DSA Webinar: Gaining understanding by structuring inquiry: probing data with one right question after another

Dear colleagues,

 

You are warmly invited to an online webinar hosted by The Digital Statecraft Academy (DSA), which may be of interest to those working with data and evidence in social policy.

 

DSA Webinar: Gaining understanding by structuring inquiry:
probing data with one right question after another

 

Date: Thursday 8 October 2026

Time: 15:00 BST / 16:00 CEST

Register: https://events.teams.microsoft.com/event/c6b38f8d-8f6c-4324-8c98-a73eeb36af86@f8ff7417-c954-4bf8-ba5a-1c103f38279d

 

Good analysis on clean data can still give a poor answer if the question behind it is wrong. This session looks at how we move from questions to evidence, in two steps.

 

Dr Stefaan Verhulst (Co-Founder, The GovLab at New York University and The Data Tank; Co-Editor-in-Chief, Data & Policy) will look at where questions come from, which questions get asked, and how governance priorities and political context shape them long before anyone opens a dataset.

 

Professor David Hand (Emeritus Professor of Mathematics, Imperial College London) will look at the next step: turning a real-world question into a statistical one that data can answer, and how this step can go wrong.

 

The session will be chaired by Dr Zeynep Engin, Co-Founder and Director of The Digital Statecraft Academy.

 

The discussion draws on Professor Hand's new book, What is the Question? Deciding What You Really Want to Know (2026)

 

The webinar is open to all. Register via this form. Please feel free to share this invitation with colleagues who may be interested.

 

Best wishes,

The Digital Statecraft Academy

 

My source: JISC SocioTech list - https://www.jiscmail.ac.uk/cgi-bin/webadmin?A0=SOCIOTECH

Beware of the Concept

Yesterday Alan Ayckbourn's gold-nugget-laden book -

The Crafty Art of Playmaking by Alan Ayckbourn. Faber, 2004, softcover, ISBN 0571215106.
https://www.concordtheatricals.co.uk/s/45898/the-crafty-art-of-playmaking 

- found a new owner. Beforehand, I turned up the following helpful advice (or, 'obvious rules'): 

ix Introduction

'The following is an attempt to describe, as far as I can, this double process [writing and directing, PJ]. Some of it is quite probably unique to me and contains procedures and practices that it would be highly unwise for others to try and copy. The rest is really just plain common sense. But if I've learnt anything it is that it never hurts to point out the obvious occasionally, certainly in the theatre - to actors, directors or writers and sometimes even to designers, stage managers and technicians. Often we quite wrongly suspect simplicity. We go digging around in the creative sand trying to make.our art more meaningful, somehow 'deeper'. Generally all we do is end up with our heads entirely buried, presenting the audience with our rear ends.'

Obvious Rule No. 3
If you don't have the initial inspiration, put down the pen,put the pencil back in the jar, switch off the computer and go and dig the garden instead.
.. 
'At its most successful, theatre views things from a human standpoint. It is after all the most human in scale of all the performance media. My feeling is that that's also a good place for a dramatist to start, at the human level. As a playwright it may be your intention to build a vehicle to take us to the stars. But do make sure you have people aboard.

Initial inspiration - that essential starting point - comes in all shapes and sizes.' p..9.

Obvious Rule No. 49
Beware of the Concept.

DIRECTING

'Don't be talked into anything you feel instinctively you'll regret later. If you must have a concept (God save us from that word) then let the concept be something that's worked out between you. Let it spring from the play and not from the fact that the production manager has 5oo square metres of black lino left over from their last production. I once heard the fateful words, 'I think it's about time we did something with mirrors.' If at all possible, try and persuade the producer, whoever it is, to let you make as many scenic decisions as late on as possible. There will always be an intense pressure to decide everything before you start. This can be fatal.' pp.118-19.

In pencil I noted: 'Hodges' model is different. So, don't panic.' Is it? Really?

I've saved this for the last: 

'Then there is the new old playwright. Far more difficult to deal with. They have probably nursed this script for twenty-five years and they're damned if you're going to mess it up for them when they've waited so long. Especially someone your age who wasn't even born when their harrowing play about World War Two was still raging, dammit.' p.110.

It's not that I believe I'm a (potential) playwright, it's the learning.

See also: 'Ayckbourn' : 'drama'

Euclidean or Projective Care?

How many dimensions does a written - narrative record have?

Sketching out some ideas, I asked the question on Google and as usual an AI Overview response followed - snippet:

AI Overview

A physical written record has two primary spatial dimensions (length and breadth/width) as a flat document, or three dimensions (including thickness or depth/height) when considering its physical form or binding. [1, 2]

In archival and Records Continuum theory, a written record exists dynamically across four conceptual dimensions: [1, 2].

