Books: Bortz's Next Medicine, a summer break and an oath

As the Northern autumnal equinox rolls in I've a book to read and review with thanks to OUP for the copy:

Next Medicine: The Science and Civics of Health
Walter Bortz, MD

Even though the health care systems of the USA and UK differ markedly the book caught my interest on several levels:

First the title: the next & civics aspects stand out. As for next something has to give in health care systems, not just in the USA but globally. Civics to me suggests a public and collective responsibility and level of engagement. The book's description also highlighted issues that I can relate to here in the UK nursing community. In the first chapter Bortz considers medicine's mission:

As I search for the first principle(s) from which to all else derives, I offer as a terse definition: "Medicine's mission is to assert and assure human potential." In a parallel vein, Norman Cousins ventured that "the physician's role is to help mankind make of itself the most of which it is capable (4)". Put yet another way, the physician's job is not only to cure illness or to fix broken bones, but to serve first as a mirror into which the patient peers to see the reflection of the problem, and secondly as a prism showing not just what is, but what might be. The physician's role transcends that of simple mechanical repair. The human body is infinitely more than than a deterministic machine. p.6.

I was delighted to enjoy a vacation in Kos this past week. Early on Walter Bortz refers inevitably to Hippocrates who was born and lived on Kos. By quite a coincidence the BBC Radio 4's In Our Time featured Hippocrates last week. Already, as the quote above shows (and Bortz stressing the need to attend to the big picture!) I'm really pleased to have this copy and look forward to a fascinating read and reflecting more here.

After'math' II of... The Difference that Makes a Difference

Continuing in the vein of challenging and stimulating ....

It seems there are several people attributed with the saying "the map is not the territory". The debate around maps and territories came up in discussion and is frequently raised on psychology and therapy discussion lists. At DTMD I referred to h2cm as a cognitive periplus, which I came across in Cunliffe's book The Voyages of Pytheas. Basically, ancient mariners would draw a map, a periplus of the coastlines for navigation and an outline of land masses. During the meeting I came to equate the basic features on the coast as data; buildings or smoke as information; and the conclusions derived as knowledge. Whether to proceed inland well, that is about pioneering, courage and wisdom.

A challenge comes with the DTMD talk of information theories. The DTMD workshop was promoted as a forum to discuss and expand our collective understanding of what we mean by information in our different disciplines.

What would an information theory based on the knowledge domains look like? Given the presence of the SCIENCES domain then the mathematical and logic-based theories are already determined for us, are the specific information theories and models that relate to the physicality, the entropic journey of the body? What information theories can we identify for the other domains:

• INTRA-INTERPERSONAL?
• SOCIAL?
• POLITICAL?
• and the spiritual, unknown?

If we categorised the 25 info theories listed by Paolo Rocchi in his session how might they be distributed across the h2cm domains?

Here is part of the listing c/o Prof. Rocchi and with many thanks:

• The statistical theory of information by Shannon (1949);
• The algorithmic theory of information by Solomonoff, Kolmogorov (1965), and Chaitin (1977);
• The economic theory of information by Marschak (1971);
• The living system information theory by Miller (1978);
• The autopoietic theory of information by Maturana, Varela (1980);
• The biological information theory by Jablonka (2002);
• The cybernetic information theory by Nauta jr. (1970);
• The dynamic theory of information by Chernavsky (1990);
• The fisherian theory of information by Fisher (1950);
• The general information theory by Klir (1991);
• The general theory of information by Burgin (2009). ...

What is the result? What criteria determines the final domain 'home'? On what basis can we differentiate such theories - quantitatively and qualitatively? As noted at DTMD where are the family resemblances? Perhaps they can be found within the care domains:

Sciences - inclusion of a mathematical - logical underpinning (There be equations in the hold!)?
Social - reference to social and family networks without explicit recourse to mathematics? The use of psycho-social concepts?
Interpersonal - reductionist-wholist rendering that incorporates perception, individual information processing? What can be drawn from the latest research in anxiety and psychoses for example? Is it appropriate to wonder if ontological* approaches have anything to offer?
Political - Theories that cover economics and also explain power relations, decision making, and choice for example? 

Even though when we see / read the word 'unified' you tread carefully, Hodges' model ultimately presupposes a unified view. Recall again the DTMD2011 challenge:

to discuss and expand our collective understanding of what we mean by information in our different disciplines.

