"Integrated - care": What's in a word, or two?

This blog post was sat in 'drafts' since 28/01/2007 (yes, I know what that suggests). It concerns an issue, or more properly a theoretical and experiential aspiration in health AND social care that should in truth have provoked many papers for Hodges' model by now.

In the almost 18 years since, I wonder about the total number of papers devoted to this subject, the service's delivery, policy, outcomes, reviews and reports on integrated care? In nursing theory, philosophy and the start of many 'learned papers', it is customary to begin with a definition of terms. What happens when we divide 'integrated care' and first treat integrated and care separately? Does this aid our understanding? Do we divide and conquer? Is there a difference in results? Conceptual analysis would see us do both, and conduct a literature search.

In practice, (and clinical - especially) we often use words in rather lackadaisical way. Not surprising really, after all we've got a job to do! When pronouncements are made regards health and social policy I hear it as good intentions. I also reach for my soap box. It is often hyperbole, rhetoric. The same applies to the related idea and ideal(?) of holistic care, and person-centredness. I'm biased, of course, but I believe that Hodges' model can help to scope, and define these idealised features of health and social care (and education). As noted, people don't have the luxury of time to stop and deliberate on the precise meaning of the language they routinely use. As noted, at the end of the day - if it gets the job done then that's sound.

In a poll of words that are both much used and the meaning taken for granted integrated must be near the top for several reasons:

• its seniority: it has been around for decades.
• its scope across sectors and day-to-day life.
• our dependence on its fulfillment.

N-Gram suggests some possible insights into integrated and related forms of care:

https://books.google.com/ngrams/graph?content=integrated+care,holistic+care,person-centered+care&year_start=1800&year_end=2022&corpus=en&smoothing=3 

[Trying to embed, results in 1/3 white space at the bottom?]

It seems that integrated care [IC] has been a standing agenda item in health and social care media, education, the workforce, conference, exhibition and policy for several decades. Perhaps, things have calmed somewhat? So either IC is either very important, complex, a hard thing in practice or maybe it's all of these and more besides? IC is a undeniably a compound concept. Is this a cop-out though? You declare something 'compound' then sit back - job-done? I've suggested the same of threshold concepts in health (and probably other contexts?). Time will tell. In the meantime I have reflected on 'integrated care' across the domains of Hodges' model:

self

|

INTERPERSONAL : SCIENCES              

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

SOCIOLOGY : POLITICAL   

|

other

INTEGRATION OF: PRACTITIONER; Team; service; org... Philosophy* assessments threshold for acceptance into service (referral criteria) patient experience & engagement health education / literacies programmes spiritual research involvement	INTEGRATION OF: health record (e- or paper) location - team base care disciplines geographical area referral sources assessments - tools/scales data and statistics research involvement
INTEGRATION OF: HEALTH & SOCIAL CARE public engagement hospital  carer (parent/guardian) experience community services social care - NHS family experience public engagement in research Patient / Public Community Advocacy Treat demand :: Support prevention	INTEGRATION OF: funding leadership / management accountability - complaints (not the same thing!) outcome measures ILLNESS - PREVENTION / education self-care <> planetary care -  Sustainability assisted dying! palliative care! Public - Private - Voluntary Sectors Provider :: Purchaser [Systems] All-Party Parliamentary Groups^

*ethics, values.

^One aspect of so-called 'joined-up government'.

'Domain-specific is wider than specific domain knowledge' Kalyuga (2013)

 'Developing learner ability to apply knowledge in relatively new situations is an important aim of learning and instruction, and many instructional programs and materials explicitly state this goal. However, not many of them demonstrate a consistency in achieving this goal using sufficiently well-specified instructional procedures and techniques. According to a popular view, transferable knowledge and skills in complex domains result from problem solving experiences (e.g. Inagaki and Miyake 2007). At the same time, there is evidence indicating the importance and effectiveness of explicit learning generalized theoretical frameworks and abstract conceptual knowledge for deep understanding of tasks and en hancing transfer capabilities (Karpov and Bransford 1995; Hinds et al. 2001). Gick and Holyoak (1983) convincingly demonstrated the value of the acquisition of abstract schémas as mediators of analogical transfer between very different task areas.'

'Many studies in expert problem solving have demonstrated that relying on highly contextualized domain-specific knowledge associated with concrete situations is the most effective way to solve problems in familiar task areas and that expert performance is largely based on the acquisition of organized domain-specific knowledge structures (schémas; Chi et al. 1982). ... For example, the game of chess has traditionally represented a classical example of expertise based on the acquisition of a huge amount of highly specific knowledge structures (chunks) corresponding to various concrete game situations (De Groot 1965; Chase and Simon 1973). However, more recent studies have indicated that experts use not only concrete chunks but also more general patterns, such as "templates" (Gobet and Simon 1998) or generalized chunks (Walczak and Fishwick 1997) representing typical classes of chess positions with substantial variations in concrete board locations. Based on his observations of the behaviour of rats in maze situations, Tolman (1948) was one of the first to discuss the role of broad vs. narrow cognitive constructs (cognitive maps) in both animal and human learning. 

Domain-specific knowledge that is applicable only to a limited range of tasks represents the most powerful tool for dealing with these tasks in terms of efficiency of achieving immediate results. On the other hand, knowledge that can be applied more broadly is likely to be less efficient for solving specific problems since it would require additional searching, reasoning, and elaborating activities, whilst specific knowledge directly leads to a definite solutions.' pp.1478-1479.

Kalyuga, S. (2013). Enhancing transfer by learning generalized domain knowledge structures. European Journal of Psychology of Education, 28(4), 1477–1493. http://www.jstor.org/stable/23580919

Invitation for User Evaluation of OntoChat

Dear W3C Semantic Web Community,^

(Sending the below on behalf of one of our PhD students-your help would be very much appreciated!) 

