Hodges' Model: Welcome to the QUAD: 2018

- 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, December 29, 2018

The Art & Science of Health: [conceptual scraps i]

The role that both art and science have to play in health, medicine and nursing is recognised by all. The distinction can be made in a great many ways using Hodges' model. Now: there is an exercise for a new group of student nurses ... ?

As I hope is evident in numerous blog posts and subjects of relevance to h2cm, notably, conceptual spaces and threshold concepts, concepts are a basic element in nursing scholarship and debate within art.
In the FT Weekend June 9-10, 2012, p.11 I read: "Conceptual: only worth the paper it's written on" (Georgina Adam). From a healthcare perspective, Adam's opening question seems fairly innocuous:

"How do you prove that you own a work of conceptual art?"
Amid the ongoing revelations involving user's personal data and the governance and values of social media companies lies the question of ownership. First though, back to Adams:
"This is an interesting issue in today’s art market, with the trend towards the dematerialisation of art, and the primacy of the idea over its physical presence.
For example, the late US artist Félix González-Torres’s works include “Candy Spills”, in which wrapped sweets are piled on the floor or in a corner, to be taken and eaten by viewers. When the pile has gone, the owner of the work replenishes it. So what stops anyone making and selling their own “Candy Spill”?

The answer is the certificate of authenticity issued by the artist or their estate. This scrap of paper is, in fact, the only proof that the work of art genuinely belongs to you, and this is actually what you buy and sell.

So losing it is a disaster."
The contrast of this within health care and its 'record' is quite stark. There are at least two ways to  distinguish between the scraps of paper we use ...:

to be continued...

Thursday, December 27, 2018

The WEF Nexus: Water - Energy - Food

“Due to the flexibility of the nexus concept, its application in empirical studies has best served to expand, rather than direct, study scope. Insights tend to be high-level, while identified actionable management and policy proscriptions are not broadly applicable. We found no clear methodology uniting nexus studies, and a lack of improvement of resource management and governance outcomes.” p.5.
"The great breadth of the WEF nexus provides an intellectual home for an expansive array of research objectives, methods, and conclusions. This has produced some valuable scholarship but simultaneously limits overall insights and lessons that can be drawn from empirical nexus work. Our review identified some high-level insights and commonalities related to the definition of the WEF nexus (centring on linkages between WEF systems), the motivations for empirical nexus study, the importance of economics and governance in the nexus and nexus analyses, and the role of social and physical factors in constructing nexus interdependencies. Beyond these, however, the findings and specific technical and policy solutions proposed in the reviewed studies are difficult to synthesize as they lack coherence." p.14.
Galaitsi, S., Veysey, J. and Huber-Lee, A. (2018). Where is the added value? A review of the water-energy-food nexus literature. SEI working paper. Stockholm Environment Institute, Stockholm.

"In this light, the ‘nexus’ has gained significant interest as a potentially effective approach for considering the interdependencies between WEF security and climate change at various scales. Put simply, a nexus is defined as one or more connections linking two or more things. The term is widely used (e.g. the environment — development nexus, the population —migration nexus, etc.)." p.445-446.
"Analytical eclecticism* is characterised by the following: (i) a pragmatic ethos that targets the world of policy and practice; (ii) interest in wide-scoped problems (in contrast to narrowly defined theoretical dilemmas) that ‘incorporate more of the complexity and messiness of particular real-world situations’, and (iii) the aim of providing complex causal stories that account for multiple causal mechanisms predominantly explored in isolation within particular research traditions (Sil and Katzenstein 2010, 412). Notwithstanding the potential of transdisciplinary approaches and analytical eclecticism, some still argue that more research and criticaltheoretical engagement is required to advance the nexus (Harris and Lyon 2014)" p. 452.

Leck, H, Conway, D, Bradshaw, M, and Rees, J (2015), Tracing the Water–Energy–Food Nexus: Description, Theory and Practice. Geography Compass, 9, 445–460. doi: 10.1111/gec3.12222.

*My emphasis and with some reformatting '-' breaks.

 Hodges' model and reference to 'nexus'

With thanks to Stockholm Environment Institute

Wednesday, December 26, 2018

i A new Health Index for England: the Chief Medical Officer's 2018 annual report


My comments are italicised below ...

humanistic ----------------------------------------------- mechanistic
health of

"... explores emerging technologies and their potential impact on health promotion, protection and treatment. This section concludes by discussing the ethics of big data, emerging technologies and the fundamental role of mutual trust between the public and health institutions."