So the purpose here on W2tQ and through h2cm is to focus on all the domains simultaneously; at least when information in the context of health is our concern. As I mentioned in my presentation, there are clear exceptions in emergency and crisis situations. Then 'holism' is suspended. Information (re)sources, selection, analysis, synthesis and salience are focussed; specialised individual, team and organisational memory are brought into play with varying degrees of technology in support. The second-by-second, minute-by-minute demand for data, information and knowledge increases, its longevity in terms of significance may decrease, replaced by updated values by turn until 'stability' is restored: by human effort or nature.

To be sustainable (applicable, creditable, relevant ...) for me a unified theory of (health) information must span situations such as the emergency and all the h2cm domains and care contexts. Now that is a challenge!

*What would it mean to create four ontologies that could be merged together?

h2cm presentation: Colombia Nursing Theory conference (slides from Feb)

As the slides from Milton Keynes and DTMD 2011 are posted, here below are the slides from February. There are some 'artifacts' in there - the question marks were included then replaced by the text as part of the animations (as with the stick figures). The Colombia slides provided the template for the ten minute talk last Thursday. It was a very useful experience, exercising discipline to cram sufficient explanation in to cover the slides in the brief time available. No time for animations. The Chairs for the sessions did a great job, providing a 3 minute warning.

Colombia remains a real highlight: three of the slides are in Spanish thanks to Luz Stella Saray and Prof. Wilson Canon Montanez for their translation skills. (Any mistakes are mine in data transfer / formatting). 

Hodges model Colombia 2011 with spanish from Peter Jones

The next event to prepare for is Dublin in November: a poster. This will really be different and I need to see what production / printing resources I can access, taking portability into account.

After'math' of... The Difference that Makes a Difference: an interdisciplinary workshop on information and technology

Here's my take on this workshop 7-9th September in Milton Keynes at the Open University. It was a really challenging and stimulating event. How so? Well...

Challenging: The first day's theme - What is information? and Thursday a.m. included presentations on quantum information. Trying to keep up with such ideas, to keep up with the progress of science and its philosophical implications demands effort, as does putting the ideas, concepts and applications in a form the public can understand. Given the academic calibre of the keynote speakers and organisers several books were held aloft and referred to:

Perspectives on Information 
Edited by Magnus Ramage, David Chapman

Decoding Reality

  Vlatko Vedral

Stimulating: Revisiting information theories with one slide c/o Paolo Rocchi, LUISS Univ. / IBM, The Concepts of Signifier and Signified Revisited listing 25 examples. The vast majority were new to me and of course as was also pointed out the list was not comprehensive.


Challenging: The maths on display here were way beyond me. With the talk about hard and soft sciences though I recalled a previous post Bell Jars and Bell Curves and how many mathematical techniques remain off limits to would-be users in the humanities. The maths didn't help my note taking - do I assume that lack of notes is shorthand for befuddled?

Stimulating and Challenging: Exposing Hodges' model and my vision of the model as a conceptual space (whether one ... four, or five) helps me focus on how best to lift a foot, and envisage the next steps. In the workshop I've found a few puzzle pieces for the draft text I have on h2cm as a conceptual space. It's a mix of nursing, informatics, Gärdenfors' definitions, ICT and aspects of education. Next month I'll post a draft content listing - adding to it as it takes shape.

Stimulating: On Wednesday evening there was a screening of a documentary film narrated by Nora Bateson An Ecology of Mind a portrait of her father Gregory. The film was quite a delight - in content and style - covering the central themes of Bateson's life and work with insights from his daughter and recognised commentators and colleagues:

"Gregory Bateson’s theories, such as “the double bind” and “the pattern which connects”, continue to impact the fields of anthropology, psychiatry, information science, cybernetics, urban planning, biology, and ecology, challenging people to think in new ways."

I remember double bind from mental health and reference to Bateson in family therapy circles. The title of the workshop - the difference - stems from Bateson as quoted on the DTMD2011 website:

Kant, in the Critique of Judgment – if I understand him correctly – asserts that the most elementary aesthetic act is the selection of a fact. He argues that in a piece of chalk there are an infinite number of potential facts. ... I suggest that Kant’s statement can be modified to say that there is an infinite number of differences around and within the piece of chalk. There are differences between the chalk and the rest of the universe, between the chalk and the sun or the moon. And within the piece of chalk, there is for every molecule an infinite number of differences between its location and the locations in which it might have been. Of this infinitude, we select a very limited number, which become information. In fact, what we mean by information – the elementary unit of information – is a difference which makes a difference Gregory Bateson (1972).

