iv WCCS26: World Conference on Complex Systems 20-22nd April

Day 1: Panel 2 - Rethinking Knowledge in the Age of Complexity

• Helena Knyazeva - Dancing with Complexity: How the World Thinks Through Us
• Carlos Gershenson - The Implications of Complexity
• Leonardo Rodríguez Zoya - Can Statistics Think? Complexity, Future, and Freedom in the Age of Large Language Models
  Panel Chair: Nigel Gilbert 

Courage is one of the 6Cs in nursing, and was on display at WCCS26.

Carlos Gershon began by offering two references, the first:

De Domenico, et al., (2019). Complexity explained: A grassroot collaborative initiative to create a set of essential concepts of complex systems. https://complexityexplained.github.io

This is a brief 20 pages, larger text, and provides a helpful primer to complexity and related concepts covering:

Interactions
Emergence 
Dynamics 
Self-organization
Adaptation
Interdisciplinarity
Methods

For each concept, the authors explain:

Definition/Description
Examples
Relevant Concepts
References

Plus, secondly:

Gershenson, C. The Implications of Interactions for Science and Philosophy. Found Sci 18, 781–790 (2013). https://doi.org/10.1007/s10699-012-9305-8

I liked the practical feel here, the encouragement to think anew, and perhaps taste the "flavors of emergence": synchronic - space; diachronic - time, weak and strong feedback, transversal of scale - upwards and downwards.

There is further conference on complexity later this year (and also online!):

CCS 2026:
The 2026 Conference on Complex Systems
OCTOBER 9 - 16, 2026 BINGHAMTON, NY, USA & ONLINE

In my search I also found:

Carlos Gershenson; Complexity, Artificial Life, and Artificial Intelligence. Artif Life 2025; 31 (3): 289–303. doi:https://doi.org/10.1162/artl_a_00462

Gershenson, C. Self-organizing systems: what, how, and why?. npj Complex 2, 10 (2025). https://doi.org/10.1038/s44260-025-00031-5

Leonardo Rodríguez Zoya's presentation helpfully connected social practice, interdisciplinary bridges, statistical rationality, complex (human) rationality and the future(s): desirable, possible, latent and probable.

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

COMPLEX (HUMAN) RATIONALITY   cognition	STATISTICAL RATIONALITY Techopraxis LLMs - technology
socio- HUMAN PROBLEMS SOCIAL PRACTICE PRACTICE (one of the 4Ps)	ELECTION - CAMPAIGN SPENDING PEACE NEGOTIATIONS ISLAND ECONOMY CRYPTOCURRENCY

To answer the prompt - 

"Give me a less likely but more fruitful interpretation of this [concept]*."

*Replace with a significant concept in your practice

Would it might help to have a simple, and yet complexity (and simplicity!) primed conceptual framework to assist reflection, argumentation, and progress?

 

I missed the poster at the afternoon break, and followed track 1. I greatly enjoyed Julian Arevalo's - Adaptive Readiness: an Agent-Based Model of Peace Negotiations. Perhaps this accounts for my having no notes or photos for this track except for one. I realise now we did speak, sitting together for the conference dinner. I'm sure I remember Negotiation Lab 1.0 - 

https://www.comses.net/codebases/1256dc74-9ae4-4f49-a235-1ec129be1930/releases/1.0.0/

 

This past week I heard discussion (BBC Radio 4) of the 'income' Norway obtains from its expertise and engagement in peace negotiations.

 

Nicholas Roxburgh, and colleagues Rachel Creaney, Mindi Premarathne and Ruth Wilson through 
Exploring Interdependencies in an Island Economy, reminded me of public engagement in research. Especially when it involves their community; and that community is somewhat rural, or remote.

 

Remah Dahdoul, with Jan Korbel and Stefan Thurner presented -

Campaign-Spending Driven Polarization Transition in a Double-Random Field Model of Elections. The following paper brings home the mathematics in complex systems. The reference is:

 

Jan Korbel and Remah Dahdoul and Stefan Thurner. (2026) Empirical validation of the polarization transition in a double-random field model of elections. arXiv. https://arxiv.org/abs/2510.00612.  doi.org/10.1103/9gjj-1df6.

 

The paper by Saida Hachimi El Idrissi and Mohamed Nemiche is not open access, but the abstract follows. 

 

S. H. El Idrissi and M. Nemiche, "Formation of Complex Societies: An Agent-Based Model Inspired by Freudian Theory," 2024 World Conference on Complex Systems (WCCS), Mohammedia, Morocco, 2024, pp.1-6, doi: 10.1109/WCCS62745.2024.10765573.

Abstract: The rise and emergence of complex societies in the Old World mark a pivotal chapter in human history, characterized by the transition from small, kin-based communities to large, hierarchical states. This transformation raises fundamental questions: How did human societies progress from small, cohesive groups characterized by face-to-face cooperation to the expansive, anonymous societies of today, often organized as states? What factors account for the significant variation in different human populations' capacity to construct stable and functional state structures? To address these questions, we developed an agent-based model grounded in Freud's hypothesis, which posits that civilization could neither emerge nor evolve without the repression of human desires. In the context of social evolution, this repression of desires can be interpreted as the repression of intra-societal competition, ultimately strengthening the society and facilitating the formation of complex social structures. We implemented this model within a realistic representation of the Afroeurasian landmass, incorporating various geographical factors. To validate our model, we compared our simulated results with historical data. The model-predicted pattern of expansion of complex societies demonstrated remarkable congruence with the observed historical patterns in the Old World. The emergence, growth, and distribution of large-scale societies predicted by our computational model showed remarkable consistency with the archaeological and historical record.

keywords: {Analytical models; Computational modeling; Predictive models; Data models; Agriculture; Rivers; History; Complex systems; component; Agent-based Modeling; Repression of satisfaction; cooperation; competition; Social Simulation},
URL: https://ieeexplore.ieee.org/stamp/stamp.jsp?tp=&arnumber=10765573&isnumber=10765499 

Unless you are a microsurgeon (increasingly with robotic co-workers), is the word practice, more likely to manifest what is larger, the big picture, a sense of space, even at a societal or continental scale? In reading, I came across four forms of attractors. For me, how they fit into the question of scale makes this paper worthy of seeking out. 

