"Reforming oral health policy to contain noma"

"In a landmark decision in December 2023, the World Health Organisation designated noma as a neglected tropical disease, shedding light on a condition that often lurks in the shadows of poverty-stricken communities across sub-Saharan Africa, Latin America, and Asia. Noma is a severe rapidly progressing disease of the mouth and face mostly affecting children between the ages of two and six years suffering from malnutrition, infectious diseases, or living in extreme poverty with poor oral health or weakened immune systems like HIV and other diseases, which can lead to death due to complications such as sepsis. In 2012, the UN Human Rights Council acknowledged that neglecting noma is affected may amount to a violation of basic child rights."

Oluwaseyi Atoyebi. Reforming oral health policy to contain noma, 15th March 2024
https://punchng.com/reforming-oral-health-policy-to-contain-noma/ 

Individual
|

      INTERPERSONAL    :     SCIENCES               

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

 SOCIOLOGY  :    POLITICAL 

|

Group

Psychological impacts
Social impacts - life chances	(neglected) neglected tropical disease

Previously:

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

Ioana Cismas (York) - What's in a Frame? A Human Rights Approach to Neglected Tropical Diseases - https://www.york.ac.uk/cahr/events/2022/justice-in-global-health-workshop/

Concept Note in Support of the Inclusion of Noma (Cancrum Oris) on the World Health Organization List of Neglected Tropical Diseases (Commissioned by the Government of Namibia, 2016), 6 pp. (with Marie-Solène Adamou Moussa-Pham).

Srour, M. L., & Baratti-Mayer, D. (2020). Why is noma a neglected-neglected tropical disease?. PLoS neglected tropical diseases, 14(8), e0008435. https://doi.org/10.1371/journal.pntd.0008435

Paper: "Control, Extract, Legitimate: COVID-19 and Digital Techno-opportunism across Africa" + Noma

Earlier this month in draft papers iii I mentioned a lengthy draft 12k words ... "Society, Technology and COVID19 in Hodges' model" which needs revision (COVID-19 waits for no person):

"COVID's source, global spread, national responses, and management are politicised; a memetic and geopolitical viral response (Kavanagh, Singh and Pillinger, 2021). The hope remains that globally we will get a grip of COVID and learn collectively; even as politics is in play (The Lancet. 2021). COVID revealed itself as signs and symptoms were reported and aggregated, patterns identified, and advice modified accordingly. Routine news was interrupted by a daily round of COVID briefings by governments, their representatives and
experts. Charts and statistics were presented, numbers crunched (mechanistically, of course). Some governments, in denial, face a legal charge. Comparisons of national cases and deaths are ongoing, hard truths (proverbial ‘cock-ups’) explained away — rationalised. The global distribution of COVID vaccinations, influenza and booster jabs, lays bare colonial traces of inequity and inequality. A further twist of the south and north seasonal oscillation.

COVID-19 is striking, simultaneously creating opacity and transparency. Accentuated and aggravated by populist governments, COVID is now marked as a pandemic and infodemic (Cinelli, et al, 2020). Post hoc governments and academia must understand the societal and cultural ramifications of news generation, dissemination, and outcomes."

Socio-technical approaches feature on this blog, in a published paper (bibliography) and in Hodges' model. Socio-Technical can help assure success but they must be tempered - shaped - by taking into consideration the individual (user's) psychology, benefit; and the political aspects - what are the costs, collective benefits and governance?

The following paper stood out on twitter (COVID-19 is not a laggard in keeping pace with robots it seems) and will inform my update of the above:

Platzky Miller, J., Sander, A. and Srinivasan, S. (2022), Control, Extract, Legitimate: COVID-19 and Digital Techno-opportunism across Africa. Dev Change. https://doi.org/10.1111/dech.12734

 INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

logic(s)? . Fear - COVID-19 attitudes - receptivity (Expectations: now - future? Such actions spoil/taint technology.) individual psychology the 'user' (active/passive..)	socio-TECHNICAL robots digital solutions track and trace apps and vaccine passports (rate of failure) Life - Bio-Sciences TECHNO-
SOCIO-technical Societies Sustainable Development (Goals?) Social development, history Logics of control, extraction and legitimation Social Determinants of Health	OPPORTUNISM Political role of public health emergencies in Africa Rwandan government ZoraBots, a Belgian company Commercial Determinants of Health Colonialism: control, power Governance Neglected Neglected diseases - Noma?