Not unexpectedly some speakers did challenge the views of Kant and Bateson. I found the recurring discussion on objects, subjects and relationships very enlightening. After the first day and the film I took Shannon's communications model SENDER, RECEIVER, CHANNEL, MESSAGE and NOISE and extended reference to this in my slides. Being situated and encompassing four care - knowledge domains h2cm can represent several contexts.  From a systems perspective we can consider the nurse, patient and carer as sender and receiver. Disease becomes 'noise', or according to Canguilhem life as the background noise with disease as (an inevitable) manifestation? The philosophical talk prompted me to cast health care practitioners as 'existential informaticians' (although the majority see themselves as assistants to a higher power).

<->

Unless speakers have indicated otherwise slides and audio will eventually appear on the DTMD website. I've uploaded my DTMD presentation comprising 13 slides:

Dtmd jones hodges model h2cm ou sept 2011 from Peter Jones

The workshop was a great experience, the organisers and  participants were very friendly, a very inclusive community; essential for all events clearly, but critical for one with interdisciplinary aspirations. I was not the only NHS employee there and now have a new NHS contact on Linkedin from finance / information governance. After Drupalcon this is great - as networking is of course a key objective. At Druplcon I was told about another nurse and Drupaller in Manchester and now we plan to meet up next month. You can learn to play the guitar on your own, but it helps to learn with others.


The organisers have applied for funding to support research and three further events tentatively proposed for 2013, 2014 and 2015. Speakers and attendees are also encouraged to submit to a special issue of tripleC - Cognition, Communication, Co-operation The Open Access Journal for a Global Sustainable Information Society.

I will add more in another post (on sessions) as time permits.

Thanks to: the Committee for being able to present and the Open University Department of Communication and Systems (http://cands.open.ac.uk/) and the ESRC Centre for Research on Socio-Cultural Change (http://www.cresc.ac.uk/) who supported the workshop.

Recast: The NHS Future Forum's four workstreams

This week's Health Service Journal HSJ is in my laptop bag.

In last weeks issue (25 August 2011) was an editorial mention
and news item (p. 6-7) on the NHS Future Forum's four workstreams.

 Apparently, the new addition on a further round of consultation is integration. It may be new for this government and in this context, but the issue of integration has been on the policy table before. 

I've set the four workstreams within Hodges' model:

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

Education and training	Public (mental) health
Integration	Information

There is a lot of overlap, perhaps that is why integration proves so problematic? Yes, integration is SO political; there are budgets, management, teams, leadership... but it's SOCIAL! Professionals are socialised - trained into practice. Maybe that is the place to start - a mash-up?

Education and training are with the individual - the self. The same issue reports the "shocking" finding of staff who have had no professional development through their careers. Staff must be sufficiently motivated, engaged to seek professional development themselves.

Public health is social too, especially when it comes to non-academic transmission. Public health though relies on evidence - science, but let's not forget the inclusion of that mental component.

Information: so many people await the new information strategy. Despite decades of focus on information, information technology, the benefits of information for clinicians, commissioning there is still so much to learn and get right.

It isn't that the three domains of SCIENCES (medicine, nursing), INTERPERSONAL (mental health, learning disability) and SOCIOLOGY (social care, social work) seek to surround and confound the POLITICAL (managers, policy makers). The ongoing challenges highlight the sheer complexity of it all. It also illustrates the immaturity of our knowledge and lack of understanding of this stuff that is information. This next week I am looking forward not only to giving a brief presentation on h2cm and engaging with information, but listening to a very varied interdisciplinary programme:

The Difference that Makes a Difference:
an interdisciplinary workshop on information and technology
The Open University, Milton Keynes, UK

If the strategy groups need a tool to help them find and integrate answers to the big questions might I suggest they adopt a suitably scalable framework.

Additional links:
NHS Future Forum recommendations to Government
http://www.gopetition.com/petitions/mental-health-is-a-global-urgent-issue/signatures.html

Patient? Client? Consumer? Some thoughts....