M. Nemiche was unable to attend the conference, and was greatly missed.

Book Review: [ii] Health System Redesign - How to Make Health Care Person-Centered, Equitable, and Sustainable

Part 1 gets straight to the matter of "challenging the orthodoxy" with a two page introduction to complexity and health. Part 1 covers:

• systems sciences
• visualization of complex systems (Capra's vortex metaphor)
• understanding the co-existence of different degrees of complexity and their dynamics within complex adaptive organisations based on Kurtz and Snowden's Cynefin model.
• health as a "complex adaptive experiential state"

All four points here are very pertinent to where we are in health and healthcare (the book rightly stresses this differentiation) and current and ongoing 21st century issues. The use of Capra helps to distinguish scale and the levels inevitably existent, experienced, and described in health and healthcare systems.

If you are familiar with Hodges' model and the Cynefin model, then the answer is yes - seeing the Cynefin model did make me hoot. (I remember Dave Snowden's work from Plaxo and a presentation he did in Lancaster back in 2007). More importantly, part 1 introduces where the focus needs to be to facilitate change; on the core driver of the system, the system's long-term direction, a specific system view and the need for a solid grounding in theoretical and applied approaches. This is were the visual tools and producing a view - perspective are so important. Chapter 2 contrasts the simple scientific world view and the complex scientific. The reader is asked to consider numerous background points, from the colloquial meaning of complex/complexity to the scientific. How do the words 'complex' and 'complicated' differ? At small scale the result is greater certainty BUT loss of context, while at the large scale we find greater uncertainty AND loss of detail.

Figure 2.3 shows the key features of complex systems (also indicating the dynamics - '+' '-'):

• System boundaries
• Interconnectedness
• Feedback
• Impact of starting (initial) condition

Some of the figures point to their means of creation "The essence of systems thinking" (Figure 2.4) produced through Insightmaker. Sturmberg's seeks to ground the discussion too by reference to the everyday. Table 2.1 runs through how systems can be related to the experience of a 'Long day at work'. Addenda are put to immediate effect with a reference to a map of the history of complexity science; the philosophy of complex adaptive systems; and the complexity and difficult questions.

As already suggested Chapter 3 on the visualisation of complex adaptive systems had my attention. The vortex metaphor (Capra) seems trite on first encounter, but it works.* The four different ways to map a system:

1. Systems map
2. Influence map
3. Multiple case diagram
4. Sign graph diagram

are quite important as if you can take the explanations onboard you really will be on the way to fully understanding and utilising theoretical and applied approaches. The learning here is allied with understanding common system dynamic behaviours which are also illustrated and explained. Figure 3.4 shows the Cynefin framework, which is still in my head. The Cynefin model deals with the continua of:

• uncertain - certain
• non-linear - linear

• Contrasts - Learning and Teaching
• and four quadrants that combine what is complex, knowable or complicated, chaos, and known or obvious (simple). The three references here span 1996-2003.

At chapter 4 - I was worried - 'Defining Health' (now there's a task) but this is also interesting, rewarding and well placed. Core notions of health are tabled (4.1) from 1911 to 2007. Health is distinguished from dis-ease. I must follow up the footnote on p.59 Marja Jylhä and her framework of self-perception of health. 

The illustrations on pp.60-61 are frustrating.

Very!

Not because they shouldn't be there, but because they are a gift that remain (as far as I am aware) unrealised in respect of those of us working in the humanities. We still lack the visualisation tools that we need.

If I mention Figure 4.1 "The somato-psycho-socio-semiotic model of health" you will get the drift and overlap with Hodges' model. There is more with 4.2 on Attractors in Health and Illness and the system dynamics of health. The political attractor is missing (and its 'gravitational' impact) in this rendering, but the barriers to progress are also raised at the book's end. Given the topic of health, the text is not science light, with the physiology of health and disease also used to explain points, so we have, gene networks, the autonomic nervous system, the hypothalamic-pituitary-adrenal axis and bioenergetics in the mitochondrion. While not in-depth the potential application across external factors-personal experiences and internal mechanisms are demonstrated. The role of the patient, public and carers are central today and realised to various degree in theory, practice, management and policy. Self-rated health is briefly mentioned and with community health and health services utilisation this closes part 1.

More to follow...

Sturmberg JP. Health System Redesign. How to Make Health Care Person-Centered, Equitable, and Sustainable. Cham, Switzerland: Springer; 2018.

See also first part...

Glossaries - calques, standards and what is, or can be canonical?

Post Marrakech and WCCS26 I'm still contemplating on matters 'complex' and 'complexity', across complex systems and complex care. We humans (and this one in-particular) have a penchant for compunding complexity, adding complications. Our languages are a case in point. 

As the conference demonstrated mathematical is central to the discovery of chaotic and complex systems. Maths itself preempted the discovery of the Lorenz System, and the Mandelbrot Set.

Efforts to look at Hodges' model mathematically has resulted in a small draft comparative glossary (4-5 terms). In addition to the history of chemistry and its adaptation of mathematical symbols, I soon came across complex numbers, complex dynamics, complex mathematics (don't worry I know my limits). But, symplectic geometry! What is that?

Apparently, 'The term "symplectic" is a calque of "complex" introduced by Hermann Weyl in 1939.'
(https://en.wikipedia.org/wiki/Symplectic).

So, over decades of ward meetings, reviews, care plans it was symplectic patients, symplectic care and situations all the time? Where am I heading with this? Probably nowhere in particular. There's still the risk of a meeting c/o gravity with the floor. I've been fascinated with the way words such as design and architecture are conjoined and added to things that do not qualify, at least from the purists perspective. This is joy of languages, they change constantly. 