Some individual users of social media platforms are learning the hard way, that they are the product. The effectiveness of technology depends upon user-testing and attending to the user-interface and ultimately deploying a socio-technical approach.

"The first section identifies health as one of England’s primary assets through analysing the links between health and the economy, the local health environment, social health and how the maintenance and treatment of health could be experienced in 2040."

Tangible assets are by definition readily identified. Much data gathering is focussed here: events, contacts, referrals and sessions ... Healthcare systems and health systems can be described, economics studied and quantified. Additional perspectives can and must be integrated from the experience of individuals and society as a whole (more subjective considerations). 'Here' things are described objectively as far as possible (until disproven). On this future policy can be based ...
"... identifies the potential health gains and reduction in health inequalities that could be possible with a ‘prevention first’ approach."

The effects of a 'prevention first' approach may be small initially, but it is here in society as a whole where inequalities are experienced and witnessed that the benefits will be felt.

nation as
"... explores current and future uncertainties in health and identifying the potential of futures thinking methods to inform and ‘future-proof’ health policy." Chap 1, p.2.

There are problems that demand cross-party and long-term political sustained approaches to policy if progress is to be assured.

a whole

Davies, S.C. Annual Report of the Chief Medical Officer, 2018, Health 2040 Better Health Within Reach. London: Department of Health and Social Care, 2018.

My source: twitter

Image: https://www.imperial.ac.uk/news/189627/diversity-champ-producing-plastic-news-from/

Sunday, December 23, 2018

Butt up against the Boxes...?

humanistic --------------------------------------- mechanistic



Hodges' model may seem to suggest (as above) that its purpose is to help categorise and put things - concepts - into boxes. While this is true, the model's primary purpose is to support users (and especially learners) to 'see' and reflect upon the (disciplinary) scope of what is being paid attention to and what is not. Ultimately, as we organise our thinking, we can collapse this series of boxes into what will hopefully be a meaningful whole. If this scoping is also conceptual, then the model's two axes also serve to denote implicitly the many oppositions - dichotomies that must also be negotiated (one way or another). This does not represent an appeal to, or for conceptual or information overload. Quite the contrary. We may acknowledge that uncertainties remain, information is missing. It is meaning that counts. What is salient. Meaningful as pertains to the specific context or situation at the time and the sharing of this meaning.

Image: Sisifo rassegnato/Sisyphus Resigned (1983) Copper engraving, 109 x 161 mm

My source: Cuttings, Obituary Jürgen Czaschka (1943-2018), Printmaking Today, Autumn 2018, p.19.

Tuesday, December 18, 2018

c/o BBC Radio 4: Inherited Fear

humanistic ----------------------------------------------- mechanistic

Inherited Fear

"Scared - but not named."

 The ghost of a ghost or
the memory of a

Germ cells
PAG or periaqueductal gray -
the primary control centre for pain modulation

Know your surroundings
Facial recognition


Transmission of trauma across generations

Who is Who

All around the World
War, Perpetual Conflict
Ethnic cleansing
Climate migrants ...

The Past
The Present
The Future

My source: BBC Radio 4: Inherited Fear

Monday, December 17, 2018

India: Health needs of manual scavengers: Does our health system care?

humanistic ----------------------------------------------- mechanistic

“In India, a man is not a scavenger
 because of his work.
He is a scavenger because
of his birth irrespective
 of the question whether
 he does scavenging or not.”

– Dr. B.R. Ambedkar

WORLD other

Three forms of manual scavenging:
1. removal of human excrement from public streets and dry latrines;
2. cleaning septic tanks;
3. cleaning gutters and sewers.
Health risks & risk of death 
Reported: 1 death every 5 days
Infectious diseases
Respiratory diseases
Carbon monoxide and methane poisoning
Safety, Protective equipment?


"Dalits of specific sub-caste and
is an archetype of the
oppressive legacy of the
Hindu varna system"
WORLD others

International Labour Organisation

The Employment of Manual Scavengers and Construction of Dry Latrines (Prohibition) Act (1993)
Prohibition of Employment as Manual Scavengers and their Rehabilitation Act (2013)

International Dalit Solidarity Network
National Safai Karmachari Commission Rashtriya Garima Abhiyan
Ministry of Health and Family Welfare

Original source: twitter

Friday, December 14, 2018

Study: Measuring Different Types of Relationship Styles in Psychosis

Division of Psychology and Mental Health
2nd Floor, Zochonis Building
The University of Manchester
Brunswick Street
M13 9PL

Participant Information Sheet

Measuring Different Types of Relationship Styles in Psychosis

You are being invited to take part in a research study developing a questionnaire to measure different types of relationship styles in psychosis. Before you decide whether or not you would like to take part in the study, please read the following information carefully so that you can understand what taking part would involve for you. Then click the button at the bottom of the page to continue. If you have any questions or queries about taking part in the study, please contact the principal investigator, Catherine Pollard (catherine.pollard AT postgrad.manchester.ac.uk). You do not have to make a decision straight away, so if you have any doubts or feel unsure please take some time to think it over.