We are a research team at King's College London conducting a study on the user experience of OntoChat, a tool built on large language models and designed to assist ontology engineers in creating user stories for ontology development. If you are currently or have previously been involved in ontology engineering projects, performing tasks such as ontology development, refinement, alignment, extension, or evaluation, we invite you to participate in this study to help improve OntoChat's design.

Participation Details:

• Duration: Approximately 35 - 40 minutes
• Activities:
• Use OntoChat to create an ontology user story relevant to your project while sharing your thoughts
• Answer open-ended questions about your experience
• Complete a brief questionnaire evaluating OntoChat's usefulness

We are flexible and can accommodate your availability within 19th November and 10th December 2024. If you are interested in participating in this study, please indicate your preferred time and agree to the user consent form by completing the registration form at:

https://forms.office.com/e/2wkmugH9v1

Your feedback is invaluable for refining OntoChat to better support ontology engineering processes. Please be assured that all personal data will be kept confidential and anonymised.

Thank you for considering this opportunity to contribute.

Kind regards,
Yihang Zhao
PhD Researcher, King's College London
Contact: yihang.zhao AT kcl.ac.uk

^Via semantic-web mail list.

The naïve approach ii - Seeking / Avoiding a Catastrophe

In addition to Dodson's book I borrowed:

'Catastrophe Theory'
Image: Amazon

Zeeman, E.C. (1977) Catastrophe Theory-Selected Papers 1972–1977, Reading, MA: Addison-Wesley.

From the mid-1970s I remember catastrophe theory rather bursting on to the science scene. Articles in New Scientist (in a box somewhere?), Scientific American plus a BBC TV episode of Horizon (seeking details - originally aired July 28, 1975, 60 minutes 'Happy Catastrophe')*, that highlighted potential for new insights into the behaviour inside prisons. and other applications in the social sciences.

The CONTENTS reads:

GENERAL INTRODUCTORY PAPERS 

1. Catastrophe theory : Draft for a Scientific American article 1

2. Levels of structure in catastrophe theory 65

 BIOLOGICAL SCIENCES 80

3. Differential equations for the heartbeat and nerve impulse 81 

4. Primary and secondary waves in developmental biology 141 

5. A clock and wavefront model for the control of repeated structures during animal morphogenesis (with J.Cooke) 235

6. Gastrulation and formation of somites in amphibia and birds (Addendum by R. Bellairs.) 257 

7. Dialogue between a Biologist and a Mathematician 267 

8. Brain modelling 287 

9. Duffing's equation in brain modelling 293

 SOCIAL SCIENCES 302

10. Some models in the social sciences (with C.A.Isnard) 303 

11. On the unstable behaviour of stock exchanges 361 

12. Conflicting judgements caused by stress 373 

13. A model for institutional disturbances (with C.S.Hall, P.J.Harrison, G.H.Marriage, P.H.Shapland) 387

14. Prison disturbances 403 

PHYSICAL SCIENCES 408 

15. A catastrophe machine 409

16. Euler buckling 417 

17. Stability of ships 441

MATHEMATICS 496

18. The classification of elementary catastrophes of codimension <= 5 (with D.J.A.Trotman) 497

19. The umbilic bracelet and the double-cusp catastrophe 563 

DISCUSSION 604

20. Research ancient and modern 605 

21. Catastrophe theory : its present state and future perspectives (with R.Thom) 615

22. Afterthought 651 

As an area of contention the subject of catastrophe theory (CT) possibly presents(?) a dual-cusp of contention. Firstly, CT brought with it controversy within academia and mathematics. The book was reviewed by T. W. Barrett, Department of Physiology and Biophysics, University of Tennessee Center for the Health Sciences, Memphis, TN 38163: 

'Catastrophe theory (CT), as a new field in mathematics with many possible ramifications for both the physical and biological sciences, has recently been the subject of much controversy (see [1]-[5]). This controversy, in this reviewer's opinion, has served a valuable purpose insofar as it has stimulated the theory's proponents to refine and delineate their concepts more clearly. Catastrophe theory was developed by the Field prize winner, Rene Thom; but much work has been accomplished by E. C. Zeeman and his group, especially with respect to applications.' pp.609-610. IEEE TRANSACTIONS ON SYSTEMS, MAN, AND CYBERNETICS, VOL. SMC-9, NO. 9, SEPTEMBER 1979. https://ieeexplore.ieee.org/stamp/stamp.jsp?arnumber=4310286 

Stephen Smale also reviewed Zeeman's book; BULLETIN OF THE AMERICAN MATHEMATICAL SOCIETY Volume 84, Number 6, November 1978. 1360-1368. 

https://www.ams.org/journals/bull/1978-84-06/S0002-9904-1978-14580-7/S0002-9904-1978-14580-7.pdf

'To write a review in this environment has a very personal side for me. On one hand my own work on dynamical systems is closely connected to the origins of CT. I have had a long and close personal and professional relationship with both Thorn and Zeeman. More than 20 years ago I was discussing singularities of maps, transversality, and immersions with René Thom. Thom tried to interest me in an early draft of chapters of his book Structural stability and morphogenesis in 1966.

On the other hand I have remained skeptical and aloof from CT, perhaps due to my conservatism in science. While my colleagues and students were showing enthusiasm for CT, I gave critical lectures, one at the University of Chicago in 1974, one at the Aspen Institute of Physics in 1975. More recently I have been quoted negatively in the "Science" and New York Times references above. This is the first time I have written on the subject, and I should warn the reader of this negative bias, far from shared by many of my fellow mathematicians.' p.1360.