Familiar with 'standard' in the clinical and informatics sense; 'canonical (form)' has come up within maths. It occurs in health too:

Graham, M., Winter, A. K., Ferrari, M., Grenfell, B., Moss, W. J., Azman, A. S., Metcalf, C. J. E., & Lessler, J. (2019). Measles and the canonical path to elimination. Science, 364(6440), 584–587. https://www.jstor.org/stable/26649426 

Sepehri, A. (2015). A Critique of Grossman’s Canonical Model of Health Capital. International Journal of Health Services, 45(4), 762–778. http://www.jstor.org/stable/45140527

Lee, H.-S., Paik, M. C., & Lee, J. H. (2009). Estimating a Multivariate Familial Correlation Using Joint Models for Canonical Correlations: Application to Memory Score Analysis from Familial Hispanic Alzheimer’s Disease Study. Biometrics, 65(2), 463–469. http://www.jstor.org/stable/25502307 

Voit, E. O. (2000). Canonical Modeling: Review of Concepts with Emphasis on Environmental Health. Environmental Health Perspectives, 108, 895–909. https://doi.org/10.2307/3454323 

 

Goddu, A. (1985). The Effect of Canonical Prohibitions on the Faculty of Medicine at the University of Paris in the Middle Ages. Medizinhistorisches Journal, 20(4), 342–362. http://www.jstor.org/stable/25803849

 In drawing up a glossary, and starting with a blank sheet (that is not Hodges' model) this is all worth consideration. Could Hodges' model find a place as a canonical form - even clinically?

Threshold Concepts: Pre-conference Health and Social Care

Yesterday afternoon there was a video-linked workshop between Glasgow, Halifax, Nova Scotia - Dalhousie University and an interest group member in Plymouth. This was to try to further thinking on threshold concepts in healthcare and one of two pre-conference workshops at:

6TH BIENNIAL THRESHOLD CONCEPTS CONFERENCE

Our agenda:

Workshop: To disaggregate or not? The dilemma of complex threshold concepts

• What do we mean by complex thresholds?
• Is this particularly relevant to healthcare and if so how?
• Can we identify some examples in health and social care?
• What problems do complex thresholds bring for teachers, learners, the curriculum?
• Is disaggregation helpful (and how) or unhelpful/reductionist/simplification?
• Do we have any evidence or theories that can help us?

We did not cover all the points in depth, but in respect of the first point I could define 'complex thresholds' with recourse to Hodges' model. The paper I'm working on includes a table that alludes to this. I could take this question more literally in that draft.

Thinking about complexity and aggregation, by complex is this the same as compound? Compound suggests something that can be taken apart (it is composite), but complex involves the whole (domain-based?) situation / context?

The example I have in mind is learner's recognition, appreciation and understanding of:

• mental capacity
• best interest
• deprivation of liberty

By learner's I am thinking of student nurses (plus other disciplines), healthcare assistants and future associate practitioners. In the era of lifelong learners, public engagement and patient involvement/engagement I have include others (despite the academic demands for specificity).

Philosophy Now 113

On the last question - Do we have any evidence or theories that can help us? - I still feel evidence can be found in Hodges' model. As ever: data, data, data!

Feelings are never enough (until they are all we are left with).

Discussion included the curriculum as the questions indicate, and again one of the original purposes for the model was in curriculum development. but in addition the position and role of the 'big picture'.

Issue 113 of Philosophy Now featured New Realism. I'm cherry picking from pragmatism, idealism and realism. New realism questions whether a unified picture (in philosophy) is available (p.7). While this is a damaging critique to Hodges' model, it might also be an opportunity.

Steinbauer, A. (2016). Interview: Markus Gabriel, Philosophy Now, Apr/May, 113; pp.6-10.

Have workspace, workbench - let chaos ensue

Whether trying to write computer programs, engage in woodwork, artwork or needlecraft the workspace that you need is critical to what follows.

Having a dedicated workspace is the sign of a professional.

If these activities are purely a hobby you may need to create the space on the fly. Getting the easel and paints out, protecting the carpet and then after all those creative juices are spent you have to organise the clean-up.

The Health Career Model can provide a workspace: a dedicated one. So if like many researchers your focus is (global) health, nursing, social care and social policy ... Hodges' model can provide an assurity space. Whatever your approach here is a great way to explore the scope and boundaries of your plans, objectives and final outcomes.

I noticed a letter by Fawcett et al. (2008):

We congratulate Chaffee and McNeill on the publication of their article, “A Model of Nursing as a Complex Adaptive System”.  The development of a new conceptual model of nursing always is a cause for celebration of the advancement of our knowledge. We are, however, concerned that Chaffee and McNeill did not place their conceptual model within the context of or show an evolution from relevant existing nursing conceptual models. We refer readers to Holden’s¹ concept analysis of complex adaptive systems. She explained the relevance to nursing of the concept, complex adaptive systems, by tracing the “rich tradition” of systems thinking in nursing and pointed out that nurse theorists, including Dorothy Johnson, Imogene King, Martha Rogers, and Callista Roy, have developed conceptual models of nursing that reflect systems thinking. Holden concluded, “This rich tradition in nursing that has emphasized connections and interactions within a systems paradigm continues today. Complexity science merely represents the next stage in understanding how systems operate.”¹

Jacqueline Fawcett, RN, PhD, FAAN
Professor, College of Nursing and Health Sciences, University of Massachusetts, Boston.
Jacqueline Fawcett, Elizabeth Ann Manhart Barrett, Barbara W. Wright, Letter to Editor, Nursing Outlook, Volume 56, Issue 2, March-April 2008, 49.

REFERENCE
1. Holden LM. Complex adaptive systems: Concept analysis. J Adv Nurs 2005;52: 651-7. Nurs Outlook 2008;56:49. doi:10.1016/j.outlook.2008.01.003

Whilst explanations of systems have an essential place in understanding nursing, for me the concept of primary interest within (and without) systems is information. This is not just symptomatic of the paradigm of our times, but a fundamental facet of not only engaging leading edge (quantum) sciences, but relating nursing, complexity, systems, art and science to patients, carers, citizenry and global (eco-) health.

If this appears a recipe,
which when executed on the workbench will result in indigestion,
- have faith -
the problems of our times demands a framework with a massive conceptual maw.

