1. Lab #2 – Ghost Ma and Conceptual Framework

2. Agenda RAT Overview of today’s purpose & process Conceptual Framework.
Notes & quotes from the Ghost Map
Free writing
Sub-team discussion & topic decision
Free writing and conceptual framework (individually)
Sub-team discussion & presentation preparation
Present

3. Announcements
Bring your textbook tomorrow

4. RAT

5. Return RATS to folders

6. Learning Objectives for Today
Develop an understanding of the process through which scientists develop their own conceptual framework.
Develop ideas on how to structure your own unstructured assignment.
Elicit important and interesting lessons and ideas from Ghost Map.

7. Our Process for Developing a Conceptual Framework
Overview of:
Conceptual Framework
Structuring your own project
Hodgson presenting on Ghost Map.
Free-write thoughts on Ghost Map
Sub-team discussion of book: Identify topic to present on.
Free writing on topic / conceptual framework
Sub-team comes together to create conceptual framework.
Sub-team creates slides.

8. Slide template

9. Two Bummers Today…
I will explain what a conceptual framework is, but you will not immediately get to create one. You will have to go through a process of generating ideas and collaborating first.
You will have amazing ideas that will not end up in your final presentation. But there is a space to submit them.

10. Deliberate Practice & Expertise
Practice matters. Top performers: 10,000 hours
Repetition / revision
Concentration
Planning / structure
Study style / self-reflection
… Development of mental models via deliberate practice

11. Deliberate Practice & Expertise
Practice matters. Top performers: 10,000 hours
Repetition / revision
Concentration
Planning / structure
Study style / self-reflection
… Development of mental models via deliberate practice

12. World view Definition: A particular conception of the world.
There are things you have no worldview about:
Defined benefit & defined contribution retirement plans
Long-term care insurance (nursing home insurance)
The proper methods for conducting heart surgery
Things you have a worldview about (partially):
Good and evil
Your favorite political issues
What constitutes good friendship
Why education is important
Through a well-developed worldview on a topic, you develop expertise.

13. Conceptual Framework Correlation ≠ Causation
However, there is not always perfect causal evidence. You need to construct a worldview anyway.
You want that worldview to be:
Flexible
Responsive to evidence, but
Well-grounded enough that it isn’t vulnerable to the whim of anyone with data and an agenda.

14. Generating New Ideas / Structuring Time in an Unstructured Assignment

15. Use a “Thinking” Document
Free write
Ask yourself questions about…
The problem you are trying to solve
The process for solving that problem
Separate two parts of the brain:
The idea generating part of the brain from the
The quality control part of the brain
Invite feedback and discussion from collaborators and let that shape your thought

16. Conceptual Framework

17. Cyclical Process

18. Causality Sequence

19. Venn Diagram

26. The Model
max 𝑛 𝐾 𝑛,𝑏 −𝑀 𝑛,𝑐 +𝑊(𝑛,𝑐) n = number of medical specialties K = Depth of medical knowledge/experience applied to patient M = Medical mistakes due to miscommunication/coordination failures W = Whole-person perspective of doctors b = base of knowledge and technology in existence c = quality/efficiency of coordination practices (electronic medical records, meetings between doctors, etc)

27. The Chronic Quadrangle

28. From my own paper with students

29. Conceptual Framework Strategies
Word web brainstorm
Consider Causality
Consider cycles and patterns of change
Comparisons between examples
Similarities and differences
Changes over time
Line people up in order on a graph
Use theoretical tools you know from class

30. Our Process for Developing a Conceptual Framework
Overview of:
Conceptual Framework
Structuring your own project
Hodgson presenting on Ghost Map.
Free-write thoughts on Ghost Map
Sub-team discussion of book: Identify topic to present on.
Free writing on topic / conceptual framework
Sub-team comes together to create conceptual framework.
Sub-team creates slides.

31. Ghost Map

32. Problems with Ghost Map

33. Chapter 1: The Night Soil Men (Background)
Mini thesis: An efficiency in recycling waste is common characteristic among:
Thriving cities
Coral reefs
Organisms evolving (bones come from calcium waste)
Night soil men recycled waste in the cities

34. Chapter 1: The Night Soil Men (Story)
Public health problem: rising wages of night soil men, invention of water closet  cesspools overflowing.
Setting for our story: a somewhat wealthier neighborhood.