What is the study about?

Our early relationships have been linked to the development of psychosis, a mental health problem that means people interpret things differently from those around them. Psychosis involves experiences such as hallucinations, where a person hears, sees and in some cases feels, smells or tastes things that are not there; or delusions, where a person has strong beliefs that are not shared by others.

When people are young, they develop a sense of how they relate to themselves, others and the world. This includes how others relate to them. Some people grow up seeing their parent/guardian as fearful. Research suggests that when these young people grow up they are more likely to report hearing voices and feel paranoid. However, it is not clear how this happens.

At the moment, it is difficult to understand why these people are more likely to hear voices and feel paranoid. Therefore, more research needs to be done. We aim to develop a questionnaire that measures whether people have grown up feeling scared of their parent/guardian so that we can use this in research to help us understand the link between feeling fearful in early relationships and the development of psychosis.

This study will not directly offer you any benefit, but the study addresses a gap in psychosis research. Our work will help to understand the development of unusual experiences and help us develop more treatments for distressing experiences.


humanistic ----------------------------------------------- mechanistic
early relationships 
lived experiences
sensory experiences -
hear, see, feel, smell, taste ...
hallucinations, delusions
psychosis, distress, trauma

Confident with

Involved in major accident
antipsychotic medication

English language

social environment
parent(s), guardian, significant others
fear, traumatic loss of other
 Therapeutic input: CBT, Psychologist


Treatment in a Mental Health
Unit / Hospital
Input from Community Mental Health Team or Early Intervention Service

subjective ------------------------------------------------------------------------------------- OBJECTIVE
qualitative -------------------------------------------------------------- QUANTITATIVE

My source:
@HearingVoicesUK & @RSInPsychosis

Thursday, December 13, 2018

Care Haiku

care this race for you
and I on this planet all
domain by domain

humanistic ----------------------------|--------------------------- mechanistic

intra- interpersonal




Monday, December 10, 2018

Book: Nine Pints

humanistic ----------------------------------------------- mechanistic
group - population

Source: Marriot, J. (2018) History lesson that will get your blood up, Saturday Review, The Times, November, p.20.

Sunday, December 09, 2018

BREXIT: On the Border

humanistic ----------------------------------------------- mechanistic
group - population

Medicines, Medical products
Time - Logistics

"Border Delivery Group"

import - export

(crunch) Commons Vote (deferred)

Source: Hughes, L. (2018) NHS faces risk of reduced drug access for six months, FT Weekend, 8-9 December, p.2.

Thursday, December 06, 2018

Patient Education: Stable - Unstable Plaques c/o twitter ...

humanistic ----------------------------------------------- mechanistic
group - population
'The patient'
Insight, Awareness, Understanding
Attention, Engagement, Recall

Health Literacy

Stable-Unstable Plaques
Post Myocardial Infarction
Evidence-Based Care

Post MI Intervention
Pre MI?
Clinics ('Real time'?)

Public Health Funding

Art & Science: The need 4 Care Notation

McQueen - 'Picnic'

If you can make the core notation 
fit for purpose 
(assess, plan, intervention, evaluation)
then annotations can be added 
according to the context 
(illness, strengths, recovery, end of life)
for a unique performance
(person centredness, integrated, holistic care)

My source: Battle, L. (2013) Scores unsettled, FT Arts, Sept 28-29, p.13.

Image: https://www.classicfm.com/discover-music/latest/graphic-scores-art-music-pictures/mcqueen-picnic/
8. McQueen - Picnic

Graphic scores serve a dual purpose: as well as looking beautiful, they explain abstract ideas about how the music should be played. In this piece, written in 2006, each line represents a different instrument, with the colours and shapes informing how the music might sound.