So, in turn I would request that future nurse and complex systems researchers look further afield and factor in the need for and use of a high-level global (ethnoculturally agnostic), universal (multidisciplinary, objective, subjective) workspace:

One with sufficient bandwidth.

Having a dedicated workspace that can be shared across disciplines
- that is multidisciplinary -
denotes a mature profession
and a 21st century professional.

Image source: With thanks to Chunx.com 'Chaos Field'

See also:

'assurity space'

Information: See bibliography.

Jones, P. (1996) Humans, Information, and Science, Journal of Advanced Nursing, 24(3), 591-598.
Jones, P. (1996) An overarching theory of health communication? Health Informatics Journal, 2,1,28-34.

2019 Post:
c/o JAN: Formal Concept Analysis ... and an encouraging footnote

Abstract accepted: 6th World Conference on Complex Systems - WCCS 2026

April, 20-22, 2026

Mohammed VI Polytechnic University, Ben Guerir-Marrakech, Morocco

About Us

Building on the success of previous editions, we are delighted to announce WCCS26, organized by the Chair of Complexities ∞ Humanities - UM6P and the Moroccan Society of Interdisciplinary Studies, with technical sponsorship from IEEE. This conference remains a premier international platform where researchers and Ph.D. students come together to share cutting-edge research, address emerging challenges, and explore new frontiers in complex systems and interdisciplinary science.

WCCS26 fosters collaboration and debate on the most advanced methodologies and approaches for understanding, modeling, simulating, predicting, and mastering societal, ecological, biological, and engineered complex systems. By bringing together experts from diverse disciplines, the conference bridges theory and real-world applications, driving scientific progress and innovation.

Join us for a stimulating exchange of ideas at WCCS26!

WCCS26 Theme :

Navigating Contemporary Complexity:
Transdisciplinary Approaches to Economic, Social,
Political, and Environmental Challenges

Conference Topics (But not limited to...) :

• Foundations and Approaches to Complex Systems
• Social and Economic Complexity
• Complexity in the Anthropocene
• Biological Complexity: From Cells to Societies
• Complexity in Health and Medicine
• Philosophical Dimensions of Complexity
• Complex Systems With Artificial Intelligence
• Complexity in Emerging Technologies
• Grand Challenges in Complexity Science
  
  

Continued at: https://wccs-conference.org/wccs26/#call

See also: 'complexity'

n.b. I am attending (unsponsored) as an independent scholar and researcher; and by abstract alone.

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. 

v WCCS26: World Conference on Complex Systems 20-22nd April

Day 2 Tuesday 21st April (Revisiting) Keynote Speaker: Abderrazak El Albani - 
Emergence of Intercellular Cooperation: At the Origins of Eukaryotic Complexity
Session Chair: Khawla Tadist

This keynote was fasacinating. As I begin this post on the 100th birthday of Sir David Attenborough, who would have us all see life in the broadest terms, value life and diverse habits, and Earth as our collective and shared home.

Abderrazak El Albani explained the search for LUCA the last universal common ancestor - 3.8 billion years ago. Many dates in the emergence story of humanity, have been progressively pushed back. The first fire, art, languages, our co-habitation and intimate relationships with Neanderthals.

In healthcare, as a practitioner you have to be aware of your scope of practice. At WCCS, scale (as in iv) was ever present across research in complexity, and complex systems. Not just physical size nano-to-mega but temporal too, as we journeyed billions of years. Several of the slides are presented here:

https://www.synchrotron-soleil.fr/en/news/discovery-oldest-macroscopic-planktonic-eukaryotes-contribution-nanoscopium-beamline (with a reference).

There is a video (French): https://www.youtube.com/watch?v=bh3t26cU7xc

I asked a question, which may have been psychological preparation for own presentation to follow. Listening, I could see how the work Abderrazak El Albani and his team are doing, could be readily translated to the search for life on Mars. There has been a 'routine' interchange of planetary material between Earth and Mars over the aeons. Fitting surely that the sedimentary rocks sought lie in  A key lesson, is that light helps us see, but not all lights are equal. Light sources brighter than the sun become incredible scientific instruments. The longevity of the dinosaurs was highlighted, at least 140 million years. There is no comparison with homo sapiens then, even as those dates have been pushed further back in time. Time defeated me as I tried to make the observation that even the dinosaurs did not make it to their first galactic birthday (c.250 million years - and what a carousel). I like the thought (slide) of 'Earth as Memory'. 

What really counted was the expressed concern about what is happening now: in the Anthropocene.

The second keynote:
Nigel Gilbert - Policy in a Complex World: Towards Complexity-Aware Policymaking
Session Chair: Ali Idri 

Was helpful to me, as the dated conundrum of benefits realisation from our technologies, and evidence-based policy still leaves a gap (for me) within the POLITICAL care/knowledge domain of Hodges' model. The illustration/graphic elements of Prof. Gilbert's slides were a brilliant complement to the content:

Prof. Nigel Gilbert - WCCS26 21st April

I wonder if within policy the constant in the equation is continuity and as a quantity it is an unknown? This seems to the case in health policy, across successive governments. You may (also) find this chart informative: https://www.cecan.ac.uk/news/the-visual-representation-of-complexity/

Perhaps, a key factor in complexity is the fact that nothing stays the same, so continuity is nuanced? Michael Quinn Patton's book Developmental Evaluation was noted re. learning while doing. Now I wish I'd held on to Qualitative Research & Evaluation Methods (4th ed.). The discussion of 'obesity system map' and 'whole systems analysis' was appreciated here.*

Since Marrakech and WCCS, I've noticed acknowledgement in the literature that 'research' is currently flooded with AI tools. I'm sure PRSM - Participatory System Mapper is a welcome addition, (as noted in iv) tools to facilitate participation are much needed:

Collaborative Creativity

The Participatory System Mapper (PRSM) is an app that makes it easy to draw networks (or 'maps') of systems, working together collaboratively.'