Some defenders of CT may accuse me of discussing very special examples not characteristic of the literature of the subject. I feel that the problem of lack of justification discussed above, is also found in Zeeman's other models. Furthermore Thorn's models are even less specific and less developed. On the other hand, Thorn's work in CT covers many subjects; in this connection Zeeman writes in his Scientific American article, April 1976, p. 65: "The method has the potential for describing the evolution of form in all aspects of nature, and hence it embodies a theory of great generality."' p.1366.

The book's introductory papers are somewhat confusing in content, as drawn to 'SOCIAL SCIENCES' it is the introductory section (and Part Two) that includes  'Anorexia nervosa', Example 9 pp.33-52. 

This is the second 'cusp' as the assessment, diagnosis, intervention, outcomes, skilled staff, access to specialised mental health services remains contentious to this day. As a charge nurse on a female acute admission mental health ward in the early 1980s, eating disorders have always presented a 'clinical' challenge. Often within a staff group and for individual staff members too.

Twitter/X is hardly an objective record but it appears today, that people and families affected by eating disorder continue to advocate for appropriate service provision, treatment and recognition. Recognition that can also develop evidence-based interventions. As discussed by Dr. Agnes Ayton, consultant psychiatrist and others in the video below:

A related paper:

Ibrahim, A., Ryan, S., Viljoen, D. et al. Integrated enhanced cognitive behavioural (I-CBTE) therapy significantly improves effectiveness of inpatient treatment of anorexia nervosa in real life settings. J Eat Disord 10, 98 (2022). https://doi.org/10.1186/s40337-022-00620-y [ My source: @AgnesAyton ]

The Zeeman chapter on anorexia nervosa is interesting graphically and conceptually ...

Page 42. Figure 20. The effect of the butterfly factor, d>0.
(Sorry for the image quality)

- but is of course 'from another time' and is clearly not person-centred. Eating disorders affect many people in the UK and are a cause of trauma, distress, disrupted life-chances and mortality. Referring to Hodges' model, such graphics, reinforce the idea that 'solutions' are to be found in the mechanistic and quantitative domains of the sciences and politics (choice, power, services, safety..). Here, maths and theories (seemingly) provide an explanation for people who are ill, and need treatment. As a teenager for most of the 1970s, Hodges' model was not yet a reality. As I have found since 1987-8 looking at the POLITICAL care/knowledge domain, the model's relevance has increased since the start of my nursing career in 1977. Consider for example, the politics of:

• the global phenomena of famine
• - whether or not associated with economic crisis, drought, other natural disaster, or conflict, political crisis
• ultra-processed foods
• obesity pandemic
• weight loss drugs
• appetite stimulants
• appetite suppressants
• eating disorder (anorexia and bulimia) across care sectors - primary, secondary, specialist
• community / in-patient care
• person-centred care
• user involvement in service design
• the availability of treatment modalities - psychotherapy (as in the video)
• the impact on family relationships and peer group (estranged - loss of friends)
• diagnostic blurring - psychosis, borderline personality disorder - the rise of 'anti-psychiatry'

Here then is the purpose of this post, what potential is there to look at nutrition from a situated individual and collective (global) perspective? This could be focussed on nutrition, or eating disorder; or alternately take a collective stance to encompass the global food supply and the industry. Discovering the diffeomorphism, I wonder if there are others, and their respective properties and character? 

INDIVIDUAL

|

INTERPERSONAL : SCIENCES              

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

SOCIOLOGY : POLITICAL   

|

GROUP

COGNITIVE THERAPY EMPATHY&RAPPORT LISTENING - MUTUAL ENGAGEMENT MENTAL HEALTH DIAGNOSIS TRAINED / SKILLED STAFF EVIDENCE-BASED INTERVENTIONS* MOTIVATION MOOD MULTIMORBIDITY	RESEARCH EATING DIET NUTRITION NUTRITIONAL VALUE WEIGHT BMI IN-PATIENT UNIT place of safety
PUBLIC HEALTH SOCIETY FAMILY CARERS	Developed nations are collectively and increasingly 'eating disordered' and exporting this 'lifestyle'.

Before I return the book, I will revisit the discussion section.

See also:

Jones P, Wirnitzer K. Hodges’ model: the Sustainable Development Goals and public health – universal health coverage demands a universal framework. BMJ Nutrition, Prevention & Health 2022;5:doi: 10.1136/bmjnph-2021-000254

*I could not find on BBC website. I have contacted the Open University. I did find - 'In this Horizon episode, Rene Thom's mathematical discovery of the catastrophe theory is investigated.' at  https://thetvdb.com/series/horizon/episodes/1385431

The naïve approach

Categories, Bundles and
Spacetime Topology  

'First steps' are by their nature plagued by uncertainty of intent and direction, ungainliness, missteps, stumbles and ('finally') possibly falls.

Finding a starting point can be difficult.

Where to find a hand-hold, place one's foot, or other anchor?

At Lancaster University library I came across this book, first published in 1980. The cover displayed is from the 1988 edition.

In order of appeal I read:

applications, categories, spacetime and topology.

Section I starts with Preliminaries: Notation and Abbreviations; always useful (reminder).

The next, Section II Naïve Category Theory, had my immediate attention. We often speak of learners as being naïve. As lifelong learners we all meet this descriptor. I keep revisiting this word, concept - 'naïve'.

Naivety is a starting point for practitioners in health and social care too. Hence the need for supervision, mentors, the tokens of probationary (driver) and 'newly qualified'. 