Monday, December 03, 2018

A vision for population health: Towards a healthier future - c/o The King's Fund

I have taken the four pillars above and mapped these to Hodges' model, essentially a horizontal flip -

humanistic ----------------------------------------------- mechanistic
group - population

Health behaviours
 and lifestyles

Wider determinants 
of health

The places and communities
 we live in, and with

Integrated health 
and care system

Wednesday, November 28, 2018

WHO Housing and health guidelines

"Recommendations to promote healthy housing for a sustainable and equitable future"

The quality of housing has major implications for people’s health. Housing in cities is of particular concern, with the world’s urban population predicted to double by 2050 and, with it, the demand for housing. In both developed and developing countries, improving housing conditions and reducing health risks in the home is thus critically important.

Improved housing conditions can save lives, reduce disease, increase quality of life, reduce poverty, help mitigate climate change and contribute to the achievement of a number of Sustainable Development Goals, including those addressing health (SDG 3) and sustainable cities (SDG 11). Housing is therefore a major entry point for intersectoral public health programmes and primary prevention. [Foreward, p.xii]

humanistic ------------ SDG 3 HEALTH----------- mechanistic
Mental Health
Peace of Mind
Sense of Well-Being

"Functional impairments are often operationalized in terms of whether a person can accomplish activities of daily living (ADL) or instrumental activities of daily living (IADL). IADL refers to basic tasks of everyday life such as bathing, dressing, transferring, toileting, continence and feeding. -

SDG 11 Sustainable cities
Housing - Dwellings
Indoors - Pollution - Outdoors
carbon monoxide, particulate matter, ...
Indoor heat :: Indoor cold
Injury hazards, structure
Heat - Temperature - Cold
Space, Noise, Fuel, Energy, Light
Accessible home environments for people with functional impairments

ADL refers to a range of activities that are required for independent living in the community, such as preparing meals, housekeeping, taking medication, shopping, managing one’s own finances, travelling and using the telephone." p.69.

 belonging, security and privacy

Household Crowding - health
Water access
WASH water, sanitation and hygiene
Social interactions

local, regional, national government
Ministries of Health
Housing regulations
Funding - Cost Effectiveness
Reduce poverty
Impact of housing on:
staying well, relapse risk
hospital admissions
recidivism  ...

Tuesday, November 27, 2018

Thought Cages: c/o BBC Radio 4

humanistic ----------------------------------------------- mechanistic


"Elephant in the brain"

Friends, Family (+ the test)
Receiving treatment
Patient - Professional relationship

Health expenditure

Be Successful or Be Loved: The NHS Dilemma

Wednesday, November 21, 2018

The - Profound Statement

humanistic ----------------------------------------------- mechanistic

Big (ethical?) questions

BIG questions

"We can do this"

“Fund the NHS properly” 

The Profound Statement here is just the same ...


help 2c More - help to Listen - help to Care

Hitchens, D. (2018) Deep and meaningless, (When did advertising become so banal? The more starry-eyed the corporate motto, the bleaker the reality it conceals). THE SPECTATOR, 22 September. p.12.

Stern, S. Chanting fake mantras won’t save the NHS. Proper funding will, The Guardian.

Tuesday, November 13, 2018

Purple Tuesday - National Day Disabled Shoppers

HUMANISTIC ----------------------------------------------- MECHANISTIC

Ability to exercise choice
(visually impaired - buying clothes)

Cognitive access

Do not assume a person
does not have mental capacity

Thought... that really counts

Physical access
mobility, reach

"Transact on the pavement"
Conduct business with the shopper
outside the store/shop without access

Equipment - maintenance  Extent of provision

Do not assume that the person
who is with
a disabled person is their carer.

The shopping experience
cafe, restaurant, shops


The Purple Pound 
£249bn a year on retail and leisure 
customers - clients - citizens

The Disability Discrimination Act 1995
The Equality Act 2010

My prompt and source:
BBC Radio 4 You and Yours - Consumer Affairs

Sunday, November 11, 2018

Self Care Week Europe 12th November @Self_Care_EU

What does self care involve...?