My source:

How many lives did a robot save fighting #COVID19 in Rwanda? Short answer: ~none. Long answer: that's not the point. A collab bw @RwandaGov, @Undp and a Belgian robot firm, it's one example of rampant techno-opportunism across #Africa during the pandemic, with worrying effects... pic.twitter.com/6FWtlLR8b8

— Sharath Srinivasan (@sharath_sri) October 22, 2022

Plus: Re. Noma ...

Ioana Cismas (York) - What's in a Frame? A Human Rights Approach to Neglected Tropical Diseases - https://www.york.ac.uk/cahr/events/2022/justice-in-global-health-workshop/

https://philevents.org/event/show/101162

Concept Note in Support of the Inclusion of Noma (Cancrum Oris) on the World Health Organization List of Neglected Tropical Diseases (Commissioned by the Government of Namibia, 2016), 6 pp. (with Marie-Solène Adamou Moussa-Pham).

Srour, M. L., & Baratti-Mayer, D. (2020). Why is noma a neglected-neglected tropical disease?. PLoS neglected tropical diseases, 14(8), e0008435. https://doi.org/10.1371/journal.pntd.0008435

Maguire et al. - 'A systematic scoping review of the noma evidence landscape: current knowledge and gaps'

Abstract

Background Noma (cancrum oris) is a severe gangrenous disease of the mouth and oro-facial structures. Noma often affects young children living in extreme poverty, malnutrition and poor sanitation. Gaps remain in understanding its aetiology, pathogenesis, prevention and treatment.

Methods and findings We systematically searched databases for all primary research studies (clinical trials, cohort studies, case–control, cross-sectional, other observational studies, case studies/series) reporting noma patients of any age up to 7 December 2022. The 366 publications (published between 1839 and 2022) included in our scoping review describe 15 082 patients. Although 53 cohort and 29 cross-sectional studies were identified, enrolling 13 489 patients, interventional research remains extremely limited, with only six studies identified (101 patients, range: 7–26) and only one in the past decade, highlighting a critical gap in treatment evaluation. A total of 380 different treatment modalities were described, which underscores lack of a standardised practice. Disease aetiology remains unclear, with 117 microorganisms reported across 113 studies, yet none more consistently linked to noma development. Since 2000, 91.2% of cases have been reported in Sub-Saharan Africa, though occurrences outside the ‘noma belt’ and into Asia and the Americas suggest a broader risk. The 212 potential risk factors identified in 269 (73.5%) publications reflect substantial heterogeneity, complicating efforts to determine definitive causative factors. Additionally, the inconsistent definition and reporting of noma staging significantly hinder comparability across studies, with wide adoption of the WHO staging classification needed.

Conclusion This comprehensive review of the literature underscores the urgent need for robust, policy-driven research to address the vast knowledge gaps in the physiopathology of noma and the limited evidence currently available to guide therapeutic and preventive policies. Collective action and increased research investment are crucial, especially now that noma is officially recognised as a neglected tropical disease by the WHO.