35. Chapter 1: The Night Soil Men
“A mass grave of decomposing bodies was an affront to both the senses and to personal dignity, but the smell it emitted was not a public-health risk. No one died of stench in Victorian London. But tens of thousands died because the fear of stench blinded them to the true perils of the city, and drove them to implement a series of wrongheaded reforms that only made the crisis worse… The history of knowledge conventionally focuses on breakthrough ideas and conceptual leaps. But the blind spots on the map, the dark continents of error and prejudice, carry their own mystery as well. How could so many intelligent people be so grievously wrong for such an extended period of time? How could they ignore so much overwhelming evidence that contradicted their most basic theories?” (p. 15)

36. Chapter 2: Eyes Sunk, Lips Dark Blue (Story)
Whitehead: Gregarious assistant curate (pastor). Made rounds to parishioners and drank at pubs.
Broad street pump: pulled water from 25 feet below ground, colder and preferred water, “slightly carbonated”.
Whitehead took rounds and noticed that the cleanliness of housekeeping was no predictor of which households would be hit. He knew the households well, and noticed some were wiped out while others were barely effected.

37. Chapter 2: Eyes Sunk, Lips Dark Blue What is the Cholera?
Symptoms: Vomiting and diarrhea
Cause of death: So much water expelled from your body that it dehydrates and kills the victim.
Cure: Drink water / rehydrate. A water/salt/sugar combo is best.
Source of illness: Drink water with the bacteria. Usually that bacteria comes from another person’s excrement.

38. Chapter 2: Eyes Sunk, Lips Dark Blue
“[Whitehead] detected these early patterns of the diseases course precisely because he possessed such a fine-grained understanding of the environment: the houses that had been praised for their sanitary conditions, and the ones considered to be the filthiest on their blocks. Without that kind of knowledge, the platitudes would have been far easier to settle back on.”

39. Chapter 3: The Investigator John Snow’s History as a Doctor
Was a scientist and surgeon.
Was an early person to learn of anesthesia.
Within two weeks of seeing anesthesia, he invented a device to help administer it in proper doses.
Helped with pain management during the Queen of England’s child birth.

40. Chapter 3: The Investigator John Snow’s Hypothesis about Cholera
Competing Cholera hypotheses of the day:
Contagious: Passed from person to person
“Miasma”: Arose from living conditions.
Hypothesis: Cholera was borne in water contaminated with fecal mater.
Published an empirical investigation of this hypothesis.
South London had water sources more likely to be connected to the river (where fecal mater was more likely to end up
Cholera happened at a much higher rate in South London than North London, even for people of similar social standing.
Medical community response: Correlation established, not causality.

41. Chapter 3: The Investigator
Skeptic’s response to Snow’s theory on Cholera: “The experimentum crucis would be, that the water conveyed to a distant locality, where cholera had been hitherto unknown, produced the disease in all who used it, while those who did not use it, escaped.” This critique stuck with Snow, and the Broad Street Pump provided a real-world implementation of this experiment.

42. Chapter 5: All Smell Is Disease
“During the plague years of 1665 – 1666, popular lore had it that the disease was being spread by dogs and cats. The Lord Mayor promptly called for a mass extermination of the city’s entire population of pets and strays, which was dutifully carried out by his minions. Of course, the plague turned out to be transmitted via the rates, whose numbers grew exponentially after the sudden, state-sponsored demise of their only predators.” (p )

43. Chapter 5: All Smell Is Disease
“…The problem is one of emphasis; there’s obviously nothing wrong with ensuring that hospital rooms have fresh air in them. The problem arises when supplying clean air becomes the single most important task of the doctor or nurse…..” (p. 124)

44. Chapter 7: The Pump Handle
“The committee begins with the assertion that cholera is transmitted via the atmosphere. When it discovers evidence that contradicts this initial assertion…. The counter-evidence is invoked as further proof of the original assertion: the atmosphere must be so poisoned that it has infected the water as well. Psychologists call this type of faulty reasoning ‘confirmation bias’: the tendency to force new information to fit one’s preconceptions about the world.” (p. 186)