I will definitely check this resource out; and CECAN. After Prof. Gilbert, the next Track included my contribution, which I will return to. Rather distracted, I have a somewhat blurred slide, with: 'The global tensor of educational research is' then headed 'Learning poverty. Being unable to read and understsand a simple text; with points 1-4.'. I'm not sure which presentation this was, but zeroed in on the literacy theme, and the word tensor. Another slide refers to '6. Topological substitution for Success'. I think it is (writing this is helping recall!):

Harvey Spencer Sánchez-Restrepo, Jorge Louçã, Martha Belén Carmona-Soto and Sofialeticia Morales-Garza
Topological Patterns of Academic Success: Insights from Complex Network Analysis

'Always Label Your Axes' - Zazzle.

Before that there was another model, as the next keynote speaker: Chris Bauch demonstrated during the conference wearing a t-shirt:

Critical Transitions in Coupled Human-and-Natural Systems and their Early Warning Signals
Session Chair: Mohamed Essaaidi  

Previously: 'nexus'


*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

Wirnitzer, KC. et al. (2025) Toward a roadmap for addressing today's health dilemma – The 101-statement consensus report. Frontiers in Nutrition. Volume 12.
https://frontiersin.org/journals/nutrition/articles/10.3389/fnut.2025.1676080 DOI:10.3389/fnut.2025.1676080

S. Bettiol, P. Jones, H. A. Onyedikachi, and W. G. Kernohan, (2026) Bridging Gaps in Oral Health Frameworks: Mapping With Hodges' Health Career - Care Domains - Model, Journal of Public Health Dentistry. 1–14, https://doi.org/10.1111/jphd.70034

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

In reading this book and others on W2tQ, I must make the following points:

  * my need to remember the purely USA context (I have never worked there);
  * my healthcare, nursing, informatics experience is NHS-based;
  * this review (and others) is motivated by the project here - Hodges' model;
  * as a result, I will be quoting heavily, there is much to bring to your attention.

As noted in post (i) there is much to whet the appetite, a paradigm shift, 'comprehensive, collaborative, and integrated care' (p.11) certainly have become popular topics in the medical literature. Not only that but 'interpersonal and intersubjective treatment models' too (p.12).

The role of 'Case Managers' is highlighted, plus the Case Management Society of America, which is committed to:

•  Improved Consumer Health Outcomes
•  Professional Diversity, Equity, and Inclusion
•  Cultural Competency and Humility
•  Advocacy for the Health Consumer
•  Integrity and Ethical Principles
•  Promoting Health Equity
•  Educating Case Managers Across the Care Continuum
•  Evidence-based Quality Care
•  Holistic, Compassionate Care
•  Fostering Communication and Collaboration
•  Advancing Research, Innovation, and Use of Technology
•  Fiscal Accountability [ https://cmsa.org/about/ ]

Whether the USA influences global trends in the structure and form of healthcare is another post, but there is a UK Case Management Society too: https://www.cmsuk.org. I can see a fit here [UK] with the development in recent decades on social prescribing. A different role, of course but part of a complex jig-saw.

As expected definitions are provided: 

'Roger Kathol has eloquently defined "health complexity" as "the interference with the achievement of expected or desired health and cost outcomes, due to the interaction of biological, psychological, social and health systems factors when patients are exposed to standard care delivered by their doctors" [1].' p.10. 

Roger G. Kathol, Rachel L. Andrew, Michelle Squire, Peter J. Dehnel (2018) The Integrated Case Management Manual: Value-Based Assistance to Complex Medical and Behavioral Health Patients. 2nd ed. Basel: Springer.

I can see where this definition comes from, but for me, it does not sit right. The problem when there is 'interference' is the assignment of responsibility and consequence that blame can follow. We've seen this, and in mental health too), with the recover model^. Some of the terms here may be completely innocuous politically speaking (which is the author's intent of course), but they can also be 'weighted'. Hence they can become concrete terms of judgement. Think about it: achievement, expected, desired, cost (and) outcomes, standard care, delivered (by doctors)? Or, am I over-thinking again.

In the margin I pencilled/drew:

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

Standard -	care
Other -	factors

As ever, the individual patient is our focus. The individual is supported (literally) by the social and political (infra-)structures that act as a scaffold, safety-net for most.

Time flies, I can't believe it was 2007 I posted 

Plush HQ foyer, shame about the mannequins!

I had this notion of life-size cardboard cutouts representing the average people who use a given health service provider (local, or not so local these days?). The data will be there in statistical annual reports. I'd noticed the displays - analogue and digital that greeted visitors at a local NHS Trust HQ. This would be the book's 'routine patients' who receive standard care. 

Chapter 3 introduces 'variables' which again is brief, but imporant as variables recur throughout the book. The 'Clinical Field' is first outlined, as in:

• Sources of clinically relevant factors;
• Dynamic factors;
• and: Variables representing contributions from practitioner(s).

Abstract variables are differentiated from those that are concrete. It's reassuring to read there is no true simplicity within the clinical field, and the author's goal is to 'unpack complexity so it remains as true to life as possible, not just manageable conceptually.' p.18.

Frankel et al. are primed to go beyond this. Maths, as in statistical procedures are one tool. Chapter 4 adds to this with a theoretical model to guide clinical understanding of patients with biopsychosocial complexities, the foundations of our paradigm shift. p.23.

If you have an understanding of Hodges' model you can picture my response to this. But, staying grounded, the whole book and paradigm shift represents a form of scientific "emergence". It is frustrating that literature searches fail to pick out Hodges' model. 

Frustrating too as reading of "awe", also on page 23, I have experienced this many times (over say 1977 - 2019 ...). So, I held on to my dummy (pacifier!?) and read on ...  

Chapter 4 Technical Considerations is one the longest and contributes all of Part III. Here you can read about science, measurement, statistics, empirical, operational definitions, intelligence, reliability. I often see a chapter, book section as a useful primer for students and the same applies here; with inter-judge realiability, validity, control, null hypothesis, statistical methods and much more. Reference to mathematics (axiomatic too) had me hoping for more. I picked out Structural Equation Modelling:

 'We would also like to suggest that following the steps involved in "structural equation modeling" (path analysis) is a good way of conceptualizing and reasoning about complex clinical variables altogether. For example, constructing a clinical model informally (intuitively, loosely from data) and thinking about (diagramming) how the variables involved may moderate and mediate each other can be a useful activity for clarifying the nature and requirements of a complicated clinica1 situation. 
 