Brittany J Maguire, Rujan Shrestha, Prabin Dahal, Roland Ngu, Lionel Nizigama, Sumayyah Rashan, Poojan Shrestha, Elinor Harriss, Paul Newton, Yuka Makino, Benoit Varenne, Philippe J Guerin - Systematic scoping review of the noma evidence landscape: current knowledge and gaps: BMJ Global Health 2025;10:e018023 https://gh.bmj.com/content/10/7/e018023

Individual

|

      INTERPERSONAL    :     SCIENCES               

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

 SOCIOLOGY  :    POLITICAL 

|

Group

PSYCHOLOGICAL IMPACT mental & emotional complications WITHDRAWAL LOST EDUCATION & LIFE CHANCES DEPRESSION PSYCHO-	malnutrition and poor sanitation PHYSICAL IMPACT LIMITED EVIDENCE - DISEASE KNOWLEDGE GAPS - AETIOLOGY  knowledge gaps in the physiopathology of noma
-SOCIAL MANAGEMENT SOCIAL IMPACT - LIFE CHANCES STIGMA SOCIAL EXCLUSION	extreme poverty, infrastructure NEED FOR POLICY-DRIVEN RESEARCH THERAPEUTIC - PREVENTIVE POLICIES RECOGNITION

Previously: 'neglected' : 'noma'

My source: https://x.com/benoit_varenne/status/1950955812915982487

Guinea worm announcement

c/o The Carter Center Guinea Worm Eradication Program

"13 Human Cases of Guinea Worm Reported in 2023 – Remaining at the Lowest Level Since the Eradication Campaign Began"

Individual
   |

      INTERPERSONAL    :     SCIENCES               

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

 SOCIOLOGY  :   POLITICAL 

|

Group

mental health emotional distress anxiety - impact on life chances, ability to study, earn knowledge - awareness my health literacy access to knowledge brokers respect what is 'old' but what is new - insight?

"Dracunculiasis is a crippling parasitic disease on the verge of eradication, with 27 human cases reported in 2020. From the time infection occurs, it takes between 10–14 months for the transmission cycle to complete. About this time, a mature female worm emerges from the body. The parasite is transmitted mostly when people drink stagnant water contaminated with parasite-infected water fleas. Dracunculiasis was endemic in 20 countries in the mid-1980s."

rural - remote communities daily practices access to information (valid, evidence-based) stigma - disgust

"March 27 is the anniversary of the start of the Guinea worm cease-fire that former U.S. President Jimmy Carter brokered in 1995 during the Second Sudanese Civil War."

Individual
   |

      INTERPERSONAL    :     SCIENCES               

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

 SOCIOLOGY  :   POLITICAL 

|

Group

SUN & AMON (2018). Addressing Inequity: Neglected Tropical Diseases and Human Rights. Health and Human Rights, 20(1), 11–25. http://www.jstor.org/stable/90023050	"Two boys drink through pipe filters at Kuse Dam, Terekeka County, Southern Sudan, in 2010. During the 1995 Guinea worm cease-fire, health workers distributed 200,000 cloth household filters. Both types of filter strain Guinea worm larvae out of water, making it safe to drink."
Curtis, V. (2011). Why disgust matters. Philosophical Transactions: Biological Sciences, 366(1583), 3478–3490. http://www.jstor.org/stable/23035750	AMON & ADDISS (2018). “Equipping Practitioners”: Linking Neglected Tropical Diseases and Human Rights. Health and Human Rights, 20(1), 5–10. http://www.jstor.org/stable/90023049

See also: 'Noma'

My source: Times Radio UK

Periodic Table of Visualization Methods [Net-Gold]

Plenty here to think about... (source ack. Terri Willingham & Net-Gold):

Date: Tue, 21 Oct 2008 14:50:54 -0000
Subject: [Net-Gold] E-LEARNING: Visual Literacy

Visual Literacy
http://www.visual-literacy.org/

See, especially, the Periodic Table of Visualization Methods:
http://www.visual- literacy. org/periodic_ table/periodic_ table.html

This e-learning site focuses on a critical, but often neglected skill for business, communication, and engineering students, namely visual literacy, or the ability to evaluate, apply, or create conceptual visual representations. After this tutorial, students should be able to evaluate advantages and disadvantages of visual representations, to improve their shortcomings, to use them to create and communicate knowledge, or to devise new ways of representing insights.