45. Chapter 8: The Ghost Map
“The map may not have had the impact on its immediate audience that Snow would have liked, but… it had a certain quality that made people inclined to reproduce it, and through that reproduction, the map spread the waterborne theory more broadly. In the long run, the map was a triumph of marketing as much as empirical scientific evidence.” (p. 199)

46. Chapter 8: The Ghost Map
“The vast majority of the retellings of the Broad Street case fail to mention the signal fact that among the public-health authorities of the day, Snow’s investigation was of no significance.” (p. 200)

47. Chapter 8: The Ghost Map
With respect to the emerging technology and idea of mixing Google Maps with local information… “As in 1954, the amateurs are producing the most interesting work, precisely because they have the most textured, granular experience of their communities.”

48. Chapter 8: The Ghost Map
With respect to the new model of sharing information in society (like with the ghost map)…. “The second principle is the lateral, cross-disciplinary flow of ideas. The public spaces and coffeehouses of classic urban centers are not organized into strict zones of expertise and interest, the way most universities or corporations are. They’re places where various professions intermingle, where different people swap stories and ideas and skills along the way.” (pp )

49. Problems with Ghost Map
Intuitive Medicine
Empirical Medicine
Precision Medicine
We have no idea what the impact of a “treatment” is. All treatments are based on doctor’s intuitions.
You have a “treatment”. People respond differently to the treatment. What “works” is empirical: it works on a certain share of the population, but we cannot predict exactly who.
The effect of any “treatment” is perfectly predictable.

50. Progression Over Time Intuitive Medicine Empirical Medicine
Precision Medicine
Treatment recommended by a doctor using intuition
Controlled experiment evidence shows treatment works for 30%
Controlled experiment evidence can predict which people will respond.

51. p. 144 – “Why was John Snow immune?” (to miasma theory)
Author (Johnson) thinks/implies:
Anesthesiology either works or doesn’t work on patients.
It is crazy to think that people’s immune systems would respond differently to the same stimulus.
Science is black-and-white.
In reality:
People respond very differently to anesthesiology, even with today’s technology.
Even today, people’s immune systems, genetic makeup, etc lead to very different medical responses to the same stimulus.
Science is usually empirical. (Exceptions: physics, some biology?)

52. Things students were interested in
Role of government during cholera
Society, policy and science (how they work together then and now)
History of public health efforts (failures and successes)
Investigation process for tracking down a disease
How the mindset/beliefs of the majority influences the implementation of services/investigation of hypotheses by experts.
Connection to modern public health crisis = integrative nature of the profession
“What other diseases have been wrongly tracked to the source, like the cholera and many assuming it was caused by smell?”

53. Things students were interested in
How social norms inhibited the discovery of the water borne theory
What beliefs could be inhibiting our discoveries?
Different medical perspectives that came together to help solve the issue.
“The book seems very story-like for nonfiction.”
Current outbreaks and how we can use Ghost Map to solve them.
Most important lessons from Ghost Map
How social stigmas impact how diseases are treated/perceived
Process of the development and proving an idea, like the water source for cholera.
How are the sewer and water systems organized in the U.S.?

54. If you are interested in shit…
Vlog brothers video on “What happens after you flush?’

55. Our Process for Developing a Conceptual Framework
Overview of:
Conceptual Framework
Structuring your own project
Hodgson presenting on Ghost Map.
Free-write thoughts on Ghost Map
Sub-team discussion of book: Identify topic to present on.
Free writing on topic / conceptual framework
Sub-team comes together to create conceptual framework.
Sub-team creates slides.

56. Free write thoughts on Ghost Map

57. Sub-team discussion of book: Identify topic to present on

58. Free write thoughts on sub-team topic

59. Individually brainstorm visual representation of ideas individually

60. Individually brainstorm visual representation of ideas individually

61. Sub-team comes together to: (a) Create conceptual framework and (b) Create presentation slides

62. Presentations

63. The End