Hodges' Model: Welcome to the QUAD: March 2008

- learn about the conceptual framework Hodges' model. A tool that can help integrate HEALTH and SOCIAL CARE, INFORMATICS and EDUCATION. The model is situated, facilitates person-centredness, integrated - holistic care and reflective practice. A new site using Drupal is an ongoing aim - the creation of a reflective workbench. Email: h2cmng @ yahoo.co.uk Welcome

Saturday, March 29, 2008

Week ahead: Ruby/Rails conference and next paper?

It should be a stimulating week ahead as the clocks spring forward (why not two weeks ago?) and I check the schedule for Scotland on Rails and plan the sessions to attend. Now with a new Eee PC I should also have something to write on and connectivity.

Yesterday jQuery in Action arrived. I've started to read it and am finding already that the two CSS books that were until recently just sitting on the shelf are helping me to grasp what jQuery is about. One of those titles - Keith or Cederholm - highlighted that learning CSS helps you to understand and learn other languages and this really does seem to be the case. jQuery in Action will definitely be travelling to Edinburgh. Even though I'm only at chapter 2 it's a good read. There's a Selector Lab a web page to enter jQuery selector strings and see how the code relates to the DOM (document object model).

Over the past week I've been investigating Ruby graphical user interface (GUI) toolkits - specifically Tk (must check version 8.5). Just as with Drupal and settling on a theme, eventually - it seems? - I will have to choose a GUI. For now it's a case of seeing what they offer and how to run them within Eclipse (and without). The jQuery book will help push me with Drupal and enliven what will be essentially be static (archive) content:

  • Archive - Brian's original notes; my introduction
  • Biographies - Brian, myself - and who knows other contributors
  • Chronology
    • - still thinking about other content
      • old - e.g. the informatics pages
      • and new - a h2cm collaborative book.
There is no word as yet about the socio-technical chapter submitted in the new year, which may be good news? Although there's enough going on above, I like to have a paper on slow cook. So, we will see what arises on mapping, concept organisation ... in health care, communication and education. As a starter (c/o free access to SAGE journals) there are several papers on intervention mapping within public health and health promotion that will be essential reading. Another ingredient to (potentially) add to the mix - I've long wondered about case formulation within psychological therapies and Hodges' model. Time to make a start, but real slow like...

Personal PC timeline - What's Your Footprint?

Like many IT enthusiasts my interest goes back a long way. Trying to pin this down though is quite difficult. Back in the late 1970s I bought every copy of a magazine - OMNI - that mixed technology, science and science fiction. At school some of my friends did computing, visiting the nearby technical college. I missed the boat on that occasion.

Then in OMNI they started to advertise the Sinclair ZX80 and in Nursing Times there was a computers in nursing supplement, it was called CINNEWS I think. There were no doubt other influences, but I decided to wait for the ZX81 before jumping on-board.

After the ZX81 3.25 MHz 1K of RAM (added 16K RAM pack) it goes as follows:

  • BBC micro MODEL 'B' BBC Micro
  • Elonex 286 12Mhz
  • Elonex 486 33Mhz
  • Dell Pentium II 266Mhz
  • Evesham Pentium 4 2.66Ghz

The Evesham PC was 6 years old last November. It's still going strong, though would benefit from a major sort out and its days are numbered as the main machine.

The latest purchase is an Asus Eee PC. Although we are still getting acquainted, I really like this little piece of kit. It seems I've done a Palin and gone full-circle.

I hope so - because back in 1981 BASIC and programming really took hold for a couple of years at least before the family came along and now the youngest is 14 - how time and technology flies....

Tuesday, March 25, 2008

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 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 ...

Monday, March 24, 2008

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:


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.

Sunday, March 23, 2008

Drupal, Eclipse and Ruby - GUIs?

It was a long day yesterday. The wind (outside) woke me at 0500 so that was that. After collecting the recycling bins and the contents I set to work.

Last Thursday I attended the NW England Drupal meeting again, a great way to find inspiration and lessons on how to 'best proceed'. There is a training event organised for next month by Chris and James of menus & blocks, but being mid-week I can't make it (even with funds). After the meeting I started the server again and loaded the Drupal sites versions 5.2 and 6.0. The last time with 6.0 there was a problem with modules and memory limits. This is now resolved and tomorrow I'll explore some more. jQuery in Action should arrive this week. I should follow-up on the kind offer of free hosting by Chris Ward from last December.

Although missing the Drupal training event, I have managed to book for two days for Scotland On Rails. I'm really looking forward to this as already mentioned here.

Over the weekend Eclipse and Ruby have been a pre-occupation, especially GUI support for windows, buttons and graphical widgets. Before things go awry I watched a screencast on debugging in Eclipse and proving that this (basically!) works on my set-up and with require 'tk' in place I've run through several Tk tutorials and started to explore just what the GUI toolkits have to offer.