The didactic approach consists of rooting visualization in its application contexts, i.e. giving students the necessary critical attitude, principles, tools and feedback to develop their own high-quality visualization formats for specific problems (problem-based learning). The students thus learn about the commonalities of good visualization in diverse areas, but also explore the specificities of visualization in their field of specialization (through real-life case studies). They will not only learn by doing, but in doing so contribute new training material for their peers to evaluate (peer learning).

Terri Willingham

Auction: Twenty-two photographs of psychiatric patients at the Surrey County Lunatic Asylum [1850s]

DIAMOND, Dr Hugh Welch (1808–1886)

Twenty-two photographs of psychiatric patients at the Surrey County Lunatic Asylum [1850s]

Estimate - GBP 100,000 – GBP 200,000

Christie's London - December 10th 2025

https://www.christies.com/en/lot/lot-6564110?ldp_breadcrumb=back

Asylum patient by Hugh Welch Diamond, c1850-58
Hugh Welch Diamond (English, 1808-1886)
Public domain, via Wikimedia Commons

'The women Iook out at us across 170 years of history with a variety of expressions - bold and shy, serene and distressed. Yet all of them were regarded at the time as "lunatics". These faces were the  subjects of a pioneering project by the 19th-century psychiatrist Hugh Welch Diamond, superintendent of the female division of an asylum in London and the world's first photographer to take pictures of patients for the purpose of diagnosis and therapy.

Twenty-two of Diamond's asylum portraits - the largest surviving group - will be put up for auction on December 10 at Christie's in London, as part of a sale of books, manuscripts and photographs from the library of The Royal Society of Medicine. If they achieve their estimated prices, RSM, a membership charity, will raise more than £2mn to invest in physical and digital infrastructure.' ...

'Diamond was working at a time when society's views of people suffering from mental illness were changing. The earlier practice of shutting patients away in secure "madhouses" was giving way to more humane treatment. Diamond seems to have believed that photography would help doctors both to diagnose and to treat patients. His diagnoses were based partly on the idea, popular in Victorian medical circles, that an individual's physiognomy - their physical features, particularly the face - could reveal their mental state.

"He wanted to make people better and put them back into the world," says Sharrona Pearl, a medical historian at Texas Christian University who has studied Diamond's work. "He also enjoyed experimenting and liked the idea of bridging his expertise in medicine and photography.' p.32.

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group-population

Mental Illness PERSON - SUBJECT Patient's names not recorded Portrait - Consent?	Diagnosis and Treatment person - DATA - SUBJECT Photography as records Eagerness to classify - label
Social history Change in social attitudes Stigma and fear of mental illness Current relatives?	Confidentiality Institutional change Power imbalance Shift from 'custodial' to health care

My source:
Clive Cookson, Mind Hunter, FT Magazine, November 15, 2025, 1151, pp.30-34.

I have noticed Prof. Brendan Kelly is a regular FT respondent, as with this article:

'These photographs were likely to have been taken without meaningful consent and in the context of power imbalance. Yet publication can reclaim their individuality, address historical injustice and underscore our common humanity. Compassion, respect and humility should guide decisions. 

 Proceeds should support medical, educational, or justice-oriented programmes. Most importantly honouring forgotten patients of the past demands better care for people with mental illness today, who often languish, neglected, in homeless hostels or prisons. We can do better.'

Brendan Kelly Professor of Psychiatry, Trinity College, Dublin, Ireland.

Letters, FT Weekend. 22-23 November 2025, p.10.

See also: 'asylum' : 'photos'

c/o GPonline: "Social prescribing patients curate art exhibition at leading Cornish gallery"

"The ‘What Lies Behind’ exhibition, a recent display in Newlyn Art Gallery, saw 10 patients from Morrab Surgery in Penzance select works of art from Arts Council national collection of more than 8,000 pieces.

The group were asked to choose pieces that reflected their personal response to the pandemic. The works on display included textiles, sculpture, prints and paintings by artists including Pablo Picasso, Henry Moore and Chila Burman.

