On the Problems of Mixing RCTs with Qualitative Research: The Case of the MRC Framework for the Evaluation of Complex Healthcare Interventions

In the perceived hierarchy of research designs, the results from randomized controlled trials are considered to provide the highest level of evidence. Indeed these trials have been upheld as the gold standard in research. The benefits and limitations of the randomized controlled trial as a method of evaluating the effectiveness of healthcare interventions are presented. The article then examines the different levels of complexity within healthcare interventions and the problems this poses in determining effectiveness. In an effort to provide a solution to this problem, the Medical Research Council produced a framework to assist investigators to develop and evaluate complex healthcare interventions. The framework is described with reference to an example of implementing and evaluating protocols for weaning patients in the intensive care unit. The framework is critiqued on the basis that it involves an ambiguous or contradictory ontology, which fails to articulate the relationship between the positivism of randomized controlled trials with the relativism of qualitative approaches. It is concluded that the use of realist strategies in combination with randomized controlled trials provides the most coherent solution to this quandary

Thermal conditions in nests of loggerhead turtles: further evidence suggesting female skewed sex ratios of hatchling production in the Mediterranean

Temperature was recorded in 23 nests of the loggerhead turtle (Caretta caretta) and control sites of nest depth at Alagadi (35 degrees 33'N, 33 degrees 47'E), Northern Cyprus, eastern Mediterranean. Control site sand temperature was found to be highly correlated with mean daily air temperature and mean nest temperature. Mean temperature in nests ranged from 29.5 degreesC to 33.2 degreesC, with mean temperature in the middle third of incubation ranging from 29.3 degreesC to 33.7 degreesC. Hatching success was significantly correlated with incubation temperature, with nests experiencing very high temperatures exhibiting low hatching success. All nests demonstrated regular diel variation in temperature with mean daily fluctuations ranging from 0.3 degreesC to 1.4 degreesC. Increase in temperature above that of the prevailing sand temperature attributed to metabolic heating was clearly demonstrated in 14 of 15 clutches, with the mean level of metabolic heating of all nests being 0.4 degreesC. However, the level of metabolic heating varied markedly throughout the incubation period with levels being significantly higher in the final third of incubation. Incubation duration was found to be significantly correlated to both the mean temperature of nests throughout the incubation period and during the middle third of incubation. The relationship between incubation duration and mean incubation temperature was used to estimate mean incubation temperatures at most major nesting sites throughout the Mediterranean from available data on incubation durations, showing that mean incubation temperature is likely to be above 29.0 degreesC at most sites in most seasons. (C) 2001 Elsevier Science B.V. All rights reserved.

Perturbations to trophic interactions and the stability of complex food webs

The pattern of predator-prey interactions is thought to be a key determinant of ecosystem processes and stability. Complex ecological networks are characterized by distributions of interaction strengths that are highly skewed, with many weak and few strong interactors present. Theory suggests that this pattern promotes stability as weak interactors dampen the destabilizing potential of strong interactors. Here, we present an experimental test of this hypothesis and provide empirical evidence that the loss of weak interactors can destabilize communities in nature. We ranked 10 marine consumer species by the strength of their trophic interactions. We removed the strongest and weakest of these interactors from experimental food webs containing >100 species. Extinction of strong interactors produced a dramatic trophic cascade and reduced the temporal stability of key ecosystem process rates, community diversity and resistance to changes in community composition. Loss of weak interactors also proved damaging for our experimental ecosystems, leading to reductions in the temporal and spatial stability of ecosystem process rates, community diversity, and resistance. These results highlight the importance of conserving species to maintain the stabilizing pattern of trophic interactions in nature, even if they are perceived to have weak effects in the system.

Trauma typology as a risk factor for aggression and self-harm in a complex PTSD population: The mediating role of alterations in self-perception

This study examined the role of prolonged, repeated traumatic experiences such as childhood and sectarian trauma in the development of posttraumatic aggression and self-harm. Forty-four adult participants attending therapy for complex trauma in Northern Ireland were obtained via convenience sampling. When social desirability was controlled, childhood emotional and physical neglect were significant correlates of posttraumatic hostility and history of self-harm. These relationships were mediated by alterations in self-perception (e.g., shame, guilt). Severity of sectarian-related experiences was not related to self-destructive behaviors. Moreover, none of the trauma factors were related to overt aggressive behavior. The findings have implications for understanding risk factors for posttraumatic aggression and self-harm, as well as their treatment. © 2013 Copyright Taylor & Francis Group, LLC.

THE CHEMISTRY OF COMPLEX-MOLECULES IN INTERSTELLAR CLOUDS

This paper is concerned with the chemical evolution of large molecules in interstellar clouds. We consider the chemistry and ionisation balance of large polycyclic aromatic hydrocarbon (PAH) type molecules in diffuse clouds and show that certain PAH molecules can be doubly ionised by the interstellar ultraviolet radiation field. If recombination of the dications so produced with electrons is dissociative rather than radiative, then PAHs are rapidly destroyed. PAHs which can only be singly ionised have much smaller recombination energies and can be long lasting in these regions. This type of property may be very important in selecting the PAH species which can populate the general interstellar medium and account for certain of the diffuse bands observed in optical spectra. Destruction of PAH molecules via formation of dications may be responsible for the weakening of the diffuse bands observed in regions of high UV flux.