HUMANISTIC ----------------------------------------------- MECHANISTIC

(States of) Mind
Basic (and greater) Education
 Knowledge and Skills - Health Literacy
Cognitive access - understanding
Motivation, Attitude
Personal ethics, personal values
Self-esteem, Self-image
Personal philosophy, beliefs, expectations
Emotional - mental well-being
Resilience, coping strategies
Balanced Life experiences
Formative experiences
Upbringing, memory, character
Stress and Vulnerability
Risk taking: substance (mis-)use

(States of) Matter
Knowledge of physical fitness
Daily exercise
Presence of medical conditions, patient education: self- monitoring, treatment, recording, reporting
Body image, diet, nutrition
Treatments, Research - Antibiotics
Physical infrastructure:
Built environment,
Rural, Transport.
Physical access
Environment, climate change,
Eco-systems, Sustainability

Care, Compassion, Love
Social network (actual / virtual)
Community infrastructure
Carer support

Global Eco-nomies
Financial knowledge, access to banking
Health Service provision - Systems
Public Mental Health Programmes
Professionals, Global Health
Government policies
Welfare funding
Employment opportunities
Health, SDGs
Food industry

Saturday, November 10, 2018

South Sudan Medical Journal - November 2018


Dear SSMJ Reader,

The November 2018 issue of the South Sudan Medical Journal is now on online and includes articles on Ebola, Caesarean Section and Obstetric fistula. You can download the complete issue as a pdf here or the individual articles listed below.

Please share this notice with your colleagues.

Keeping an eye on Ebola Virus Disease Edward Eremugo Kenyi
Between June and November 1976, the medical world was baffled by an outbreak of a ferocious haemorrhagic disease in Nzara, South Sudan (then part of Sudan). This became known as Ebola Virus Disease (EVD). The West African outbreak in Guinea, Liberia and Sierra Leone in 2014 was devastating.  A new outbreak in DR Congo in 2018 is a warning to South Sudan to be on high alert.

Knowledge of type 2 diabetes mellitus and adherence to management guidelines: a cross-sectional study in Juba, South Sudan Alexandre Ali M. Bili and Longying Zha
Inadequate education and the lack of efficient diabetes care centres compounded by high costs are common barriers for diabetes care. This study assesses the level of knowledge and adherence to guidelines for management of type 2 diabetes in South Sudan.

Knowledge, attitude and willingness to accept Caesarean Section among women in Ogbomoso, southwest Nigeria Olumuyiwa A Ogunlaja, Idowu P Ogunlaja, Samuel E Akinola, Olufemi O Aworinde
Caesarean Section (CS) is a common procedure in obstetrics and has contributed immensely to improving maternal and foetal outcome. The study which seeks to assess the level of knowledge, attitude and acceptance of women about CS in Ogbomoso, Nigeria, concludes that mothers should be educated on the process involved in Caesarean delivery.

Obstetric fistulae, birth outcomes, and surgical repair outcomes: a retrospective analysis of hospital-based data in Dodoma, Tanzania Athanase Lilungulua, Balthazar Gumodokab, Mzee Nassoroc, Patrice Sokac and Kibusi Stephen
Obstetric Fistula (OF) among pregnant women remains a widespread condition with devastating consequences and poses a significant challenge in a community as well as globally. The study concludes that timely fistula repair by experienced fistula surgeons will improve outcomes and limit the clinical insult and distress that OF invariably causes.

How to repair a vesico-vaginal fistula Brian Hancock
Most fistulae are caused by ischaemic necrosis of the genital tract and adjacent organs through prolonged obstructed labour. This article provides a brief overview and refers the reader to resources that cover the practical aspects of the surgery and holistic care of the patient.

Ebola Virus Disease: epidemiology, management, prevention and control Gasim Abd-Elfarag
Ebola Virus Disease (EVD) is part of the group of illnesses known as viral haemorrhagic fevers, and was previously known as Ebola haemorrhagic fever. Infection with EVD is acute, severe and often fatal in humans. The paper provides an outline of what is known about EVD.

Ebola on our doorstep: Ebola Virus Disease preparedness in South Sudan Richard Lako and Otim Patrick Cossy Ramadan
South Sudan has previously experienced three EVD outbreaks in 1976, 1979 and 2004. With recent outbreaks in DR Congo, it is possible that a sporadic outbreak can happen in South Sudan, and so the country is always at risk. Preparedness is key.

Internship training in South Sudan: the challenges and way forward Jessry Pasquali Oboya
The House Officer is the professional whom the patient meets most often when entering hospital and will remember for a long time. The extraordinary commitment and work load of the House Officers at Juba Teaching Hospital has received little recognition by the authorities despite the challenges they face in the course of their training.

The current crisis of human resource for health in Africa Brian Madison
Brain drain has been a source of despair for developing countries, and the healthcare sector arguably bears the biggest brunt imposed by this growing problem. The author argues that if Africa is to counter the healthcare human resources crisis, member states may need to adopt radical reforms in the healthcare sector.