I put the question to the Records Management list with the above snippet and received several useful suggestions and sources. Perhaps I can share that at a future point? 

Acutely aware of not pursuing maths and category theory for its own sake, the query was driven by an attempt to look at Hodges' model in mathematical terms. Starting, rather obviously with the models structure and axes. When the model is assembled, as per many posts, the vertical axis:

INDIVIDUAL
|
GROUP

- shouts out the issue of parity and the distinction between mind and body. It does this at the individual and collective level. If we were to draw a silo, a cylinder springs to mind, and there are specific reasons for silos adopting this shape. Descartes gives us the perfect excuse, in the ongoing legacy. 

     Mathematical Visions

The question above came up from Joan L. Richards book 'Mathematical Visions' (c/o Lancaster Univ. library). Euclidean and the emergence of projective geometry is described. There is an interplay between 2D and 3D representation, that made me think about the health record and its dimensions. Not in a dataset sense (multi-dimensional), more generally and concretely(?). A patient's record on paper has physical dimensions (A4), there is a flow. An EHR has its virtual dimensions (discuss!). Abstractly the content is a time machine. At some point in a health encounter it is a literal 'history', the level of detail in accord with the context. The record might present the problem, premorbid situation, diagnosis, current state, observations and prognosis and much more.

I can revisit this, Richards provides a series of figures. We progress from two distinct circles (my silos) through to examples with a discussion of continuity and projection that sees the circles touching, then intersecting. This is a radical axis.

Richards, Joan L. (1988), Mathematical Visions: The Pursuit of Geometry in Victorian England, Boston: Academic Press, ISBN0-12-587445

Book cover: Amazon.

Book Announcement | The Examined Illness: A Philosopher's Confrontation with Deadly Disease

The Examined Illness

Intellect is pleased to share that The Examined Illness: A Philosopher's Confrontation with Deadly Disease, by Darrel Moellendorf, is out in paperback and hardback.

A visceral personal memoir of being seriously unwell – and the consolations of philosophy during sickness. Being a patient is part of being alive. Disease and serious illness often strike randomly, and when they do, we quickly become subject to the impersonal forces of biochemistry and pharmacology. We rarely think about sickness beforehand and are often totally unprepared for it when it happens. Suddenly, there we are, subject to a standard treatment protocol. Darrel Moellendorf learned this by experience during a month confined to a solitary and sterile hospital room where he received a life-saving stem cell transplant. His room was somebody’s workspace, his schedule was somebody’s work routine, his immune system was systematically crushed, and his prognosis was out of his hands. There was no assurance that it would all work out.

Having spent thirty years teaching philosophy to college students, He was facing the biggest test of all—perhaps the final exam. These are his reflections before, during, and after his cancer treatment, written in real time. He writes, “My brain was sometimes addled by the chemotherapy that sapped my energy and destroyed my immune system, but I wrote out of the conviction that living well includes living well with disease, and eventually living well facing death.” This memoir expresses the conviction that the virtues of patience, courage, trust, and hope serve us well. A measure of good humor also can’t hurt.

Part of the Global Health Humanities series.

Table of Contents

Acknowledgements
Introductory Note

Part I: Diagnosis
1. First Thoughts and Second Opinions
2. Healthcare for All Pt. 1
3. Patients and Patience
4. Father to Son and Back
5. Give It Up for Lent!

Part II: Inside
6. Day 7: The Countdown Begins
7. Day 6: Carpe Diem
8. Day 5: Vegetarianism Is Not an Option
9. Day 4: Sweatin’ and Shakin’
10. Day 3: Making Decisions When You Can’t Think
11. Day 2: Nausea and Fatigue
12. Day 1: Courage
13. Day 0: Communion
14. Day +1: Confinement
15. Day +2: Waiting and Anxiety
16. Day +3: Relaxed
17. Day +4: Toiling and Spinning
18. Day +5: Healthcare for All Pt. 2
19. Day +6: Patience and Hope?
20. Day +7: A Letter Arrives
21. Day +8: Anaemia
22. Day +9: Why I Write
23. Day +10: Why I Dyed My Hair Blue
24. Day +11: Shorn
25. Day +12: Tired, Itchy, and Hiccupping
26. Day +13: Waiting
27. Day +14: Signs of Progress
28. Day +15: Turn Me Lose, Set Me Free
29. Day +16: Fresh Air
30. Day +17: Postponement