 In simplest terms, an independent variable is the causal or influential variable that impacts and effects the dependent variable. A moderating variable is a dichotomy, and refers to two comparison groups (e.g., male/female; passed/fail; religious/nonreligious; tall/short; high versus low socioeconomic status) that display significantly different degrees of magnitude on a correlated relationship. For example, the relationship between a specific treatment for a medical disorder and treatment outcomes may be moderated by socioeconomic differences. The treatment outcome relationship may be stronger and more positive for individuals with elevated socioeconomic standing who therefore have better support systems and access to medical professionals, and fewer economic stressors.' p.36.

I think from this the authors might be sympathetic to giving 'life' to the POLITICAL domain and Hodges' model; after all it lives in people's daily experience - acknowledged or not. The book's structure works thus far: Chapter 5 Nature-Nurture (n.b. no escape!)  and the Epigenome. The structure - flow - works, as at just over four pages, it begs further reading (beyond the listed references). I still have my copy of:

Fritjof Capra and Pier Luigi Luisi (2014) The Systems View of Life - A Unifying Vision. Cambridge: Cambridge University Press.

 

With the epigenome being added to the 'patient complexity equation' in chapter 5, I wondered whether this was predictable, a promise, or a tease?

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

nature?	NATURE?
NURTURE?	nurture?

 

Previously: 'complex' : 'nature' : 'mental health' : 'person(-centred)'

More to follow ...

^Jones P. (2014) Using a conceptual framework to explore the dimensions of recovery and their relationship to service user choice and self-determination. International Journal of Person Centered Medicine. Vol 3, No 4, (2013) pp.305-311. 

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.

vi WCCS26: World Conference on Complex Systems 20-22nd April

April and WCCS26 seems an age ago, but the motivational impetus provided by this experience has been ongoing.

Luis Comolli - Best Paper Award 
for Emergence in Designed Agroecosystems:
Collective Dynamics in a Perennial Multi-Species 
Agroforestry Network

At the closing ceremony there was an award for the best paper which was awarded to Luis Comolli for:

Emergence in Designed Agroecosystems: 
Collective Dynamics in a Perennial Multi-Species Agroforestry Network

Sat by Luis, I offered to take his photo to which he agreed - so better late than never! And: Well done Luis!

My presentation on the 21st April was part of:

Parallel Session 2
Track 1 - Agent-Based and Social Complexity
Session chair: Helena Knyazeva

    ▪ Peter Jones
Presenting a Universal and Simple Conceptual Workbench to Situate and Encompass Complexity

    ▪ Nisrine Jarmoune and Bouchra Lebzar
The Ontology of Behavior: Formalizing the Institutional Project as a Complex System
    
    ▪ Lionel Scotto d’Apollonia, Florian Charvolin, Lise Verlaet, Deborah Nourrit, Dominique Deveaux, Elisabeth Sénégas and Nourdine Bara
Participatory Action Research with and for Society: The Case of “Oasis of Fraternity”

▪ Harvey Spencer Sánchez-Restrepo, Jorge Louçã, Martha Belén Carmona-Soto and Sofialeticia Morales-Garza
Topological Patterns of Academic Success: Insights from Complex Network Analysis

To be clear there was a great deal in all the sessions (see below!). I noticed in Nisrine Jarmoune's presentation, however, more specific conceptual overlap in terms of the individual, collective - groups, behaviour and institutions, with reference to ontology and philosophy. Several mathematical concepts also arose and since April online discussion has proved very interesting. In the near future I hope to report on how ideas develop and may be taken further, both for Nisrine's PhD studies and my work on Hodges' model.

We are considering, especially with the options to participate available -

https://www.measuringbehavior.org/

'The next Measuring Behavior conference will take place from 28 to 30 April, 2027, in Düsseldorf, Germany. Düsseldorf is in a region with a high concentration of behavioral research across a variety of fields both in universities and industry. It is easy to reach by international trains and flights. It is a city combining innovative modern architecture with a historic city centre. The conference will take place in the Clayton Hotel, which is in the Little Tokyo region of Düsseldorf, with its distinctive Japanese flavor. We will be hosted by the Heinrich Heine Medical University and the location is within easy walking distance of the central station.'

https://www.measuringbehavior.org/call-for-symposia-mb2027-2/

Going back to the Monday, the closing Keynote Speaker: Abdelmajid Ibenrissoul 

Public Decision-Making and Complexity: What Rationality for Evaluation?

- provided fascinating insights and economic history:

Abdelmajid Ibenrissoul - Public Decision-Making and Complexity: What Rationality for Evaluation?

There remains much to follow up, seek understanding and see how this relates to Hodges' model.

More details to follow.

I have noticed the main website for WCCS appears to be unavailable? I will check.

c/o The King's Fund: Making sense of integrated care systems, integrated care partnerships and accountable care organisations in the NHS in England

When I see a 'model' I ask myself; what does this mean in itself? What is its purpose? I also (invariably) ask how does it relate to, or how might it support the theory and application that might underpin h2cm?

In February 2018 The King's Fund posted this item on integrated care systems. It wasn't just the 2x2 figure that caught my eye, but the axes and the additional amber tab (figure 1). Pondering for a time I have transposed this to Hodges' model below figure 1. Beneath that, I've provided an explanation for the altered schematic; recognising that as with h2cm such models are idealised representations.

c/o The King's Fund

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

Individual care management Care for patients presenting with illness or for those at high risk of requiring care services	Population Health (systems) Improving health outcomes across whole populations including the distribution of health outcomes [Improving population health outcomes requires multiple interventions across systems]
'Making every contact count' Active health promotion when individuals come into contact with health and care services	Integrated care models Co-ordination of care services for defined groups of people (eg. older people and those with complex needs)

INTRA- INTERPERSONAL:
Individual care management has been changed from care services and individuals to this domain, which conceptually preserves the original placement. In h2cm as can be seen the interpersonal domain combines the individual and humanistic. In the 4Ps this domain also includes 'purpose'. Whenever possible it here (individual motivation) that self-care and self-efficacy and staying as well as possible relies on the patient's awareness and education about their condition and level of health literacy. There is recognition now that children need some awareness of mental health issues and the law needs to protect what images and content youngsters are exposed to on social media. So, ultimately 'how I manage myself' has a major bearing on the 'whole care management enterprise.' The focus on 'high risk' also denotes a need for an assessment and one that is part of the move to parity of esteem in respect of physical and mental health.