The project came about during lockdown after Morrab Surgery’s social prescribing link worker Ellie Moseley realised that many of the patients in the practice that she was working with had an interest in the arts." [ On GPonline ].

 

  Self - Individual - Person
|

 INTERPERSONAL    :     SCIENCES               

HUMANITIES - ARTS ----------------------------------  SCIENCES

SOCIOLOGY  :   POLITICAL 

|

Community - Group - Population

Personal expectations (care, medicine...) Emotional wellbeing Person-centred care Social prescribing as a care intervention	'What lies behind' exhibition, Newlyn Art Gallery
	Social prescribing as a care policy needs community resources (to match). Amid health policy calls for innovation and  sustainable healthcare systems and services; the community remains the sustainable resource (if not neglected). Funding - ... ££ $$ €€ ¥¥ ฿฿ ₫₫ ₴₴ ₪₪ ₽₽ ₹₹ ₩₩ ... local :: global health.

 

My source: @ActivateEurope

https://twitter.com/ActivateEurope/status/1491751271539351562?s=20&t=ZQHyHs2a9--xJpmJDzrdHQ

@GPonlinenews

Out of the Shadows - Mental Illness

"How a pioneering approach to treating mental illness is helping to fight one of the world’s most neglected diseases."

Out of the Shadows


My source: Email re. an INTAR 2016 conference call.

Peter's penchant for boxes...?

Although the number of posts using Hodges' model may suggest I'm obsessed with putting things in boxes and I am extolling you to do the same, please note; this is not the case [well not entirely ;-) ].

The model recognises the common need to make sense of things, hence our tendency to dichotomise, categorise, to seek meaning and order. The model makes explicit 'four basic boxes', but then invites us to transcend them by testing each one, subjecting the four domains to reflection. Five domains, taking in the spiritual also.

Given a situation, a context, a patient, or carer, or student ... we can ask what are the facts, what are the issues and how are they linked? Mentally we can consider what important concepts are missing?

It is not for me to provide all these concepts. I may|should|must also listen, observe and liaise in order to identify them. The solution is about teamwork, partnership and collaboration.

Yes, the 'boxes' really are there. The disciplinary divides do still exist. In h2cm they are integral to the structure of the model. But as we progress in applying the model we seek to blur, if not erase the boundaries. To achieve holistic and integrated care we need to collapse the boxes. It seems something more than interdisciplinary and interprofessional is needed to connect and integrate what are frequently neglected knowledge (care) domains and content.

I should be able to explain some of this in my review of Prof. Carel's book 'Illness'.

NPR: What is your wish to improve life on earth in 2025?

Dola Sun for NPR

With thanks to NPR, 'an independent, nonprofit media organization that was founded on a mission to create a more informed public'. NPR asked 11 global health professionals to share their wishes for 2025.

Read in full here:
https://www.npr.org/sections/goats-and-soda/2025/01/06/g-s1-40820/2025-world-wishes-haiti-bird-flu

We asked global thinkers how to improve life on earth in 2025. Here are their wishes

My wish: Honor the legacy of Jimmy Carter Dr. Ifeanyi M. Nsofor, project director, VaxSocial HPV Vaccination Initiative, Nigeria

My wish: World, awaken to the medical emergency in Haiti Dr. Ousmane Abdoulaye, Port-au-Prince in Haiti, medical coordinator, Haiti Mission, ALIMA — The Alliance for International Medical Action

My wish: Nothing too grand. Just a small wish that things for us go back as they were three years ago — when women could go to parks or markets but most of all go to school. Maryam S., Afghanistan, former Master's student of Pashto literature. She asked to be identified by her first name only out of fear that her criticism of Taliban policies would put her and her family in danger.