Part III: Recovery
31. Home Sweet Home
32. Home Update
33. The Social Determinants of My Survival
34. Letting the Days Go By
35. A Thread of Good Fortune
36. Magical Thinking
37. Hope Kept Me Eating
38. Sunshine, Suffering, Rebirth, and Freedom
39. Food Aversions
40. Inching Towards Normalcy
41. Human Fatigue and Canine Anxiety
42. Healthcare for All Pt. 3
43. Still Wearing My Helmet
44. Same as It Ever Was
45. Who Is That Masked Man?
46. Inspiration in the Oncology/Haematology Waiting Room
47. With a Little Help from My Friends
48. Springtime on My Face
49. Feeling the Love … and the Likes
50. Disease, Bodily Alienation, and Transhumanism
51. Dem Fingernails
52. Traversing the Rim of the Valley of the Shadow of Death
53. The Examined Illness

Epilogue: Living with Mortality
References

Please visit our website for more information:

www.intellectbooks.com/the-examined-illness

--

My source: Georgia Glasspole

Marketing Executive (she/her)

Intellect  | 0117 9589910 | georgia AT intellectbooks.com

Celebrating Black History Month with the RCN NW Multicultural Group

From Allyship to Action: Building an Inclusive, Anti-Racist Future for Nursing

22 Oct 2026, 10:00 - 16:00
6 Mount Street, , Manchester, M2 5NS

Free

Book onto our celebration for Black History Month.

Join us for a full day at the Friend's Meeting House in Manchester to celebrate Black History Month!

North west members are invite to join us in celebration alongside the RCN President, who is making a special trip to Manchester to join us for part of the day.  This year we will be exploring the theme: From Allyship to Action: Building an Inclusive, Anti-Racist Future for Nursing.

The event, organised by the member-led North West Multicultural Group, will hear from speakers including:

Estephanie Dunn: Non-Executive Director of the Caribbean and African Health Network (CAHN)

Estephanie will discuss exceptionalism and how intentional and unintentional actions can negatively impact equity, inclusion and belonging in healthcare. Her session will encourage reflection on bias, challenge inequitable practices, and promote more inclusive workplaces for all.

Temitope Babajide: General Practice Nurse

Creator of both the General Practice Nurse Starter Manual and a separate nursing-themed colouring book, will share her inspiring journey in primary care. Her session will recognise and celebrate the historic and ongoing contributions of Black nurses, while showcasing the achievements, leadership and influence of Black nursing professionals in the North West and beyond.

Patricia Hughes: Associate Director RCN : Nursing Practice Nursing

Patricia will focus on equality, leadership and career progression, encouraging greater representation of Black nurses in senior and decision-making roles.

Bejoy Sebastian: RCN President

The President, will discuss the importance of allyship and the role nursing professionals play in creating anti-racist, inclusive workplaces. He will recognise and celebrate the significant contributions of Black nurses to the NHS and wider health and social care sector. The session will explore how inclusive leadership, workforce equality standards and fair career progression can help create a culture of belonging. Attendees will be encouraged to take practical action to challenge discrimination, support equality and inspire the next generation of nursing leaders.

Anandi Ramamurthy: Professor of Media and Culture, Sheffield Hallam University; Principal Investigator, Nursing Narratives: Racism and the Pandemic; Co-Editor, Anti-Racist Nursing and Midwifery: A Resource for Students, Practitioners and Activists.

The Anti-Racist Nursing and Midwifery book, the Nursing Narratives research project, and the film 'Exposed'.

There will also be a panel discussion and a poetry workshop and 'Allyship in Action' challenge workshop in the afternoon. 

Book now to avoid missing out. This event will take place in person and is open to all North West members. A sandwich lunch is provided. 

For further information regarding the aims and objectives of the NW Multicultural Group, please visit our webpage. 

Olanike Babalola

Olanike.Babalola AT reps.rcn.org.uk

Blueprints ...

individual

|
INTERPERSONAL : SCIENCES             

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

SOCIOLOGY : POLITICAL   

|

group

Du Sautoy, M. (2024). Blueprints: How mathematics shapes creativity. Glasgow: 4th Estate.
https://www.4thestate.co.uk/products/blueprints-how-mathematics-shapes-creativity-marcus-du-sautoy-9780008685034/

Burgis, B., Bhaskar Sunkara, B., and Beggs, M. (2026 - 26th Sept) The Blueprint: How Socialism Can Work in the Real World. London: Verso.
https://www.versobooks.com/en-gb/products/2843-the-blueprint/

Book covers c/o Waterstones (Du Sautoy) and Verso Books. 

My source https://www.liverpool.ac.uk/philosophy/philos-l/ (Beggs et al.) and various.