The experimentation in the Ruby GUI space continues. There are many old style bindings to GUI toolkits such as Qt or GTK, or embedded DSLs or APIs based on JRuby such as these three new ways of building GUIs with Swing. These libraries use different approaches for building and arranging GUI components.

Ruby Shoes is a GUI toolkit with a slightly different focus. Ruby Shoes is a creation of Why The Lucky Stiff, author of Why's (Poignant) Guide to Ruby and prolific programmer of libraries such as HPricot (HTML Parser), the web framework Camping and many others. Why's toolkit Ruby Shoes, is a GUI toolkit built on GTK technologies Cairo (drawing) and Pango (for text). The number of GUI controls it supports is limited by design, and the ones that do exist use OS GUI specific components. Currently MacOS X, Windows and GTK versions are available.

The entry goes on to describe the influences behind Shoes that includes Processing - 'an open source programming language and environment for people who want to program images, animation, and interactions.'

Tuesday, March 18, 2008

ICMCC Event: Patient Empowerment - The Power of Information

ICMCC Event 2008: Patient Empowerment - The Power of Information

The 5th ICMCC Event will be organised from June 9-11, 2008, at University of Westminster, London. It is sponsored by The BCS Sociotechnical Group.

 For its fifth annual event, ICMCC will focus on the power of information. Information is both the result of data put to use and, once combined with experience, the basis of knowledge. If used properly it can empower patients, both actively and passively. Information is one of the primordial aspects of medical and care compunetics, the field of social, societal and ethical aspects of computing and networking.

Using knowledge to create knowledge is the major concept of the emerging knowledge society. This way, knowledge becomes sustainable and a tool to realize the millennium goals. But to achieve this in the most effective way, we will have to make inventories of knowledge. Knowledge is derived from the synthesis between information and experience.

ICMCC is becoming the global guiding platform in bringing information and experience related to medical and care compunetics together, thus creating the necessary inventories of knowledge. As we are aiming at both the patient/citizen and the professional we also target and facilitate the shifting relationship between the two.

The ICMCC (International Council on Medical & Care Compunetics) is an international foundation operating as the knowledge centre for medical and care compunetics, making information on medicine and care available to patients using compunetics as well as distributing information on the use of compunetics in medicine and care to patients and professionals.

Medical and Care Compunetics is the field concerned with the social, societal and ethical implications and applications of ICT in health and care (COMPUting & Networking, its EThICs and Social/societal implications).

Monday, March 17, 2008

Fundamental-ism lost to nursing

Nursing, health and social care are full of fundamentals:

- of care, aims, objectives, arguments, issues, targets, values ...- and much more besides. Fundamentals fuel and provide the oxygen that sustains the research literature and media. Fundamentals are the constant heat for education, practice and policy. Amongst the definitions of -

fun·da·men·tal (fŭn'də-mĕn'tl) [Answers.com] there is

Basic, base, foundation, central, core, essential, necessary, key, primary, significant ...

Language is amazing in how far a short detour can take us.

has always been associated with religion and of course no less today; when the literal reading and interpretation of religious texts means that fundamentalism is tainted by beliefs and actions that extend from intolerance, through to extremist tendencies and terrorism. Fundamentalism in this extremist religious guise is not the focus here.

Looking at nursing text book titles fundamental still sells. At times seeking out high standards of nursing care makes you wonder whether a fundamentalist reading of nursing (and human rights) is needed?: and as you get older the need gets ever more acute.

In our informationally overloaded world maybe the message of high quality (fundamental) basic nursing care is lost in the noise. The problem I believe lies in the other meanings of fundamental -

Physics.a) Of or relating to the component of lowest frequency of a periodic wave or quantity.
b) Of or relating to the lowest possible frequency of a vibrating element or system.

This means that even though those low frequency, infrasound messages can travel an awful long way and strike an occasional significant ethical chord: the population at large is hard of hearing.

Sunday, March 16, 2008

BASIC, Ruby, DATA and Scotland On Rails

This weekend reading more of Hal Fulton's The Ruby Way, there was a blast from the past in the form of '10.1.25 Reading Data Embedded in a Program' and a reminder of all those DATA statements typed in from magazines.

Ruby not only supports the industry database and SQL standards, but other approaches such as embedded data and KirbyBase. Fulton's book is designed for 'random access' and yet I'm reading it through. There are jewels in the texts on Ruby. Sentences that while fairly obvious still serve to catch my breathe '... They differ in the amount of context they copy. ...'

10.4.7 Object-Relational Mappers discusses ActiveRecord and Og (object graph). Apparently Og can generate a database schema from Ruby class definitions (rather than vice-versa). This is a useful and powerful ORM 'especially if you design your database after your objects.' p. 384.OK ....