My wish: Make monumental strides in using advanced technology to detect emerging pathogens Dr. Abraar Karan, physician and researcher, Division of Infectious Diseases & Geographic Medicine, Stanford University

My wish: Let us recognize that violence has never been the true solution to conflict KR Raja, Madurai, India, lawyer advocating for criminal justice reform and the founder of the Indian charity Global Network for Equality, which supports children orphaned by crime

My wish: I dream of a future where there are safe and healthy conditions for workers, where they are free of discrimination and can earn a fair wage. Ashila Dandeniya, Colombo, Sri Lanka, founder and director of the Stand Up Movement, a women-led organization that advocates for workers' rights.

My wish: Make progress in developing treatments to reduce deaths and complications from dengue André Siqueira, head of the Dengue Global Programme at Drugs for Neglected Diseases Initiative and public health researcher at the Oswaldo Cruz Foundation's National Infectious Diseases Institute in Brazil

My wish: For trekkers and travelers to help clean up the waste they leave behind — and to help protect our natural treasures Raj Kumar Shrestha, trekking guide, Kathmandu, Nepal, and founder of Let's Clean Up Nepal, an environmental conservation organization

My wish: Use digital innovation to enable health workers to deliver their care, especially in places where resources are constrained Dr. Junaid Nabi, public health researcher specializing in health-care reform and innovation, and a senior fellow at the Aspen Institute and a Millennium Fellow at the Atlantic Council

My wish: May the year bring peace to the world Dr. Atsbha Merhawit, Ayder Hospital, specialty in endocrinology and diabetes, Mekelle, Ethiopia

My wish: Follow the rules of war regarding the welfare of children Joe English, New York, N.Y., emergency communication specialist for UNICEF ==

What is your wish for 2025?

Best wishes, Neil

HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil AT hifa.org

n.b. My wish: That "Hodges' Health Career - Care Domains - Model" continues to emerge as a generic conceptual framework shared and understood by all learners for lifelong learning.

Thanks Neil. I will post this with HIFA link.

What does professionalism mean to me? #IND2017 (dnf: draft never finished)

Something along, within and across these lines...

INDIVIDUAL

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

POPULATION

Being self-aware, reflective and reflexive including aspects of your role that either you don't especially like, or you're just not 'good' at. Recognise when to ask for help, advice, supervision. Anticipating needs. Indicating pros and cons. Keeping up-to-date. *Have the courage to blow that whistle if you must. Communicate to the best of your ability and learn constantly as human nature dictates you must. Look after yourself: if ill Be ill. Take care of your personal ethics and values, don't be bullied into lowering them and running with the crowd. Nurse = Lifelong Learner ... then you will question your own competence. As you strive to be someone else remember you can be yourself. The things you take personally are those you open the door to. Learn from them. Never forget your shield, protect yourself and others in what you disclose about yourself and others.

Being compass-ionate requires 360 degree vision, hearing ... learning and forgetting... Your keen are you? So really observe. Care about time, your management of it as a resource and the time frames of past, now, future, hoped for and imagined. Remember you need to understand information systems, data management in so far as it supports or places at risk the care you deliver and the safety of your patients. If I use IT based media I bear in mind the scope of the platform. Open to innovation: but see the elephant as an elephant. When the robots knock on your door being professional means you won't be in: "Moved On" As you care, draw on learning regards where you stand -  you are a guest in someone's home, As your feet are then grounded politically, so too is touch and negotiating personal spaces.

Learn from others  Expectations Expectations Expectations Manage them in a way such that you do not make promises you can not keep. Be committed to what you do. Learn from your peers, especially for safety's sake, but also form your own opinion. Talk this and work through with colleagues. Not everyone will 'like' you; you in turn may not 'like' people. Working through this (without experiencing abuse) as your role demands is being professional. By all means be a team player, but don't let the games that people play distract you from being professional. Patient-Carer Community Care End of Life Care  As you learn from others  pay most attention to the lessons  in Love as you will witness many.