Previously: 'creativity' : 'socialism' : 'politics'

"Poetics of Relation" by Édouard Glissant

'The Slave Trade came through the cramped doorway of the slave ship, leaving a wake like that of crawling desert caravans. It might be drawn like this:

African countries to the East; the lands of America to the West. This creature is in the image of a fibril.

African languages became deterritorialized, thus contributing to creolization in the West. This is the most completely known confrontation between the powers of the written word and the impulses of orality. The only written thing on slave ships was the account book listing the exchange value of slaves. Within the ship's space the cry of those deported was stifled, as it would be in the realm of the Plantations. This confrontation still reverberates to this day.' p.5.

'Not just a specific knowledge, appetite, suffering, and delight of one particular people, not only that, but knowledge of the Whole, greater from having been at the abyss and freeing knowledge of Relation within the Whole.' p.8.

 
Édouard Glissant. (1990, 2025) The Open Boat. Poetics of Relation. Dublin: Penguin.

The above image runs within the text in the book.

My image source: https://annstreetgallery.org/Nolan-Oswald-Dennis

"Hey Jonesy: Where's the book?"

This prompt from yesterday is far from new. There are outlines for papers on W2tQ.

Seriously though, what would a book outline look like - now?

The introduction is probably already written, it just needs to be pulled-together. But, in truth it (desperately) needs a new perspective. The question of how to update the explanation - short of running a workshop? The model's original purposes 1-4 are a statement of fact. The intro figures that invariably show how the axes 'create' the model's care, or knowledge domains? What if...? Could we also present the inverse? That would be a new slant. Does the model still 'work'? 

Details aside, here is a quick outline:

Part 1

Introduction and Background 

1.1 Brian E. Hodges and Post-Registration Nurse Education

1.2 Peter Jones - Primed to mind-map

1.3 Web presence: Initial website 1998-2015 - Blog 'Welcome to the QUAD' 2006 ...

1.4 Brian's original lecture notes

1.5 Looking back and forward: Models of care for the 21^st Century

1.6 Confessions: So, where is the new site / platform? 

Part 2

 The Four (Five) Care Domains 

2.1 Science

2.2 Interpersonal (& Intrapersonal)

2.3 Sociology

2.4 Political

2.5 Spiritual

Part 3

Hodges' model in Practice - Applications

3.1 Self care

3.2 Clinical

3.3 Social Care - Community 

3.4 Management

3.5 Informatics

3.6 Policy 

3.7 Education

3.8 Workforce: Local - Global 

Part 4

The Legacies (still) in Our Midst

4.1 Person-centredness

4.2 Integrated Care

4.3 Holistic Care

4.4 Parity of Esteem

4.5 The Theory-Practice Gap

4.6 Change - Transformation: When? Disease to Prevention

Part 5

It's Tomorrow Now

5.1 Health Promotion

5.2 Public (Mental) Health & Protection

5.3 Citizenship

5.4 Global Health

5.5 Planetary Health

Part 6

Research

6.1 Hodges' model as a Research Tool

6.2 Climate change

6.3 Planetary Health

6.4 Beyond the Bio-Psycho-Social Model: The Political Domain

6.5 The Literacies 

6.6 InterDisciplinary, Multi- and Transdisciplinary

6.7 Hodges' model as a Mathematical Object?

Part 7

Philosophy

 

7.1 Revisiting the Original Purposes

 

7.2 AI - The Elephant in Mind

 

7.3 Value & Values  

...?

Much to add, revise ... 'Education as Part X'. Political and Literacy too - a specific part - and with AI (in every part!)?

STOP!!

OK. It's a minefield. Even a proposal is a 'non-trivial' task.

Who's writing this? Not me! Not all of it, and for me; not AI either.

It would be marvellous to be one of several editors: one day? 

Clearly, a great project for students and early career researchers and current practitioners. 

An inoculation to help new cohorts deal with the realities, ravages and rewards of 'care' in its entirety*. 

P.S. With the start of a title right there? PJ

Reading group: Kantian Justice - KantianDESERT

Dear all,

The KantianDESERT project's reading group will return on Tuesday 11th August, from 12-1:30 UK time. We will be starting to read Joseph de la Torre Dwyer's 2020 book 'Chance, Merit, and Economic Inequality'. The first session will focus on the Introduction and chapter 2.

The reading group will take place both in-person in Liverpool, and online via Teams. All are welcome. Please email: erc.kantiandesert.ukri AT liverpool.ac.uk if you'd like to attend and we can send you the room details/invite/reading.

My source: Kantian DESERT list and Philos-L "The Liverpool List". Messages to the Philos-L are archived at 
http://listserv.liv.ac.uk/archives/philos-l.html. Follow the list on Twitter @PhilosL. Follow the Department of Philosophy @LiverpoolPhilos

[n.b. With apologies for short-notice. PJ ].