With all this reading on databases whatever happened to the Associative Data Model? Still alive and very well I believe, yet more Sentences to figure out.

In order to try and make some headway, next month I'm heading for Edinburgh and the Scotland On Rails conference.

I can't attend the full event, but plan to make sure the trip is well worthwhile. While I hope all the speakers stay in fine fettle, there is a speaker for Saturday whom I pray stays in finest lustre - a presentation on DSLs! Just one highlight of what should be a great talk. [Stay well Joe!]

Tuesday, March 11, 2008

Ruby Holistic I

Using BBC BASIC many years ago as I recall I used an array to capture user input and then save this data to files.

I've just written a very simplistic Ruby program, not very Rubyesque in its code style to capture some data and store this in an array. There are many options here and not limited to:

  • declaring an array from the outset;
  • using a hash;
  • using MySQL.
At present it's just about getting used to the Ruby syntax. I have yet to write a class and methods of my own and resort to file handling. Looking forward to doing so. Not far into the Ruby on Rails book it was getting very interesting so I need to pick that up again too...!

Also need to get back to Drupal and the new versions of Brian's notes and my introduction to the model and website. How many themes and modules are Drupal 6 compatible now? It's the NW England Drupal user group meeting again on the 20th in Manchester.

Sunday, March 09, 2008

CARE = Plastic + Paper + Packages

The commodification of health seems to be a new phenomena and yet of course the search for 'cures' and 'spells' to ease this universal aspect of human existence has been with us for millennia. Now though the world of pyramid selling has ramped things up. The world at large has stepped on the gas. Plastic may well rule as the means to pay for the COS-plas-ME-tic surgery and presents a public face to the digital world of bits and bytes.

Now as we've seen the superstores and global IT players are getting in on the act (is that an unfortunate turn of phrase?) with Tesco, Google and Microsoft on board the bus with their respective partners. Health tourism clearly extends the notion of 'package holiday' AND 'care package'.

So - 'global health' anyone?

There must be a risk that the real messages of global health will get lost in the fog of contrails and business transactions.

In the meantime the heady interplay of plastic and paper and getting the biometrics to fit just right - points to the need for vigilance. As this blog and website makes clear I'm an ICT champion. I'm also a community mental health nurse. This means with fellow champions that two perspectives need to taken into account and monitored for risks and opportunities. I just wonder whether the move from paper to paperless records opens the door to the dilution of high standards of care?

Fragile warning tapeLook at it this way: there we are in our care sectors with our care packages. In health we are trying to get leaner, stripping out redundant processes, delays, duplication, trying to magnify real purposes and strengths. As for the superstores well they (and we!) still need to get to grips with packaging. I hope this does not just prove to be a straight swap - variously labelled -


Fragile tape: image source http://adifferentvoice.wordpress.com/2007/09/18/labels/

Saturday, March 08, 2008

Hodges' domains and the 'audience'

In Tuesday's post on the NHS health library services four key purposes cited in the report were listed:

1. Clinical decision making by patients, their carers as appropriate, and health professional
2. Commissioning decision and health policy making
3. Research
4. Lifelong learning by health professionals.

It is encouraging to see that my assumptions about the scope of Hodges' model can be identified elsewhere. This is clearly the case with the four key purposes above and the four introductory pages  to Hodges' model - listed as follows:

library purpose -|- h2cm audience -|- h2cm knowledge (care) DOMAIN

patients, carers (person-centred) -|- Individuals -|- INTRAPERSONAL
commissioning ... policy making -|- Policy makers, Managers -|- POLITICAL
research -|- Students, Researchers, Lifelong learners -|- SCIENCES
health profs as lifelong learners -|- Society, Public, Learning culture# -|- SOCIOLOGY

# The SOCIO- in socio-technical

Friday, March 07, 2008

Personal Health Records: Microsoft, Google & NHS HealthSpace...

This post follows from an item by Neil Versel at Digital HealthCare & Productivity on Google CEO Discusses Google Health.

This sentence makes interesting reading:

Schmidt said Google can change that by delivering a product that is not “too vertical” or “too specialized” like so many of the PHRs out there.
Wherever you find Google discussed, Microsoft are also in the mix, so there's an invite to open the HealthVault (see: https://www.microsoft.com/en-gb/industry/health?rtc=1). There are many more PHR players as Versel's article highlights.

All of which begs the question how long has the NHS's HealthSpace been around for - quite a while by my reckoning.

While on things personal and public - the journal Health Expectations - promotes critical thinking and informed debate about all aspects of public participation in health care and health policy.