SCIENCES:
I have shifted Population Health (systems)from population to this (physical) individual domain, on the basis that our research, as in, quantitative and qualitative, needs to be synthesized and then ultimately generalised - across populations. While complex systems cannot be taken apart it is from the sciences (including social sciences) that evidence-based practice flows. There should be a feedback loop here, research that also takes into account the multiple interventions across systems (the amber tab in figure 1) and the outcomes achieved.

POLITICAL:
The King's Fund's figure 1 stands as it is of course, but I have 'moved' Integrated care models most radically. If there is no organisation, rules, order, policy, procedures ... then things will NOT happen (as they should). Agreement is also needed on definitions for reasons of standards, measures and accountability. Such matters are political (even if ignored - kicked in the long-grass). For services that are evidence-based (as just mentioned in SCIENCES) we need when possible for health and social care policies to also be evidence-based (for reasons of efficiency, equity, effectiveness and equality). While we cannot 'break' complex systems we can break models; 'health care systems' need to break ("be broken whilst still in flight") in order to be transformed for the 21st century.

SOCIOLOGY:
Making every contact count I have placed in the h2cm's Sociology domain. To me this initiative remains with care services, but I have switched this from individual to group-population within h2cm. Health care education places constant emphasis (research, CPD, mandatory training) upon interpersonal - communication skills and this is where clinical and social care interactions and interactions ultimately count. It is here that trust, the 6Cs, unconditional positive regard ... are 'counted' in qualitative terms. If the psychological represents the theory of psych-social intervention, it is in the social outcomes and benefits were the practice is (truly) delivered. It is also here that partnerships are forged and social capital found.

In social care as an example, the integrated care model should politically permit - allow for a sufficiently skilled and remunerated work-force (socially valued?) with sufficient time to ensure that every contact really does count.

<>

Forty years in the NHS suggests that when ever 'integrated care' is being written and even spoken about, then the context should be indicated at the same time; so at least - integrated care^1-5 as above?

'integrated' as in -

• philosophy (ethics, morality, values)
• spiritual (values) (and part-whole of 1-5)
• political - policy, government funding
• economically - commissioning (models of care, sustainability)
• management
• care delivery
• team organisation
• community involvement
• patient involvement
• health literacy, health promoting

...?

Accessibility: apologies that there is no equivalent text to figure 1.

My source: https://twitter.com/TheKingsFund/status/1093556280248147969

NW England: UCLAN - Postgraduate Student Conference 2015 Designing and Delivering Research to Inform Clinical Practice

School of Health

Monday 26th January 2015 

9am to 4pm Adelphi Conference Room

A series of short talks to stimulate and inform those contemplating, planning and undertaking research

Supporting UCLan’s postgraduate students

8.30 Registration. 9.00 Start.  

9.00 – Welcome by Professor Tim Thornton, Professor of Philosophy and Mental Health. Why do we need different research methods?  Chair: Professor Caroline Watkins, UCLan School of Health Director of Research.  

9.20 – Dr Louise Connell, NIHR Career Development Research Fellow. Developing a health research career.  

9.40 – 10.20 Session 1 - Systematically reviewing the evidence.  
• Dr Stephanie Jones, Senior Research Fellow & Colette Miller, Research Assistant. Searching the literature to explore what impact training health professionals has on patient outcome. 
• Dr Gill Thomson, Senior Research Fellow Maternal and Infant Nutrition and Nurture Unit (MAINN). Metasynthesis – why and how we do it. 

10.20 - 10.30 Questions 

BREAK – 10.30– 11.00 (30 minutes tea/coffee/networking) 

11.00 – 12.00 Session 2 - Clinical Trials and complex interventions. 
• Dr Chris Sutton, Principal Lecturer and Associate Director Lancashire Clinical Trials Unit. The role of feasibility trials in the development and evaluation of complex interventions. 
• Dr Michael Leathley, Post Doctoral Research Fellow/Principal Lecturer (Research). Health economics in feasibility trials. 
• Dr Lois Thomas, Reader in Health Services Research. What do process evaluations contribute to trials of complex interventions?  An example from the ICONS: Identifying Continence OptioNs after Stroke Trial.  

12.00– 12.20 Questions  

LUNCH 12.20 until 13.20 networking. Sandwich lunch provided  

13.20 Chair: TBC  13.20 – 14.20 Session 3 - Implementation science and service user involvement. 
• Dr Rob Monks, Senior Lecturer and John Billington. Experienced-based co-design. 
• Dr Mick McKeown, Principal Lecturer, Centre for Mental Health and Wellbeing. & Fiona Jones, Community Futures.  Activism, action and alliances: meaningful involvement in research.  

14.20 – 15.00 Session 4 Qualitative research to answer health and social care questions. 
• Dr Janine Arnott, Research Fellow, Children’s, Families and Transitions. Data collection from children. 
• Prof Soo Downe, How qualitative research can influence national and global policy in maternal and child health.  

15.00 – 15.20 Questions  

15.20 – Dr Alexis Holden, Head of UCLan Funding Development and Support. ‘UCLan Research and Innovation Office (RIO) – How can we help you?’  

15.40 – Final session - TBC.  

16.00 CLOSE

...