Koln 75

The film Koln 75 was very enjoyable ...

'Brandes quit the music business a few years ago, after a very successful career. Why? "Digital formats were taking over the record industry, which was giving away entire repertoires to companies like Apple with a completely idiotic accounting system in the background, which would never, ever allow for the artists to get properly remunerated for their rights. The whole industry thought that digital would be the biggest portion of whipped cream on top of the cake that they would continue to be eating until the end of all time.'"

Instead, inspired by a 1993 study that found that listening to classical music-specifically Mozart-enhances spatial-temporal reasoning, and by Don Campbell's bestselling 1997 book The Mozart Effect: Tapping the Power of Music to Heal the Body, Strengthen the Mind, and Unlock the Creative Spirit. Brandes studied psychology at university and then, funded by the Austrian Ministry of Culture, established the Research Program for Music-Medicine at the Paracelsus Medical University in Salzburg. "Being a music producer, I dreamt about doing scientific research on the effect of music and trying to figure out what effects music has on us - cognitive, emotional, whatever," she says. "Since then I have developed a method to use music to help people with chronic depression."

individual

|
INTERPERSONAL : SCIENCES             

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

SOCIOLOGY : POLITICAL   

|

group

cognitive emotional chronic depression
Jazz

Stuart Jeffries, How a teenager helped to make jazz history, Life&Arts, FTWeekend, 30/31 May 2026. p.15.

See also: https://www.youtube.com/watch?v=3CrFdGMj4cM

How is your Odyssey (thus far ...)?

THE ODYSSEY

As a tool for lifelong learning Hodges' model must be capable of providing a structure through which a narrative can woven. A person's career, as in work, is another distinct example. And again the 'health career' through health, illness, physical and mental trials and tribulations is perhaps the prime example. As the example, it forms the basis of myth underpinning the world's cultures, pre- and ancient histories.

Tomorrow, is the day of "Two Odysseys". No: this is not 2001, 2010, 2061 or 3001.

One odyssey, heads off to the South West, to a place where the land ends, apparently. Memories to be made, a story to unfold.

The other, is based on a voyage: an incredible tale, an epic journey - the epic (in the west). This ODYSSEY will be found in the cinema (and not on a phone, TV, PC, laptop ...); and vitally also in an amazing book. Recounting, what was originally the oral tale of Odysseus on his fantastical 10-year journey home after the Trojan War.

Hodges' model provides a structure to weave this narrative, the twists and turns of patients, carers, students and personnel - all the narrative forms.

Image: https://www.rottentomatoes.com/m/the_odyssey_2026

See also: The Hero's Journey and Joseph Campbell

Project 2000: The Judge Report 1985

Somehow, or perhaps that is being kind, I have a feeling that sources on the history of 'recent' nurse education may come to the fore. It is interesting that the guest editorial below reflects itself on the preceding 25 years. Not just several cohorts of students, careers, but a whole life-time. 

We must hope today, that British nurse educators can find more security, if not the contentedness described by Rye in 1985 ...

'The main principles for policy change contained in the commission's report are as follows.

1 The uncoupling of education from service. Students should no longer be employees of the National Health Service. Nursing education should now be part of the main-stream of higher education, students being financed through a suggested bursary system.

2 A single level of basic nurse qualification leading to registration.

3 Curriculum development (as discussed in chapter 4 of the report) must take into account the need to retain certain speciality options, and prepare students for practice both in hospital and community settings. It creates the possibility of direct entry into district nursing, health visiting and midwifery. 

This 3-year course would have educational credibility as it will be at diploma level, the first year being a foundation programme, furnishing a basis for informed choice later. The second year would contain practical placements (in the community, adult nursing and mental health). It would consist of three modules, the first to be based in a community setting, the second (focused upon the nursing of adults) in a hospital setting, and the third in a variety of environments related to mental health. Roughly 30% of the time will be dedicated to carefully supervised practice in clinical settings. The final year will be characterized by increased specialization. The opportunity to make a selection from a number of available modules will equip each successful student to become registered and to take up work either in an institutional or non-institutional setting. The academic award will be that of Diploma in Nursing Studies. 
...
This new approach to nursing education will not create a 'generic' nurse, but will prepare students to work in their chosen speciality in hospital or in the community. If nurses are to respond to the changing patterns of health care, it is critical for future development that preparation for working in the community takes place in the basic diploma programmes. This may be seen as one of the more controversial implications of the report, but the profession must address itself now to these matters, as nursing education must become more flexible and capable of change to meet the needs of clients.'

