps bring us into being, but this friction can hurt especially over time. See worthiness is tested, confidence wanes. Psychically isolation chall