Many posts on W2tQ stress the diagrammatic quality of Hodges' model. It is visibly a 2x2 matrix, (once again..) beloved of management consultants, psychologists and change agents. In Section II Dodson recognizes the London Underground map as a graph. A small example is developed, explained and illustrated on p.6. 

Graph example, drawing on the London Underground. p.6.

Section II may be a small part of the overall book but it is invaluable to me. As the photo above suggests, the book is old, especially as 1st edition. I will try to access the 2nd edition. If this work is a project with which you can (more ably!) assist, I would greatly appreciate your input. The aim is to signpost Hodges' model as a potential focus for all researchers. Especially researchers interested in trying to conjoin the sciences and humanities and develop visualization in the latter. 

C.T.J. Dodson. Categories, Bundles and Spacetime Topology. 1st Edition, Shiva, Kent. 1980.

Previously: 'math'

'Diagram' resources listed on former, now archived website.

'Little Shrew' (Snowflake)

INDIVIDUAL

|

INTERPERSONAL : SCIENCES              

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

SOCIOLOGY : POLITICAL   

|

GROUP

Chappell, P. Heathcliff, it's me again: more new music from Kate Bush on the horizon, The Times, October 26th 2024, pp.18-19.

Ethics and the 'big picture'

'It has been my experience that many of the most successful and creative heads of major research labs around the country came to their place from other disciplines. For example, one prominent geneticist that I know has his Ph.D. in chemistry. He told me that coming to genetics from outside the discipline gave him an awareness of structures and values that were invisible to those laboring inside the established system. Much as one has critical insights into the ambience of a city or culture when one comes from outside as a foreigner, so also is there critical understanding of academic disciplines. Thus, one response to the add-on question is to reply that the material you are providing can make your students better scientists by giving them a more global, contextual perspective. A global, contextual perspective allows one to consider divergent research designs that approach a problem in many directions. This is sometimes called "big picture" thinking. Part of the big picture includes other scientific contexts. For example, biology is seen in the context of chemistry, and chemistry is seen in the context of physics. But it is more than that. It also includes values. Should I, as a scientist, pursue all questions with the same vigor? Are there some questions that should be avoided because of the social consequences of their results? Is the scientist compelled to think in terms of helping humankind or helping himself to a Nobel Prize in any way he can? All of these involve values and ethics. They are critical components to global big picture thinking. Such a perspective is a valuable tool for anyone seeking excellence in scientific research.' p.28.

Boylan, M., & Donahue, J. (2003). Ethics across the curriculum : a practice-based approach. Lexington Books. 

INDIVIDUAL

|

INTERPERSONAL : SCIENCES              

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

SOCIOLOGY : POLITICAL   

|

GROUP

PERSONAL ETHICS INDIVIDUAL INTEGRITY MY EXPERIENCE MY REFLECTIONS INTERSUBJECTIVITY PURPOSE BELIEFS CHARACTER EDUCATION PROFESSIONAL EDUCATION

PROCESS OBJECTIVITY FACTS  EMPIRICISM 'We define ethics as the process of reflection on the moral meaning of actions.' p.5. 'BIG PICTURE' PROFESSIONAL EDUCATION

PRACTICE COMMUNITY OF PRACTICE ETHOS^ (Chap. 6) 'Ethics is not a discrete body of knowledge that one simply acquires for application and use in particular situations. It entails the ongoing appropriation of ideas of the good as they relate to the changig situations, contexts, and developments in individuals and groups lives. ^ Ethics reflects on actions the actions of individuals and groups.' p.5.

PROFESSIONAL BODIES PROFESSIONAL STANDARDS PROFESSIONAL & COMMERCIAL - ACCOUNTABILITY PROFESSIONAL ETHICS DUTY OF CARE POLICY LAW JUSTICE autonomy; nonmaleficence; beneficence; justice*

^Stackhouse, M. (1972) Ethics and the Urban Ethos: An Essay in Social Theory and Theological Construction, Boston: Beacon Press. (Chap. 6, Boylan & Donahue)

*Beauchamp, T. L., & Childress, J. F. (2013). Principles of biomedical ethics (7th ed.). Oxford University Press. (Chap. 6, Boylan & Donahue)

'Fake news' - nothing new under the Sun

INDIVIDUAL
|

 INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

	PD Reporter with "fake news" from an 1894 illustration by Frederick Burr Opper

Kruck, D. A 'ROYAL' BIT OF FAKE NEWS. Gibbons Stamp Monthly, August 2021, pp.28-30.

Image source:
https://aleteia.org/2018/02/09/fake-news-post-truth-and-technology-in-the-19th-century/

Hello? Is anyone there? 'The Homeless Mind'

individuality

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INTERPERSONAL : SCIENCES              

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

SOCIOLOGY : POLITICAL   

|

group

'Put differently, the componentiality of the cognitive style pertaining to technological production extends to identity. Again, a specific kind of double consciousness develops. In this case the dichotomy is between concrete identity and anonymous identity. The individual now becomes capable of experiencing himself in a double way: as a unique individual rich in concrete qualities and as an anonymous functionary. This dichotomization in the subjective experience of identity makes it possible for the individual to establish subjective distance vis-à-vis certain features of this identity.9  For example, the individual will now experience that portion of his identity that contains his anonymization as a 'worker' as being 'less real' than his identity as a private person or family man. Since each portion of identity relates to specific roles, it now becomes possible for the individual to perform some of these roles 'tongue in cheek'. The componentiality of identity, as the componentiality of social relations, makes possible an 'engineering' practice. This time what is involved is the 'engineering' of one's own self. Those aspects of identity that a defined as 'more real' must be protected against threats coming from the 'less real' components of identity.' p.37-38.