The trust and respect of others take time to earn, but can be lost in an instant; if you have 'it' use it to foster trust and self-respect in others. You have to remember constantly you are accountable here. Remind yourself of codes of conduct the legal aspects of your role. Know your lines - especially when crossed | STANDARDS. With your ID have your whistle ready*. What you do and who you are is a privilege. Know your scope of practice, but be ready to question it. If you do not the future will. This domain is the most powerful and neglected to the professional nurse. As a professional what are YOU going to DO here? The art of leadership is filled with wonder: at what together you can all achieve. Take stock and ask in Year 1 what are the legacy issues my seniors are wrestling with? In years 10 20 30 40 ... (robotics permitting) repeat and reflect.

... because, being professional means learning and unlearning when the lines are there for a purpose and when they need to be shifted, lifted or plain erased ...

Previous post c/o NMC

'Humanistic geography' - goes full circle

INDIVIDUAL

|

     INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

"Alongside Euclidean geometry non-Euclidean geometries were invented. Alongside the old Aristotelian logic and the law of the excluded middle, new forms of logic with, for example, multiple values were developed. This type of work, far from remaining purely speculative, proved indispensable to the progress of physical theories. Consequently epistemological research was no longer seen as fundamentally inductive. It was no longer content to follow the movement of science: it undertook to precede science by indicating which tools should be used to make the best progress. This was the atmosphere which characterised neo-positivism: some concern was already apparent, therefore, but epistemology was still only partially critical. Its role was still more prescriptive." p.227.

"Tuan states that 'humanistic geography' is 'not an earth science' and that with its purpose as the better understanding of man and his condition, humanistic geography properly belongs to the humanities. (Tuan, 1976, 266). For Tuan humanistic geography is 'event-centred'; it is the study of articulated geographical ideas such as 'place', 'territory', 'crowding', 'privacy' and religion and it is particularly concerned with describing the quality of the emotion experienced in specific settings, e.g. the study of place as a centre of meaning for an individual rather than place as described by its geographical coordinates." pp.116-7.

Now we need to think of 'biospheric geography' within which humanity plays a pivotal and critical part.

https://science.nasa.gov/resource/the-story-behind-apollo-8s-famous-earthrise-photo/

https://www.nasa.gov/news-release/nasa-administrator-honors-life-of-apollo-astronaut-frank-borman/

Rose, C., Wilhelm Dilthey's Philosophy of Historical Understanding: a Neglected Heritage of Contemporary Humanistic Geography, p.99-131; Claval, P., Epistemology and the History of Geographical Thought, p.227-239. In. Stoddart, D.R., editor (1981) Geography, Ideology & Social Concern. Oxford: Basil Blackwell Publisher Ltd.

More books - gone; btw I'm not finding a post in each one - honest!

Health Career Model Cygnet Hospital Bierley [II]

Dear Denise

Thanks for your message, interest and ongoing support of Hodges' model. I've copied your query to Brian. It is marvellous to read of your career to date and how you have adapted the model to fit your needs.

I have some insight into PSI (psychosocial intervention) and feel that the model could certainly be used in your new post. I suppose (as ever) there are several caveats as you may have already found...

Chief among them is that your colleagues may be reluctant to follow your lead - asking for the evidence* to support safe and effective clinical use of Hodges' model?

The website and blog represent a call for research in Hodges model and similar approaches.

In support of Hodges' model in Bierley -

* 16 bed Acute Ward(male)
* 15 bed Complex Needs Ward (male)
* 15 bed PICU Ward (male)
* 15 bed Personality Disorder Service Ward (female)

- as you will be aware the model is very high-level and it does not dictate practice or philosophy. If adopted however the model can help assure (not guarantee) a holistic approach, as you have already found.

You may care to look at the current processes - care pathways - and map these using Hodges' model. Then look at the specifics of therapeutic modality and PSI (for example, specialised cognitive therapeutic/schema therapies personality disorder) on the unit and effects on the key (h2cm) elements -

INDIVIDUAL-GROUP
HUMANISTIC-MECHANISTIC

- and across the four knowledge domains.

On the blog, check the post 'labels' (on the right-hand side) for -

process,
practice,
purpose
and policy [4P's]. These posts may help also.