Below is an edited version of a response to an item posted on LinkedIn Working Nurses, the issue raised by Genevieve M. Clavreul, RN, Ph.D. is as follows:

One day I came across “The Martha Stewart Show” as it aired a segment dedicated to nurses and Nurses Week. It began with a brief discussion of the history of nursing over the past century or so, and I recognized many of the instruments from my youth and my early career in nursing. But what caught my fancy was how the nursing school representative, a nurse herself, continually referred to the patient as the “client,” and how she seemed to struggle while using the term, as if it was a foreign concept.

The replies thus far have already addressed this question and and its ramifications very well, reflecting the scope of experience and expertise of many working nurses. We have this issue in the UK - NHS also, indeed it is no doubt a global matter.

Mental health has 'client' and 'service user'. Health care IS a business, but a business that must be allied with professionalism. I know that goes without saying, but please bear with me. Use of 'patient' seems to denote dependency and not partnership and collaboration. Being a 'patient' you are compliant with your treatment, rather than concordant with insight into your care plan and the pros and cons of medication (intervention or non-intervention).

As nurses though we have a duty of care. Each nurse represents the profession and the terms we use reflect the values we hold in theory, practice and management (the business again).

On one level perhaps the multiplicity of terms reflects upon the complexity of health and social care and the many contexts 'nursing' takes place. The emphasis on 'recovery models', self-care, the expert patient, relapse prevention, well-being is a sign of the demographic trends and the rise of social media and e-health.

I understand that patiency is a key concept and question in formulating models of nursing: When does a patient become a patient and when does that period end? It is not wholly fashionable for nurses to act as advocates and yet I would argue that being in a 'business' nurses can / should / must advocate not just for the patient but for the health of the general population. Nurses should also look over their shoulder (that's business politics) and take cognizance of the first rule of first-aid. In this case you cannot be an advocate for personal, family, local, regional, national and global health if you become the casualty. By implication the profession - nursing - suffers too.

Will we reach a point were access to and the salience of 'patiency' as a - human currency - has to be enshrined in human rights? What title do we grant to our seniors in whatever environment: their home of twenty years, their hospital bed, their Room 123 of The Nursing Home?

In any business the ethos and strategy for success should be to make the 'business' transparent. I'm in London at the moment at an IT event. One presentation focussed upon the 'user experience' - UX. Customer service in health is essential [ CX - CareX ! ], but this should not be a 'business' add-on. This is crucial to all caring professions. Rather than be thrown from side-to-side by the science OR art of health and its client OR patient equivalent we can embrace the dialogue and make a positive difference as we do so.

The astute student / learner will ask the person concerned how they wish to be addressed. As future nurses and nurse leaders in the 21st century they might also consider those populations around the world who would very much like to hear the utterance of 'patient': not in reference to themselves, but their infants and children ...

Drupalcon London - Day 4 Thur. A Keynote heralds Wedding Bells & Fashion

The final keynote Designing the Sustainable Web was delivered by two guys gents Christopher Murphy and Nicklas Persson, they teach interactive design at the University of Ulster at Belfast.

The Web Standardistas covered design, fonts and resources both online and books. Like Tom Standages' presentation they talked history. I think I lapsed into an awake, but non-note taking mode; but on their site they provide resources. There's a full and good review on Ubelly. Given the way the web struggles to re-invent rip-the-paper with grids still preeminent in design the books mentioned inc. HTML5 for Web Designers, Responsive Web Design and Ordering Disorder. There's hours of reading and visual delight at http://www.thegridsystem.org/ and Subtraction.

Two things I did spot in the keynote; one a site design, it was quite minimal on the graphics side - apart from a black header with text logo - but using fonts + and as described information architecture to emphasize the content and indeed the overall semantics of the page (and site). I must catch the video again. The other was a slide drawing on newspaper design and proportions that makes me wonder about switching things around.

After the keynote it was another look for me at mobile and theming: Adaptive, Responsive, Mobile First and Drupal Theming for the Future with HTML5, CSS3 and Omega. This session included a surprise for a young lady - a marriage proposal. Congratulations! The Omega theme was a topic at BarCamp in Leeds and I've looked at it for the DJ site. There I've settled on Black Piano. Omega is definitely worth a revisit. Many visitors to the old site arrive c/o mobile devices (possibly as an example of poor design?). Mobile first! indeed.