The homeless mind: Modernization and consciousness Helpful reference to ideas of multi-relational synchronization and institutional vectors and how our mind's became homeless. Also encouraging, even though 'historic', discussion on life plans and life planning.

'A basic presupposition is that life careers are not firmly fixed but are at least relatively open. Put simply the individual is faced with a number of alternative careers, especially in his " younger years, and therefore must make decisions about these svailable Options. It is possible for the individual to imagine, himself as having different biographies. This possibility has both positive and negative consequences for the emotional economy of the individual. Positively, it may give him a feeling of frees dom to shape at least certain parts of his life. Negatively, it increases the likelihood of frustration regarding specific careers One is, after all, less likely to resign oneself to a particular situation if one believes that other situations are, in principle, possible.' p.67. 'Implicit in this scale of probabilities is a general 'sociology', on whatever level of theoretical sophistication. The individual has a `map of society' within which he can locate and project himself in terms of both past biographical recollection and future projects. The individual's life is perceived as a trajectory across this 'map'. There is also a large body of factual knowledge, most of which is 'weighted' in terms of the individual's life plans. Thus if a particular career appears to the individual as a realistically plausible project, he will have more factual knowledge about it than about a career in which he can participate only in pragmatically irrelevant fantasy. In other words, a good deal of background knowledge is related to 'anticipatory socialization'. p.68. 'However vaguely this may be defined, there is the underlying concept of life plan, both for the individuals and for the a family unit. This life plan is the totalization of all the relevant timetables, their grand sum and their integrative meaning In modern society, such life planning has become a value in itself. Its absence is commonly an occasion for reproach. The family unit thus operates as a life-planning workshop.' p.69.

'There is a general expectation of justice. It is expected that everyone in the relevant category - as, for example, those en-titled by law to a passport - will receive equal treatment. It is, of course, understood that certain persons may be excluded from this relevant category - for example, resident aliens or convicted criminals. It is also understood that the bureaucratic procedures may codify certain preferences, for example, in favour of diplomats or other people travelling on urgent government business. Once the categorial system has been established, however, the presumption of equality holds within each category. In the most general way, bureaucracy is expected to conform to the Roman principle suum cuique. An implication of this is that there will be no favouritism or any other intrusion of personal bias in the bureaucrat's handling of each client's case. The bureaucrat is expected to handle every case sine ira et studio. In other words, there is the general expectation that bureaucracy will operate impersonally and with 'affective neutrality'.2 These considerations bring us to an important point: unlike anything discussed in the preceding chapter, the cognitive style of bureaucracy contains a moral quality, not just as a limiting factor (after all, there are also moral assumptions about technological production - for example, that no one will be killed in the course of it), but as an intrinsic part of its own structure of consciousness. The source for this moral element is probably to be sought in the primary social location of bureaucracy in the political sphere.' pp.52-53.

Berger, P. L., Berger, B., & Kellner, H. (1973). The homeless mind: Modernization and consciousness. Penguin. 

Cover image: https://www.goodreads.com/book/show/3368465-the-homeless-mind

⁹ This is an amplification, by way of phenomenological description, of what Erving Goffman has called 'role distance'.

² This term was coined by Talcott Parsons.

See also: 'homeless'

The mask ...

'I will speak from my experience with Balinese masks, but I have to go back one step before that. One of the first, knockout exercises that you can do with actors, which is used in lots of theatre schools where they use masks, is putting a plain, blank, white mask on someone. The moment you take someone's face away in that way, it's the most electrifying impression: suddenly to find oneself knowing that that thing one lives with, and which one knows is transmitting something all the time, is no longer there. It's the most extraordinary sense of liberation.

This is one of those great exercises that whoever does it for the first time counts as a great moment: suddenly to find oneself immediately for a certain time liberated from one's own subjectivity. And the awakening of a body awareness is immediately there with it, irresistibly; so that if you want to make an actor aware of his body, instead of explaining it to him and saying, "You have a body and you need to be aware of it," just put bit of white paper on his face and say, "Now look around." He can't fail to be instantly aware of everything he normally forgets, because all the attention has been released from this great magnet up top.' p.219

self

|

INTERPERSONAL : SCIENCES              

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

SOCIOLOGY : POLITICAL   

|

other

Brook, P. (1989). The Shifting Point. London, UK: Methuen. pb.

Secondhand from Reid's, Mount Pleasant, Liverpool, this book was already 'musty'. On October 18th it got 'wet' in a downpour from Sorrento to Capri and back. It smelt even more historic afterwards. It still provided great reading though! I noticed in a new pb edition the images were not included.  https://reidofliverpool.co.uk/

'Emperor' - Aphasia

individual

|

INTERPERSONAL : SCIENCES              

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

SOCIOLOGY : POLITICAL   

|

group

	'Physical Reality'
Social Reality	'Political Reality'?!

See also:
Mammary Mountain

Impulse

Faber, T. Lessons in empathy, Life&Arts, FT Weekend, October 5-6, 2024, p.13.

Podcast: Local green spaces and mental health

Dear CHAIN member,

We would like to draw your attention to the following NIHR alert. Please pass on as appropriate. Thank you.

NIHR

Local green spaces are linked with better mental health

Podcast: Local green spaces and mental health

In this podcast, Helen Saul, Editor in Chief of NIHR Evidence, and study author Sarah Rodgers, Professor of Health Informatics, University of  Liverpool, discuss the impact of local green spaces on people's mental health.

Researchers analysed data on more than 2 million people in Wales over 10 years to explore the impact of green spaces on mental health. They linked information about people’s mental health with information about the greenness of their home’s immediate surroundings and how close they lived to green or blue spaces (such as parks, lakes, and beaches). They found that people had a lower risk of anxiety and depression if:

· their home’s immediate surroundings (within 200-300 metres) were greener
· they could access green and blue spaces nearby.