Caesarean Section acceptability and rate in South Sudan
Call for submissions

Neonatal resuscitation chart
This chart is designed with the ‘Helping Babies Breath’ training in mind. However, it incorporates external cardiac massage, which can be effective in some cases.

All previous issues of the journal are in the Archive section, and you can ‘search’ for particular articles.

Please support the journal by submitting items for future issues. We are interested in articles on your research, case reports, and clinical guidance, as well as news of projects, and relevant photographs. We can help you prepare these for publication (see our ‘Authors’ Guidelines’). We welcome letters to the editor and questions. Send your contributions to the Editor-in-Chief, Dr Edward Luka admin@southernsudanmedicaljournal.com

If you are not already a member, join our Facebook Group and share your news and experiences and ideas.

You can follow us on twitter: @SSMedJournal. Other people can be added to our mailing list by clicking here.

SSMJ is a member of African Journals Online – see who is downloading SSMJ abstracts and articles here. We are listed in the Directory of Open Access Journals (DOAJ), you can find and search DOAJ for SSMJ articles here.

Kind regards
The SSMJ team

Wednesday, November 07, 2018

Articulating the Socio-Technical and much more c/o @Atul_Gawande

HUMANISTIC ----------------------------------------------- MECHANISTIC

John ---- Atul

"The story of modern medicine is the story of our human struggle with complexity. Technology will, without question, continually increase our ability to make diagnoses, to peer more deeply inside the body and the brain, to offer more treatments. It will help us document it all—but not necessarily to make sense of it all. Technology inevitably produces more noise and new uncertainties.

Perhaps a computer could have alerted me to the possibility of a genetic disorder in John Cameron, based on his history of skin lesions and the finding of high calcium. But our systems are forever generating alerts about possible connections—to the point of signal fatigue. Just ordering medications and lab tests triggers dozens of alerts each day, most of them irrelevant, and all in need of human reviewing and sorting. There are more surprises, not fewer. The volume of knowledge and capability increases faster than any individual can manage—and faster than our technologies can make manageable for us. We ultimately need systems that make the right care simpler for both patients and professionals, not more complicated. And they must do so in ways that strengthen our human connections, instead of weakening them."
Cameron ---- Gawande

"I had more time for his questions now, and I let him ask them. When we were done and I was about to get off the phone, I paused. I asked him if he’d noticed, during our office visit, how much time I’d spent on the computer.

“Yes, absolutely,” he said. He added, “I’ve been in your situation. I knew you were just trying to find the information you needed. I was actually trying not to talk too much, because I knew you were in a hurry, but I needed you to look the information up. I wanted you to be able to do that. I didn’t want to push you too far.”

It was painful to hear. Forced to choose between having the right technical answer and a more human interaction, Cameron picked having the right technical answer."

Atul Gawande, Why Doctors Hate Their Computers. Annals of Medicine, November 12, 2018 Issue

Tuesday, November 06, 2018

Liminality: "We are all conceptual artists"

humanistic ----------------------------------------------- mechanistic

Liminal states: This space is likened to that which adolescents inhabit: - not yet adults; not quite children. It is an unstable space in which the learner may oscillate between old and emergent understandings just as adolescents often move between adult-like and child-like responses to their transitional status. But once a learner enters this liminal space, she is engaged with the project of mastery unlike the learner who remains in a state of pre-liminality in which understandings are at best vague. The idea that learners enter into a liminal state in their attempts to grasp certain concepts in their subjects presents a powerful way of remembering that learning is both affective and cognitive and that it involves identity shifts which can entail troublesome, unsafe journeys. Often students construct their own conditions of safety through the practice of mimicry. In our research, we came across teachers who lamented this tendency among students to substitute mimicry for mastery (Cousin, 2006b, p.139). Cousin (2006a)


This space, behind-around, reveals...

Leo Villareal’s ‘Liminal Gradient for (RED)’ (2018)

... that we are all 'conceptual artists'.

My source: Spence, R. (2018) Seeing Red, Collecting, FT Weekend, 3-4 November, pp.1-2.

Monday, November 05, 2018

Social prescribing: c/o @TheKingsFund - Three questions

humanistic ----------------------------------------------- mechanistic

Does it work?

What is it?

And how does it fit in 
with wider health and care policy?

Social prescribing is not a quick fix, a social distraction from a clinical problem. How this is approached - negotiated - will be a clear factor in the shared success of social prescribing as an effective, intervention for the person concerned, the NHS AND society.