An often 'neglected' area is outcomes and outputs. Check what aspects of care (and outcomes) the commissioners of care are focusing upon? Public involvement, client and family engagement may be challenging aspects of care for you and your colleagues? You can also utilise the POLITICAL domain which in your work - as with the TEMSS/secure services posts is no doubt central. The focus on PSI is another crucial dimension SOCIOLOGY - POLITICAL, especially if family oriented? What areas do you want change? Should you concentrate your efforts on one care (knowledge) domain, or are there some inter-domain dependencies highlighted in the literature*?

What data do you have on your patient (referral) population (month-year?); your local (catchment area) population?

Hodges' model is a space - what can you fill it with?

What data do you already have? Sometimes this can come as a pleasant surprise, or a data-poverty shock? Who can you speak to internally - externally? Statistics, reports, intelligence? Is your organisation a learning organisation? (There are times to join in with the fashion game...) If so, does that include the clients and their families? Is anyone on a course and in need of a project? What does multidisciplinary team and integrated care (really) mean in your service? Has a staff member been away for 6-12 months, if so speak to them...

Your bed numbers:staffing ratios speak volumes to some people more than others (£...$) how does economics figure across Hodges' model? If it may help SWOT each domain?

Currently on the psychiatric nursing mail list there is a discussion on 'recovery' and employment-benefits. What does this mean for your care objectives and service overall?

If you still have any contacts at Kemple View or notes (essays) that you could possibly share please let me know. If you are interested in writing / collaborating on a paper I'd be happy to assist.

If there is a 'clinical development (governance) lead' in your new organisation it would help to get them on-board - then you are not out-on-a-limb. Your success thus far suggests you'll have this covered!

If you would like some views on your progress to date do not hesitate to tap my screen.

All the best to you and your colleagues Denise with your plans and for the holidays - 2008!

Keep in touch...

Peter J.
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Peter,
Thanks very much for your speedy response, I have already met with my two charge nurses on the ward and we have agreed a way forward. There is of course much to do to ensure that we can introduce the model successfully, your answer will prove very useful. I would be happy to keep in touch and of course feel free to add my question to the blog if you think that this will be helpful to others.

Kind Regards
Denise Banks

When 'containment' and 'protection' meet injury

INDIVIDUAL

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     INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

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GROUP

"MANUEL SUFFERED two serious brain injuries as a child in Denver, Colorado." p.54.

The function of the skull is . . ? "Brain injuries affect about 8.5% of the general population but rates among prisoners are far higher. Kim Gorgens, a neuropsychologist at the University of Denver, reckons that between 50% and 80% of prisoners and those on parole in America have brain injuries. A review of research in America, Australia and Europe suggests that the average reported rate is around 46%. Research conducted in 2010 by Huw Williams of the University of Exeter put the rate among men in British prisons at 65%. A study published in 2017 found that nearly half of all prisoners in New Zealand had been hospitalised for a traumatic brain injury before committing their crime. Researchers suspect that the numbers may be even higher in poorer countries because road-traffic accidents and violence are generally more common." p.54.

"A report in 2016 by the Centre for Mental Health estimated that in Britain the cost of traumaic brain injury in a 15-year old who goes on to offend is around £345,000 ($475,000). The cost to those affected and society more widely - is incalcuable." p.55.

The function of prison is . . ? "They are more troublesome while in prison and more likely to reoffend on release. This is especially true for those, like Manuel, who are injured as children." p.54. "Acknowledging the link between brain injuries and criminal behaviour is not to excuse lawbreaking. Most people with such injuries are capable of taking responsibility for their actions. However, it is easier to curb crime if you understand the factors that make it more likely, of which neurodisabilities are an important and neglected one." p.13.

Banged up. International, The Economist, March 27th 2021. pp.54-55;
And: Leaders. Knocked out and locked up. 438:9238, p.13.

See also:

UK Prisons Strategy White Paper

Headway: Brain injury and the criminal justice system