The Organics Groups session commenced with the lift pitch and the 2nd Drupal fashion show. Organic groups and panels make a lot of sense for a Hodges' model site. The model is a grid, the domains are panels. The links pages are currently tables. So... (whatyawaiting4)! Somebody mentioned - their first Drupalcon - that with this being my 4th a lot of the session content should be familiar.

The documentation BoF did not quite go as planned over dinner time - at least for me. This is a vital project as support, help and documentation does matter in people voting with their feet. I think the project will get a real fillip as some higher level dependencies kick-in and the potential of DITA.

As I write this it's Friday the last day and the code sprint. I'm not coding, but helping review an issue associated with #drupalEdu. (So not coding but still learning and trying to help a little.) This tag covers Drupal training, mentoring, support and general education - K12, Higher Education...

It's been great here in London. Heading North soon. I'll see if I can add a photo or two over the w/e. Tomorrow I will unpack and check the PC which has arrived home apparently, now with working graphics cards? Also to sort hosting. Liverpool on Sunday: the Matthew St Festival. 

Drupalcon London - Day 3 Weds. Tom Standage keynote, sessions, + BoF ...

Wednesday was a funny day at Drupalcon - literally. The cuppa tea at break was truly divine and delivered with that quintessential British style - very traditional.

At the morning's keynote Tom Standage of The Economist gave us an insightful and historical perspective on social media. This took in the Romans and their scribes (photo below and video), Martin Luther and English Civil War and America's fight for independence. There's  a book to follow. Given the emphasis on ethnography and anthropology in successful informatics - IT we should always be open to the lessons of history, but not constrained by it.

(Videos are appearing online now). My session pick started with Multilingual Drupal Solutions: Use Cases and Modules. This isn't the first session on this topic I've attended, but it was a helpful update - especially the use cases and modules. After dinner Jeff Noyes is clearly clued in on Creating and Measuring the User Experience. This is a must do, with a real potential dividend, but for hobbyists like me it was encouraging to hear Jeff describe a range of resources that included DIY testing.

Early on Jeff noted  the benefit of having a project charter - so last evening I started  one. Basically, what are my projects aims. Actually a things other things emerged from doing this.

I slipped up with node.js and Drupal, great stuff I'm sure but rather beyond me in terms of need and understanding. The principles were a good take home. For the final session the meeting on theming was packed out, so I headed to a BoF pivotal for the Drupal documentation team:

Doing Multiformat publishing & single source content with DITA in Drupal - status and roadmap

It's been a bit more than a year now that we started working on a DITA module for Drupal. In this session we'll review the current status, talk about the good & the bad and look forward to what we are going to be doing in Drupal 7.

DITA (Darwin Information Type Architecture) is an Oasis XML standard started at IBM that has become a major standard in enterprise technical communication. It's used in industries with modular products to publish documentation in a range of formats in minutes in stead of days while saving up to 60% of translation costs.

My new site requires new data items and on Tuesday after Entities - Emerging Patterns of Usage this was given as a key use case for entities. Of course 'entities' have been around ages in RDBSes (1969), but in Drupal they have a specific status now (a dialogue that also seems to bring in nodes, fields and taxonomy). The DITA BoF proved very relevant to me and h2cm as a health and social care -

• website;
• learning experience;
• application (!) 

- demands documentation. Not only that but standards based documentation (and classification system(s)). There's another BoF this dinner time - I'll try and get there.

Drupal's documentation is a recognised mess, hence the investment in DITA and seeking a solution. Back in Szeged 2008 I remember sitting down on that final code sprint day. I had it in mind to read some stuff and try and contribute. I do have an eye for docs. Well, I've been Editor here since April 2006. Previously (1995 - 2007) I read through and reviewed data definitions and information standards (and not just proof reading). In 2008 though I couldn't focus (really as I found out a year later). Maybe it wasn't just me! One thing: the next monitor I purchase will be optimised for text and portrait, or is that old hat these days? 


With RDF, translation, and modules like Features, Panels, Entities, DITA, Organic Groups, Context ... there are so many lucky dice to play; but there is no single roll that proves a winner: there are several!


My photo: c/o the keynote speaker Tom Standage who stated the image has not been altered in what it represents.