Friday, November 02, 2018

1959 - 60 years and still all to do ...

humanistic ----------------------------------------------- mechanistic

'Computers' have not always been a matter of mechanism. Depending on your definition, what we describe as medical informatics, clinical informatics and nursing informatics could be said to originate in the data-gathering, recording and graphic work of John Bell, Florence Nightingale and many other pioneers. If John Bell and Florence Nightingale introduced the arrival of modern public health and nursing respectively, there is still a need to 'fix' the history of medical informatics.

"Pinpointing the beginning of the field of medical informatics is challenging, but it is perhaps best to begin any discussion of the field with the 1959 paper “Reasoning foundations of medical diagnosis; symbolic logic, probability, and value theory aid our understanding of how physicians reason” by Ledley and Lusted [19]. Ledley went on to invent the whole-body CT scanner [20], and Lusted became a leader in the field of medical decision-making. Their 1959 paper, however, laid out a probabilistic model for medical diagnosis, with grounds in set-theory and Bayesian inference." p.642.
[19] R.S. Ledley, L.B. Lusted, Reasoning foundations of medical diagnosis; symbolic logic, probability, and value theory aid our understanding of how physicians reason, Science 130 (3366) (1959) 9–21.
[20] D.F. Sittig, J.S. Ash, R.S. Ledley, The story behind the development of the first whole-body computerized tomography scanner as told by Robert S. Ledley, J. Am. Med. Inform. Assoc. 13 (5) (2006) 465–469.

Wright, A., Sittig, D.F. (2008) A four-phase model of the evolution of clinical decision support architectures, International Journal of Medical Informatics. 77: 641–649.

Thursday, November 01, 2018

A Toolbox from: BCS 2nd Sociotechnical Annual Symposium

On the 26th October 2018 I attended the Sociotechnical symposium in London as planned.

There was a sense of deja-vu in terms of speakers and some content but it was worthwhile.

Peter Bednar presented his SOCIO-TECHNICAL TOOLBOX v.13.2 and I like the inclusion on the hyphen as there still is a divide to bridge, or at the very least for people on IT and complex projects to acknowledge. Peter explained how he 'landed' within academia. He also brought some copies of the toolkit and I was able to pick up one.

As a toolkit and on this particular topic the text is helpfully concise at 130 pages. As readers here will know 'information' is a concept of great interest here. The cover (lid?) appeals instantly, referring to "Information Systems Analysis and Design" that eventually arrives at "Job-Crafting". Below this is the "Infological Equation":

I = i(D, S, t)

Of course, it is what's inside that counts. There is an introduction to information systems, the above equation and ten pages devoted to systems thinking. There then follows the main section comprised of templates with descriptions, elements explained were necessary, advice, and examples of paperwork (in many cases e-forms also no doubt). From p.109 the appendix provides a series of questionnaires. Peter's own approach is included 'Critical Systems Analysis'.

What stands out looking at the various tools listed is how h2cm operates at a more generic and yet  still very useful level.

You can use h2cm to reflect and consider projects socio-technically across (potentially) all contexts. You can also however deal with so many other crucial dichotomies:

human-machine (humanistic-mechanistic)
one-to-many (individual-group)

There is no link but the toolkit 2nd edition 2018 is published by Craneswater Press Ltd

inquiries AT craneswaterpress.co.uk

I'll revisit the event and there is a related call for papers which I will post soon.

Tuesday, October 30, 2018

First WHO Global Conference on Air Pollution and Health, 30 October – 1 November 2018

humanistic ----------------------------------------------- mechanistic

Individual potential
Anxiety - Distress
Mental Health
Parity of Esteem

Schematic drawing, causes and effects of air pollution: (1) greenhouse effect, (2) particulate contamination, (3) increased UV radiation, (4) acid rain, (5) increased ground-level ozone concentration, (6) increased levels of nitrogen oxides. Source: https://en.wikipedia.org/wiki/Air_pollution

Outdoor Air Quality
Local, Regional, National, International, Global
7 Million deaths

Home  & Work
Indoor Air Quality
Air Pollution respects Borders?

WHO Conference on Air Pollution

All private vehicles in Delhi will be stopped from November 1 if pollution worsens: Official #DelhiAirPollution #DelhiSmog #AirPollution

Urban Planning

My source:
Follow this event:

Sunday, October 28, 2018


humanistic ----------------------------------------------- mechanistic
'Who' profits?