The researchers say that local authorities could improve the mental health of their community by increasing the greenery in their towns and cities and improving access to green and blue spaces.

Read more at: https://evidence.nihr.ac.uk/alert/local-green-spaces-are-linked-with-better-mental-health/?source=chainmail

Regards,

Irina Johnston
CHAIN Administrative Assistant

(and my source.)

Previously: 

c/o @TheLancetPlanet - Paper: Residential greenness and prevalence of major depressive disorders... or "All colours fictitious"

'nature'

Simplifying universal health coverage to achieve political action

'The narrative on universal health coverage should be centred around four core elements: universality, equity, adequate financing, and preparedness in public health emergencies, write Katri Bertram and Justin Koonin'.

Bertram K, Koonin J. Simplifying the universal health coverage narrative can help to achieve political action BMJ 2024; 387 :q2441 doi:10.1136/bmj.q2441

A RESPONSE^* 

Can this be true? Why, this is absolutely marvellous! I?

Yes! Me. 

I do count! I'm seen, heard and included in the health care system and can have a voice in the service's development (1.). 

Not only that, but everyone in my - our community - has access - too (2.) ...

client - person - individual - self - patient - citizen

|

INTERPERSONAL : SCIENCES              

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

SOCIOLOGY : POLITICAL   

|

couple - family - group - community - village/town - city

1. UNIVERSALITY	4. PREPAREDNESS
2. EQUITY	3. ADEQUATE FINANCING

... Now that health and social care are properly funded, they've finally done it! They've taken the key step to include education. This is crucial, critical to preventing poor health. Whenever possible we want people to self-care. The mother of all us has always whispered of the safety net. Now she shouts and rages. We all must listen to the stories of old.  Children should be brought up to be health and media... literate and recognise for them as an individual, the merit, the joy of health and well-being.

At last - the power's-that-be are addressing policy. Not just policy on paper, but implementing it, to assure the quality and cost of food, baby-formula, the air and water (3.).

What does this mean?^ It means health budgets can be better managed. Being prepared does not mean we reach immediately for the technical solution, write the prescription (for antibiotics). No. Being prepared means wising-up too. Together, we are ready to face each other, and right across the world: S-N and E-W. Now we can look to the future, climate change and Gaia: as ONE (4-5).

^O’Connell T, Rasanathan K, Chopra M. What does universal health coverage mean? Lancet 2014;383:277-9. doi:10.1016/S0140-6736(13)60955-1 pmid:23953765

(Cited by Bertram & Koonin)

5. Spiritual.

^*A response, that is both too simple and too complex. Discuss.

Call for Papers “THE CULTURAL EXPLOSION OF AI: ...

Navigating the Intersection of Artificial Intelligence, Society, and Culture”

Artificial intelligence has burst into the cultural space with the speed of an explosion. As with any powerful explosion, its initial impact is a spectacular blinding flash, followed by a shock wave with real effects. Perhaps we are still at the very beginning, but often the intensity of the blinding flash is proportional to the real effect that follows, both in terms of sweeping away existing forms and as long-term cultural “radiation”.

According to Lotman, a cultural explosion is a period of transformation when rapid and large-scale changes occur in cultural systems, leading to a significant increase in the creation of new information. It is estimated that artificial intelligence produces as much cultural text in one year as humanity has produced throughout its millennia-long history until the advent of the digital age. More interestingly, this new textual production is entering its most productive phase with the invention of Transformer architecture, which is almost a literal algorithmic realization of Lotman's concept of translation — the main mechanism of semiotic metabolism in the Semiosphere.

Training Large Language Models (LLMs), which is the foundation of AI, suspiciously resembles the way Umberto Eco models culture in the structure of a rhizome, which computer scientists call a "neural network." His encyclopedic model is based precisely on what LLMs extract from huge arrays of existing text—the statistic constancy of sign usage. In a polemic with textual immanentists, Eco postulates as part of the reader's encyclopedic competence the ability to inferentially reproduce the possible contexts of sign usage that make up the text. For many, the “magic” of artificial intelligence in its current form lies in its understanding of our questions to it, achieved with the Attention Mechanism, which, as a principle of cooperation between author and reader, is quite literally described in "The Role of the Reader" (1994).

The hardest to find were a fruitful correspondences between generative semiotics and generative media like Chat GPT, as paradoxical as that may sound, but surely there are such correspondences, and they are likely to be discovered in the future. In any case, as a theory of meaning generation on the one hand and an endless machine for creating meaningful texts on the other, the cultural explosion of AI will not leave this breed of semioticians unemployed.

We welcome contributions on the following key topics, but not limited to them:

- Semiotic models of AI generated cultural content
- Semiotic analysis of AI texts generation
- Semiotic theory of generative media
- Socio-cultural consequences of AI's advent
- Transdisciplinary collaboration between semiotics and informatics
- AI in creative practices in the arts
- AI in creative practices in marketing and advertising
- AI in research and education
- Cultural-economic implications of AI
- AI in pop culture
- AI in videogames and XR

Send here your proposal for papers (200-300 words): DigitASC AT nbu.bg

Deadline for the abstracts : 31 January 2025;

Deadline for full papers: 15 June 2025;

Deadline for the final revised papers: 31 August 2025;

Publication: December 2025

Digital Age in Semiotics & Communication, a journal from the Southeast European Center for Semiotic Studies at the New Bulgarian University and founded by Prof. Kristian Bankov, explores the new forms of knowledge, social and linguistic interaction, and cultural phenomena generated by the advent of the Internet and information technologies.