See also: #RCN26 RCN Congress - Nurse Education 

Rye, D.H. (1985), THE EDUCATION OF NURSES: A NEW DISPENSATION. THE REPORT OF THE RCN COMMISSION ON NURSING EDUCATION. Journal of Advanced Nursing, 10: 505-506. 
https://doi.org/10.1111/j.1365-2648.1985.tb00540.x

Royal College of Nursing (Great Britain)., & Judge, H. G. (1985). The education of nurses : a new dispensation. Royal College of Nursing. (Classed as a Book.)

See also: https://wellcomecollection.org/works/p889dx97

https://eprints.hud.ac.uk/id/eprint/10084/1/ouseycontent_9838.pdf

'Oh Thomasina!' Such a drama in a diagram

Arcadia

Last evening I really enjoyed a performance of Tom Stoppard's Arcadia at the Duke of York's, or soon to be - The Tom Stoppard Theatre:

Act I, Scene 2  

'Septimus ... You should no more grieve for the rest than for a buckle lost from your first shoe, or for your lesson book which will be lost when you are old. We shed as we pick up, like travellers who must carry everything in their arms, and what we let fall will be picked up by those behind. The procession is very long and life is very short. We die on the march. But there is nothing outside the march so nothing can be lost to it. The missing plays of Sophocles will turn up piece by piece, or be written again in another language. Ancient cures for diseases will reveal themselves once more. Mathematical discoveries glimpsed and lost to view will have their time again. You do not suppose, my lady, that if all of Archimedes had been hiding in the great library of Alexandria, we would be at a loss for a corkscrew? ...'^ p.20.

 Act II, Scene 3

'Lady Croom We are intruding here - this will not do, Mr Hodge. Evidently, nothing is being learned. (To Noakes) Come along, sir! 

Thomasina Mr Noakes - bad news from Paris! 

Noakes Is it the Emperor Napoleon? 

Thomasina No. (She tears the page off her drawing block, with her "diagram" on it) It concerns your heat engine. Improve it as you will, you can never get out of it what you put in. It repays eleven pence in the shilling at most. The penny is for this author's thoughts. 

She gives the diagram to Septimus who looks at it.' p.74
...
Now Septimus retrieves his book from Thomasina. He turns the pages, and also continues to study Thomasina's diagram. ... 

Septimus Why does it mean Mr Noakes's engine pays eleven pence in the shilling? Where does he say it? 

Thomasina Nowhere. I noticed it by the way. I cannot remember now. 

Septimus Nor is he interested by determinism -------

Thomasina Oh... yes. Newton's equations go forwards and backwards, they do not care which way. But the heat equation cares very much, it goes only one way. That is the reason Mr Noakes's engine cannot give the power to drive Mr Noakes's engine. 

Septimus Everybody knows that. 

Thomasina Yes, Septimus, they know it about engines! 

Pause. He looks at his watch 

Septimus A quarter to twelve. For your essay this week, explicate your diagram. 

Thomasina I cannot. I do not know the mathematics. 

Septimus Without mathematics, then.' p.75.

 
Tom Stoppard, (1993) Arcadia (Playscript), Faber & Faber, pb. ISBN 9780571169344.
https://www.faber.co.uk/product/9780571169344-arcadia/

My text source:
https://collegearts.yale.edu/sites/default/files/attachments/arcadia_by_tom_stoppard.pdf 

^ n.b. This was therapeutic, but I still mourn the losses from Alexandria and other libraries ... today.

vi Book: 'Complexity in Health Care - A Paradigm Shift for Clinical Practice'

The rest of the book is practice-based which is a strength. Chapter 18 has three clinical illustrations, were reflection and self-reflection is brought to fore. Especially so, as it pointed out that the 'clinical situation/encounter' introduces its own 'vagaries', or noise which can impact the 'quality of the bond between clinician and patient'. Rapport is the key. 

I was still missing 'complexity' and its dynamics, but I'm sure of the following:

If this was discussed - could be represented then the book would be theory-laden and I and other would-be readers would not be able to understand.

I still think Hodges' model can help, and in chapter 19 picked out 'manifold' (p.113), as if doing so, manifests something more esoteric. There is something here, the author noting the need to shift from individual to group perspectives. So, yes I think we can do more than embrace 'complexity' (p.114).

On page 116 there is discussion of the sometimes sudden path to recovery, 'probably common but often not comprehended'. Please pardon the naivety, but I scribbled 'hidden in complexity, what would (say) the three(?) equations be?'. For a book published in 2023 'artificial intelligence' is not indexed. This might be one area that AI could assist, given the progress in formal mathematics (but see below p.183!)? Algorithm is mentioned throughout the book. Further reading here, informed me that engaging with a reading group on 'Philosophical Counselling' is worthwhile. It is!