Thursday, March 06, 2008

Book: Social Information Technology: Connecting Society and Cultural Issues

Social Information Technology: Connecting Society and Cultural Issues

Social Information Technology:
Connecting Society and Cultural Issues

Edited By:
Terry Kidd, Univ. of Texas Health Science Center, USA;
Irene Chen , Univ. of Houston Downtown, USA

An interdisciplinary field, technology and culture, or social informatics, is part of a larger body of socio-economic, socio-psychological, and cultural research that examines the ways in which technology and groups within society are shaped by social forces within organizations, politics, economics, and culture. Given the popularity and increased usage of technology, it is imperative that educators, trainers, consultants, administrators, researchers, and professors monitor the current trends and issues relating to social side of technology in order to meet the needs and challenges of tomorrow.
Social Information Technology: Connecting Society and Cultural Issues provides educators, trainers, consultants, administrators, researchers, and professors with a fundamental research source for definitions, antecedents, and consequences of social informatics and the cultural aspect of technology. This groundbreaking research work also addresses the major cultural/societal issues in social informatics technology and society such as the Digital Divide, the government and technology law, information security and privacy, cyber ethics, technology ethics, and the future of social informatics and technology, as well as concepts from technology in developing countries.

Jones, P. (2008) Exploring Serres’ Atlas, Hodges’ Knowledge Domains and the Fusion of Informatics and Cultural Horizons, IN Kidd, T., Chen, I. (Eds.) Social Information Technology Connecting Society and Cultural Issues, Idea Group Publishing, Inc. Chap. 7, pp. 96-109.

Tuesday, March 04, 2008

h2cm: Google search results meta tags

A visitor to the website today ("hello Miami") arrived c/o Google. While I contemplate the task of content revision, one thing that seems to work are the meta tags on all the pages. I'm sure more data could be added, but it is good to see that Google is picking out and listing individual pages:

As you may have noticed, I've finally taken the advertising plunge. In the side bar 'Support W2tQ' there are three book links thanks to Packt Publishing. There isn't going to be a radical change in the overall 'tone' of this blog and site, but if there are any would-be advertisers reading this - please consider joining what will ultimately be a select band. It would be nice to have some funds to offset future costs after the past decade and to help towards covering a further conference venture. Funds would also help towards some specific training in Drupal, Ruby...
Enjoy the arc that is mid-week.

Report of a Nat. Review of NHS Health Library Services in England: From Knowledge to Health in the 21st Century

This Review has highlighted the centrality of library, knowledge and information services within the NHS and describes four key purposes for library and knowledge service:

1. Clinical decision making by patients, their carers as appropriate, and health professional
2. Commissioning decision and health policy making
3. Research
4. Lifelong learning by health professionals.

The Report makes detailed recommendations to strengthen library/knowledge services so that they are fit for purpose for the future, and as efficient and effective as possible in making a positive impact on the health of patients and the population. A number of technical issues and implications are raised.
My source: NHS-HE-FORUM

Monday, March 03, 2008

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.

Star Trek Galactic QuadrantsThe 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?

Sunday, March 02, 2008

Person-centred care: "Right! Down! Down! Riiggghhht again! Spot On!"

-|- Person-centred care is one of the Grails of health and social care. It is up there with holistic care, which it precedes since holistic care needs a subject (discuss?).

In terms of Hodges' model the 'person' (for me) is to the upper-left-of-centre. Why there? Well, you really understand why when helping people cope through dementia.

It is no surprise that the development of person centred care and personhood have been especially concentrated and emphasised in the care of people living with dementia.

They need to be and constantly refreshed too - everyone forgets - some of us more than others.

Physically of course 'person' translates to the upper-right quadrant. So there you have it - in the INDIVIDUAL-group axis the classic dichotomy-debate: MIND-BODY.

I have no argument with the need for person-centred care, but faced with a Grail and the bright light that can encompass it, safety and respect dictates we step back. From a distance we can then see that person-centred care is only part of a much bigger picture.

At the end of the day (and night!) we need to be centred full-stop.

If not then saying the words that count such as dignity, respect, choice, privacy will echo in the intra-INTERPERSONAL domain and make everyone feel good in the SOCIOLOGICAL domain. All very worthy but possibly without making an impact where it counts - in the POLITICAL domain.

By placing the person at the centre of Hodges' model ALL the
domains are ready to hand and mind.

Saturday, March 01, 2008

Upon common ground: programming languages, therapies and care models ('space')

Perhaps programming languages, psychological interventions and models of care are closer than we think?

"It is worth remembering that a new programming language is sometimes viewed as a panacea, especially by its adherents. But no one language will supplant all the others; no one tool is unarguably the best for every task. There are many different problem domains in the world and many possible constraints on problems within those domains."

Fulton, Hal (2007) The Ruby Way (2nd Ed.), Chapter 1: Ruby in Review, Addison-Wesley, p.1

Fulton includes some great quotes - this from the Introduction:

The way that can be named is not the true Way.

- Lao Tse, Tao Te Ching