A topic is chosen for each issue by the editorial board, but the topics will be always related to the issues of the digital environment. The working language of the journal is English. It uses double-blind review, meaning that both the reviewer’s and the author’s identities are concealed from each other throughout the review process.

Link to the archive of the first six issues: https://ojs.nbu.bg/index.php/DASC/issue/archive

For more information and submission of papers: DigitASC AT nbu.bg

My source:
--

Departamento de Filosofia, Comunicação e Informação
Faculdade de Letras da Universidade de Coimbra
3004-530 Coimbra, Portugal

E-mail: iestudosfilosoficos AT gmail.com
Sítio Web: http://www.uc.pt/fluc/ief
YouTube: https://youtube.com/@uidief
Academia: https://coimbra.academia.edu/ief

ii "Nye" | Full Show [now ended] | National Theatre at Home

Watching yesterday on YouTube, I enjoyed NYE and was challenged by it personally and as a grandfather, son, nurse and tax-payer.

It wasn't all sweetness and light regards Aneurin "Nye" Bevin's character. Politically, he clearly pushed boundaries in response to the values he carried on his sleeve. As the family's of many health care professionals may recognise, needs outside the family can be prioritised at the family's cost. The theory-practice gap is expressed in so many ways. 

Whether by intent, or accident, the play points to the timeless challenge of social care and women's role in delivery of this care. This strikes home in the drama not just as care of the elderly, but being confronted (alone) with the slow, painful dying of a loved-one; and the reality of occupational diseases - 'black lung'. Women are exploited as carers, their hearts and feet may as well be bound; in the same way the mine owners exploited the workers. There was a stark reminder for me, of how continuity of care is often lacking today.

Nye becomes personal, as even up to 1970s working class parents would have worried, did worry about the prospect of their (invariably male - with some exceptions?) offspring going down the pit, especially in Lancashire and Yorkshire. Watching and listening to this you can appreciate how education was seen a passport to alternative white-collar work. My paternal grandfather worked in a slate quarry. I recall many invites to punch him in the 'stomach': a slate wall. He walked quite a few miles to work and wasn't that old when he died; although he (soon) followed grandma J.

For quite a while I've been drawn to the theatre. Aged 15 I was Francis Nurse - yes, the irony - in the school play, Arthur Miller's, The Crucible. It was Miss Smith, a drama teacher who first brought my attention to the idea of 'social awareness'. I recall Miss Clayton too who was a student teacher. On visits to London I've been struck by the relevance of Ibsen today. 

If there were to be a play in me, perhaps 'Axes and Crosses' must be-up-there as a working title? For  my father the 11+ exam was the icon to ward off the evil that was work down a mine; or lying under a an excavator / crane at 0400 to get the machine fixed for the shift due to start. The 11+ and need to pass this has provided its own anxiety, burden, and it must be said - motivation not just for me, but many more senior adults. I can see this now. So thank you Tim Price, National Theatre and Nye (2025!) for many further insights into stagecraft. 

See also:
https://www.bohs.org/media-resources/press-releases/detail/deadly-lung-disease-in-uk-kitchen-worktop-workers-is-avoidable/

September 2024: 'The Lightest Element'
https://www.hampsteadtheatre.com/whats-on/2024/the-lightest-element/

Previously:
What wright to care?

drama (theatre), arts

Nye | Full Show | Free (until 11th Nov) | National Theatre @home

Further to a post earlier this year regarding a play - 

Dramatherapy iii - A Specification for Care: Nye

- the play Nye is available to watch for free UNTIL 11th NOV 

on the National Theatre's YouTube channel (with Michael Sheen as Nye Bevan)

https://youtu.be/hpN--d5bXSY?si=yHiiXn1ZhN2_NDnP


My source: Politics of Health Group Mail List Messages

Visit the PoHG website for lots of interesting links and publications: http://www.pohg.org.uk/

Visit PoHG on Facebook: https://www.facebook.com/282761111845400

Follow us on Twitter: @pohguk

I walked by the NT this afternoon on the way to Bankside Gallery.

Dear Doctor, I have a list . . .

It seems reasonable to suggest that my trips to see the GP as a child:

"What's the problem Mrs Jones?"

"It's Peter, he's not eating!"

"Well, does he seem ill? ... Is he lying down all the time?"

"No, he's running around all day"

"Well he sounds OK but let's check" ... ... ...

"Say arr!"

 (That's to me - not you reader!)

"Argh!"

"Mmm.. ok, ok. ... What does he eat?"

"Tomato soup, chips, chicken, beans on toast, raw carrot, boiled egg."

"Oh! And jam butties!"

"Well he's of slim build, no doubt underweight, but he's fine. Keep the jam butties rolling, and I suspect he'll keep running around."

- were in the days pre-one-problem-per-visit to the surgery. Even now I wonder is this an urban (rural) myth. But then it rears itself with a comment by family, or overheard. The 1960s and 1970s were a different time, a different age. We always saw the same doctor. Continuity mattered then. Thankfully, I was not a regular 'visitor', or the more derogatory term frequent flyer.

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

Ever since starting in the NHS as a nursing assistant, you became aware of the anxiety provoked by many patients when it is their turn to see the doctor. Being asked to bring the patient and any relative(s) through. It often entailed a walk.

I remember one instance their being 12 professionals. Learners can soon increase numbers and restrictions were imposed. Voices were raised. Patients did see the doctor separately. Back in 1980s, I became a CMHN (CPN) in 1985, I used to encourage patient's to prepare, to make notes of points - questions they wanted to ask. I framed it as their time, their opportunity. A learning opportunity too. Of course, humour always needs to be used carefully, but on occasion we would joke about walking into the meeting with a list.*

In case of long-term mental illness families are also greatly involved. Sometimes a case review would take place in the patient's home. If it's care in the community, delivered by the community team then surely the administration can be organised in support?