Part IX had me wondering if the debate about typical and complex cases, there is a slight of perspective going on? You can end up with paradoxes in terms of an individual's needs, criteria, risk, 'need for admission'. Which I must think about! Chapter 20 has three further reading texts on abductive reasoning. There's an appeal(?) on page 129 for an appropriate treatment model, well that is my take. Collaborative care and stepped care models are suggested. But with acknowledgement that:

'In truth, all models currently available may involve a defect in continuity within or between systems'. p.129.

I beg to differ. A role of Hodges' model is to help frame aspects of care through time, to facilitate and assure continuity.

Part X tackles the required precision in assessment, hence recourse to mathematics and statistics. The next two chapters may be useful for early career researchers and yet looking over our shoulders what is ai offering here? In Case 1 I was impressed by the suggestion of a health record that is over 70 years old. Not impossible of course, but I thought of the Lloyd George envelopes, their hospital equivalents, other paper sources and inevitable scanning this would entail here in the UK? Of interest to research is the creation and validation of complexity profiling inventories (tools) not just that, but their self-assessment form of delivery. And, yes in summary chapter 24:

'We are still left with the challenge of rating the patients' severely compromised health situations where "health" includes social, emotional, and financial well-being.' p.143.

'How do you factor this interpersonal situation into your complexity equation?' p.144.

Yes, how indeed? 

The realities of research of dealt with - funding for the development of tools a problem universally. The references here concern biopsychosocial complexity. Chapter 25 describes abstraction, and hiding detail, which is of great interest here. DSM-5 criteria for major depressive disorder are listed (DSM-6 may be released in 2029?). 

In chapter 25 the authors are once stymied by 'how to include (integrate? PJ) four dimensions, three time periods,and assorted assessment items in a single assessment.' 

As noted the four domains are here again (p.151): medical, psychological, social and care delivery and on page 153, introducing chapter 26, limitations of complexity assessment tools. Parity as in 'parity of esteem' is not indexed and I don't recall having read this, but this is well represented in later deliberations on variables #2. You will find psychosis, but not in depth or severity.

 In 'Creation of a New Model for Clinical Practice' (Chapter 31) identity is stressed, as a prompt to encompass those variables that contribute to preserving the person - what is humanistic. Allied with manifold, identity is a 'coi' for me, concept of interest - for this same reason. On page 172: the authors observe they 'are left with the question of whether there are acceptably accurate clinical models that are simpler and more straightforward than ours? We believe the answer is no!'. I believe there is a way, and a model to help 'keep the life in clinical work' - not take it out. There is a sense that Chapter 32 seeks what I was looking for above: as they explore random variable and 'sample spaces' descriptively - over a page.

Ah! 'Artificial intelligence' is found in text p.183. I'm surprised an editor, proofreader aloud the following sentence to go unchallenged?

'But, as will be discussed, these computer techniques have their limitations based on their lack of flexibility.' 

I was genuinely surprised to read this. Plus, again on ai on page 185: 'Making inferences is not reliably their domain.' I think I would look more at the human-ai interface. And the status of ai within psychiatry as opposed to medicine, but that is also another (parity - divide) debate. Things really are complex now on so many fronts: ethics especially.

Perhaps I am looking for the cookbook formula as introduced for chapter 35 clinical judgement. The further reading is combined with critical thinking. More detail on the empirical-collaborative method is welcome. When I read 'illustrated' I take this literally. Again I can disagree twice on page 220. I know Hodges' model is not validated, but it can - with practice(?) - do this light (simple) or heavy (complex) lifting. 

The warning about dogma needs to be repeated regularly. It is rather like the need for nurses to revisit their profession, role and work as relates to the law. Is Hodges' model an over-valued idea? Am I guilty of thinking I'm an expert? A problem with that view is that any assumed expertise is stretched across the whole model. So if anything there is a shallowness, but this means that I see my particular scope of practice, as other colleagues / professions see theirs. Here in the UK of late, this seems to have become rather blurred. 

In closing with this and achieving a "real-life" understanding of a case, with synthesis - path analysis diagram, the author's underline the value of their book which I have enjoyed and informed my preparation for WCCS26 (more to follow there). The authors can perhaps be reassured that all practitioners have a means to achieve their paradigm shift as described here - with added value and values.

There is a missed word: "of the situation ['with'?] him" on page 114. And revision needed re. text beginning with 'his boyish Paul McCartney "mop-top" ... on page 214. Spelling error on 216 'retu(r)ning'. 