The Sciences
Qualitative - RESEARCH - Quantitative

The Public
[Locus of the 'public purse']

My source:

Saturday, October 27, 2018

ERCIM News No. 115 Special theme "Digital Twins"

Dear ERCIM News Reader,

ERCIM News No. 115 has just been published at https://ercim-news.ercim.eu/

The Special Theme "Digital Twins", coordinated by the guest editors Benjamin Sanderse (CWI) and Edgar Weippl (SBA), features 23 articles illustrating the many facets of this growing scientific field. The special theme contributions give insight in ongoing projects and allow for a glimpse into the future of digital twin technology.

The section Research and Innovation reports on news about research activities and innovative developments from European research institutes.

This issue is also available for download in pdf and ePUB

Thank you for your interest in ERCIM News. Feel free to forward this message to anyone who might be interested.

Next issue:
No. 116  January 2019
Special Theme: "Transparency in Algorithmic Decision Making"

My source:
Peter Kunz
ERCIM Office
2004, Route des Lucioles
F-06902 Sophia Antipolis Cedex

Of particular interest in this issue:

How will your Digital Twin be born?

In-silico models of human physiology and pathology are aimed at progressing and complementing medicine in several ways. These models can reproduce physiological processes and events on multiple scale levels. The goal of the individual models is to help predict the outcome of a specific disease or to support the decision-making process during treatment. p.18.
[ Plus DSLs, pp. 10-12; SpeechXRays, pp. 49-50. ]

Sunday, October 21, 2018

Quality (and Safety) Organisations come and go but ... care domains ...

"The NHS Improving Quality delivery team has developed and tested a new measure of "energy for change" which is helping to support innovation and improve service delivery." p.26.

"The energy index is evidence based - built up from a combination of academic and desk research - coupled with interviews with NHS staff." pp.26-27.

The 'energy domains' are:

humanistic ----------------------------------------------- mechanistic





Land, M. (2014) Pedal to the metal to improve the NHS, HSJ, 7 March, 124: 6389. pp.26-27.

Another perspective is provided by The Kings Fund, from:

"Improving quality in the English NHS"

A brief history of policies on quality of care in England

  • the establishment and later disbandment of the National Patient Safety Agency to collect and analyse data about adverse events
  • the establishment and later disbandment of the NHS Modernisation Agency as a central support system for improvement
  • the establishment and later disbandment of the NHS Institute for Innovation and Improvement as a (smaller) successor to the Modernisation Agency
  • the establishment and later disbandment of NHS Improving Quality as a successor to the NHS Institute for Innovation and Improvement
  • the establishment and later disbandment of strategic health authorities as regionalised resource centres for a range of tasks, including facilitating quality improvement pp.6-7.

Ham, Chris, Berwick, Don, Dixon, Jennifer, Improving quality in the English NHS: a strategy for action. London : The King's Fund, 2016, pp. 6-7.

The truly relevant - critical domains have remained a constant over the years, decades even.
Clearly, this is evidence-based -this is rocket science...?

How many times do we 'reinvent' this - evidence and desk research based...?

See also*: https://hodges-model.blogspot.com/2014/08/compare-and-contrast-potentia-energy.html

*Yes, I'm starting to repeat myself!

Friday, October 19, 2018

Observing colour from the Political domain

humanistic ----------------------------------------------- mechanistic

was ideally placed to
the absurdity of a political system
based on colour ..." p.6.

Coldwell, P. (2018) Traces of Time, Printmaking Today, Autumn 2018, pp.6-7.

Wednesday, October 17, 2018

"One-size-fits-all" Assurance of Insurance needed?

humanistic ----------------------------------------------- mechanistic
mental health problems affect

Self-employed, single
No previous history of MH problems
Psychology - Counselling
12.5 million adults - 1 in 4

PROCESSES (automated?)*

'Life cover'
Insurer access to GP record - deemed high-risk
500,000 people affected by

Untimely death of a parent
Mother killed by drug-using driver
Refused IVF treatment

insurance company
driver jailed
Voided application for life cover
(figures) suggest insurers reject up to 625,000 people a year
By law ins. companies cannot discriminate

*Need to discuss an application with a person, fill in 'gaps' then less likely to become subjected to an algorithm and an automated rejection.

# What were the reasons for referral to psychology and counselling?

My source:
Miller, L. (2018) My fight to get life cover after mental health trauma, The Daily Telegraph, Money, 22 September, pp.1-2.

See also: https://www.telegraph.co.uk/insurance/life/get-life-insurance-mental-health-problem/

Technology can, will and is helping to 'disrupt' the insurance market.