At times, I would offer to assist and the team were always responsive. This role of advocacy has changed, transformed over the decades, but it is still there. As a nurse you listen for the voice: but have to be ready to 'pick this up' on another's behalf. Ready

*Lists: Long a tool for safety and situational awareness.

'What Kingdom' by Fine Gråbøl

client - person - individual - self - patient

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

What Kingdom

'Gråbøl was lucky. Eventually she started seeing a new psychiatrist, who looked at that record "and was like, "Wow, you receive So much more medicine than all the other people who live there. Why is that?'" She didn't know. Gradually, though, she was able to come off the drugs; and two doctors decided that she didn't, in fact, have borderline personality and bipolar disorders, removing the diagnoses that had shaped her sense of her self. In time, she left the unit and rebuilt her life. She's no longer on medication today, but the ghosts of her past diagnoses haunt her. She wonders whether the conditions are merely in hibernation and she'll wake up one day and enter another depressive episode. She doesn't wish she'd never been diagnosed, but does feel that her doctors underestimated the effect those labels would have on her development. At 17, she points out - the age she was diagnosed as bipolar - most teenagers don't yet know who they are. "You want to find a box or language to define yourself, so that you can close yourself in. And one way of getting that sense is getting into the psychiatric system." Since returning to "normal" life, she has also struggled with survivor's guilt: the feeling that while she made it out of the system, others did not.

'Above all, she wishes that the emphasis would shift away from the suffering individual and onto their broader context. We need to become better, as a society, at making room for people who aren't fully functional citizens. Gråbøl's narrator phrases it as a question: "Could we not imagine treatments that are instead externally directed involving the outside world gearing itself towards a wider and more comprehensive emotional spectrum?" Gråbøl's answer, though, is the same as my own: "I don't know."'

the system citizens?

My source:
Leaf Arbuthnot, Interview. We need to make room for the mentally ill. Review, The Daily Telegraph, 21 September 2024, pp.8-9.

Image:
https://images3.penguinrandomhouse.com/cover/9781953861849

Paths, lines, corners, edges and axes . . .

'If a farmer has made a path, he is able to saunter easily up and down it. That is what the path was made for. But the work of making the path was not a process of sauntering easily, but one of marking the ground, digging, fetching loads of gravel, rolling, and draining. He dug and rolled where there was yet no path, so that he might in the end have a path on which he could saunter without any more digging or rolling. Similarly a person who has a theory can, among other things, expound to himself, or the world, the whole theory, or any part of it; he can, so to speak, saunter in prose from any part to any other part of it. But the work of building the theory was a job of making paths where as yet there were none.' 

Gilbert Ryle, The Concept of Mind (1949; Penguin, 1999), p. 272.

path

https://hodges-model.blogspot.com/search?q=path

line (line of sight)

https://hodges-model.blogspot.com/search?q=line

corners

https://hodges-model.blogspot.com/search?q=corners

edges

https://hodges-model.blogspot.com/search?q=edges

axes: STRUCTURE

domains: CONTENT

Frayn, Michael (2006). The human touch: our part in the creation of a universe. Notes. London: Faber & Faber. p.425.

Previously: 'Frayn on maths'

I will keep this book a bit longer - chapter 'Home Address' (the self) a good read.

Hear* are the Global Evidence Results: Health 10 :: Education 1

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

EDUCATION 1 MENTAL HEALTH X?	HEALTH 10
	DEFENCE 10

Key recommendations

Our main recommendation is for countries to collaborate on evidence synthesis. The most promising avenue for evidence synthesis is Living Evidence Reviews (LERs), which are systematic reviews that are continuously updated. We propose that ‘meta’ LERs are conducted across all areas of social policy to answer the questions that really matter to policymakers.

“Globally, it may be helpful for countries to join forces in producing systematic reviews and identifying evidence gaps. One proposal, currently being shaped by David Halpern and Deelan Maru, proposes that a handful of likeminded governments join forces to produce better systematic reviews and avoid duplication (Halpern and Maru, 2024)… Like the Cochrane Collaboration and the Campbell Collaboration, such an approach can help expand our knowledge of what works, and put a spotlight on the areas where more evidence is needed.”

A Blueprint for Better International Collaboration on Evidence

https://www.bi.team/publications/international-collaboration-evidence/

My source:
Harford, T. Intellect. Used in evidence. FTWeekend, Magazine 2-3 November 2024, p.9-10.

*We really need to listen and respond to this!

ERCIM News No. 139 Special Theme: "Software Security"

Dear ERCIM News reader,

A new ERCIM News issue (Number 139) is online with a special theme on Software Security. The articles in this special theme offer a comprehensive panorama of the current European research activities in software security and protection. They showcase a diverse range of research projects, highlighting the ongoing advancements and key developments of the field..

You can access the issue at https://ercim-news.ercim.eu/

This special theme was coordinated by our guest editors Sebastian Schrittwieser (University of Vienna) and Michele Ianni (University of Calabria).

Thank you for reading ERCIM News!

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Next issue:

No. 140, January 2025
Special Theme: " Large-Scale Scientific Computing". Submissions are welcome! See call for contributions.

Announcements in this issue: Call for Proposals: Dagstuhl Seminars and Perspectives Workshops - Schloss Dagstuhl – Leibniz-Zentrum für Informatik is accepting proposals for scientific seminars/workshops in all areas of computer science.

Call for Papers: ACM Digital Threats: Research and Practice

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