Thanks again to Daniela and colleagues at SpringerNature for the review copy.

Steven A. Frankel, Steven D. Thurber, James A. Bourgeois (2023) Complexity in Health Care: A Paradigm Shift for Clinical Practice. Cham. Switzerland: Springer. ISBN: 978303114948.

v Book: 'Complexity in Health Care - A Paradigm Shift for Clinical Practice'

Chapter 11 held promise in the title 'Formalising the Clinical Field'.

If anyone is interested, formalisation is what I would like to focus upon - using Hodges' model - over the next several years (taking nothing for granted). If truth be told, I'd be stressed as if (true) formalisation was discovered here, I may find this is beyond me, but this is the course I have chosen.

There was nothing new, the 'clinical illustrations' continued. The reading is worthwhile, in trying to define complexity, or what constitutes a 'complex case', hence 'Each new entry expands the complexity and gravity of the case, moving it beyond "plain vanilla" of a single medical or socially based condition'. I was reminded here of the user personas used in developing online communities. And in health the way personalised detail gets lost as personal details - emotional content gets lost (necessarily) as data is aggregated. The chapter revists the definition of clinical complexity.

'So, how does this information fit with our tentative understanding of clinical complexity as "the potential for progress toward health recovery in the context of a particular set of diagnoses and available treatments" (Kathol et al. 2018)? The phrase "particular set of diagnoses" could be replaced by "clinical challenges?" After all, where do you fit cultural considerations or family disjunctions here? Neither are diagnoses per se. Both have typically been relegated to the periphery of diagnostic considerations. Instead, they are elements in a loose matrix of clinical influencers.' p.76. [My emphasis].

Well, Hodges' model provides an ideal place for cultural considerations and family disjunctions. But replacing 'particular set of diagnoses' with 'clinical challenges' will be met with a challenge itself. This serves my purpose in advocating for Hodges' model, if challenges across the model's four care/knowledge domains can be seen as 'clinical'.

Identity morphism

Part VI on Subjectivity and Intersubjectivity is an important lesson to look; then look again - beyond the (basic!) subjective-objective dichotomy. You want patients - clients to recover quickly. The clinical illustrations are helpfully carried forward, as per the longevity their being 'complex' portends. The fact that in a clinical conference, social aspects are barely mentioned is one rationale for use of Hodges' model in practice. What has not been discussed? For 'Seth' a case formulation is raised, (I sketched a 'simple'  triangle) and the limited conceptual scope acknowledged above (p.80). Reading, I did wonder what a new edition might look like given developments in the USA? Would it make a difference? There a question about to categorise one client. And I scribbled 'identity' in the summary for the subjectivity between client and clinician.

I've always liked archaic terms^ and here cussedness springs to mind as the authors seem compelled to return to the issue of a definition for complexity. You could say - they can't put it to bed! 'Lifestyle' is not indexed. But it is clear that the adopted lifestyle of many clients also compounds, contributes to the clinically complex presentation. Case, condition, set of sign/symptoms, state of affairs, situation - all may be simple or complex. On page 87 regards Mark: 'The management challenge of this situation is evident. The situation itself is not medically complex. However, managing it is.'

When I read the aforementioned formalisation (chapter 11), I thought logic might follow, a specific illustration? Abduction is a teaser introducing chapter 14. It is chapter 15 that inference including abduction is usefully discussed:

'Abduction goes further than obtaining general and specific logical conclusions. Abduction seeks explanations beyond logic. The clinician listens to the utterances of a patient and integrates word meanings and word referents with other gathered data. The clinician abductively decodes information and concocts potential explanations for the words of the patient that fit with aggregated clinical findings. This rational processing results in what the clinician considers the best explanation for the information at hand. However, other explanations remain as viable until and unless eliminated by subsequent data. The clinician using abductive reasoning always maintains an openness to changing explanations and an intention to expunge unsatisfactory conclusions as accumulating data dictate [1].' p.96.

The author's empirical-collaborative (E-C) approach spans the book. They might find that Hodges' model as a conceptual framework can seamlessly fit with E-C. A reference on Bayesian Statistics. Lee PM (2013), plus further reading is listed.

There is a spelling mistake p.73; 'contacted a disease'?

One more post to follow ... may add here also.

Thanks again to Daniela and colleagues at SpringerNature for the review copy. 

Steven A. Frankel, Steven D. Thurber, James A. Bourgeois (2023) Complexity in Health Care: A Paradigm Shift for Clinical Practice. Cham. Switzerland: Springer. ISBN: 978303114948. 

Image:

https://krossovochkin.com/posts/2020_04_26_category_theory/ 

 

^Which is ok, I'm a grandad now.