Adelphi Building, Preston (Adelphi Conference Room, UCLan's Adelphi Building, Adelphi Street, Preston, PR1 7AY

[ I only learned of this event yesterday afternoon and have managed to secure leave and a place - there are a few more left. ]

International Journal of Integrated Care

Dear IJIC reader,

Recently PUBLISHED in the International Journal of Integrated Care

A Research and Theory paper:

An evaluation of SNOMED CT® in the domain of complex chronic conditions,
by Tara Sampalli, Michael Shepherd, Jack Duffy and Roy Fox

… It is the hypothesis of this work that showing the availability of multidisciplinary concepts for one complex condition can generate a similar expectation of available terms for other chronic conditions …

A policy paper:

Integrating care for people with mental illness: the Care Programme Approach in England and its implications for long-term conditions management,
by Nick Goodwin and Simon Lawton-Smith

… the lesson from the CPA experience suggests that there is potential for better care integration to be had in a strategy based on personalised care planning and investment in care co-ordination for people with chronic and sometimes complex needs …

And a book review:

Managing transition. Support for individuals at key point of change, edited
by Alison Petch and reviewed by AnneLoes van Staa

…This book is unique in its broad focus on different transitions in various contexts, and its exploration of the evidence for support given to people who risk getting ‘lost in transition’. This makes this publication highly interesting to readers of the International Journal of Integrated Care …

...

“All together now: Exploring the Many Faces and Facets of Integrated Care”,
Tampere Finland, June 16-18, 2010.

The INIC Conference 2010 will make an effort to look at and evaluate the challenges and status quo of mutual many-faceted collaboration of integrated care from the point of view of benefits to patients, service users and carers. The annual conferences offer an ideal meeting place for the integrated care community to discuss recent developments and future challenges across systems and continents.

On the website you can find more information on the keynote speakers, the pre-conference and site-visits, the program of the conference and the parallel sessions.

...

Thanks for the continuing interest in our work.

Erika Manten
Managing editor IJIC
ijic at uu.nl
___________________________________________________
Erika Manten - Managing editor International Journal of Integrated Care,
http://www.ijic.org/ - IJIC Editorial office: Igitur, Utrecht Publishing &
Archiving Services, University Library Utrecht, P.O. Box 80124, 3508 TC
Utrecht, The Netherlands.

Threshold Concepts: Reflection on chaos, complexity and AI

Here are the reflections on the photograph posted in June following the Conference on Threshold Concepts:

Chaos can occur in any one ... or all of the four domains of Hodges' model. The same applies to order.

http://homepages.math.uic.edu/~kjerland/Lorenz/lorenz_attractor.html

This is a characteristic of chaos and chaotic systems.

Chaos can arise at any time: in the here and now, being sown now for the future (climate change?), or springing from the past, as in pleasurable, or traumatic memories.

While the Lorenz attractor and other graphical examples are grounded in mathematics and science, in #h2cm we need to imagine the butterfly diagram extended across and simultaneously at work across the models four domains.

individual - self

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group- population

Even in instances of riot and anarchy there will be pockets of 'order', but would you would want to take your chance of finding one? Amid talk of being in the wrong place, at wrong time; to what extent is this dependent upon who we associate with socially? Or, what we believe is the political course we might, should, will, must follow?

The context of Prof. Land's slide is learning and decision making. As a 'political' matter when chaos occurs, how is it manifested in disintegration? Can we hear the 'gears grind'? What exactly goes awry? Is it the processes as in the timing, leadership and with it responsibility?

The slide is powerful in giving support, to clinical decision-making as a context in which complex decision making is very common and simultaneously encompasses political, rationale and judgemental (ethical) forms of decision making.

Hodges' model can also facilitate recognition of differentiation between relational chaos and the explicit state of decision-making. For example, a healthcare practitioner and client/patient/carer may have achieved empathy and rapport, but the complex demands of the clinical decision still presents a great deal of uncertainty. Alternately in instances when the relationship is being forged then the communications: verbal and non-verbal (and a function of the clinical team) can be a confounding factor if not negotiated professionally (and in socially acceptable terms by members of the public). Another useful perspective is Personal and Public Involvement (PPI) at what point is this achieved? What are the thresholds in the public's learning, as they engage and are engaged if they are not to label the initiative as a checkbox exercise? Again Hodges' model can help us to reflect upon the scope and complexity of such situations.


AI, artificial intelligence was mentioned (I'm sure?) in the presentation and the benefits of AI in healthcare are already being realised. This is tempered with the requirement for AI systems to be able to explain their 'reasoning', rather than this be taken at face value. As AI takes on tasks that include initial automated screening of job applications that include videos then another dimension of learning is presented to students.

Health and justice is by default complex. Consider, the task of being seen by society that justice is duly served and doing so with a duty of care and welfare of the prisoners. To this, we can add the aspiration of custody being rehabilitative. For a prisoner, even on remand, there will be times when health needs and patiency must be recognised. When a long-term prisoner becomes chronically ill, this can present a major challenge to law-makers, prisoners, their families, the healthcare team and society.

individual - self

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group- population

Identity (use of name, touch ...) (My) PURPOSE Beliefs, Personal values  Safety (personal) Thresholds Trigger warning Critical - critique  not taking it personally	PROCESS [Space] - physical & degrees of freedom in decision making constraints Rationale* Evidence Theory Quantitative Research
Qualitative Research Patient : Healthcare practitioner decision making  PRACTICE Critical - agreeing to disagree Schism - 'distance'	Consensus (bridge building)  Autonomy (in decision making) Administration / Bureaucracy Professionalism Anti- 'X' movements Riot and anarchy safety (POLICY) Critical - political

*While placed within the sciences domain, 'rationale' can be evidenced physically, psychologically,  politically and socially.  It is this that forces us to acknowledge the several edges of chaos.

See also:
Inaugural Scottish Threshold Concepts Conference: TCs in Action [i]

Inaugural Scottish Threshold Concepts Conference: TCs in Action [ii]

Inaugural Scottish Threshold Concepts Conference: TCs in Action [iii]

Images:
http://homepages.math.uic.edu/~kjerland/Lorenz/lorenz_attractor.html

https://www.thingiverse.com/thing:3774260/comments
(Original image)