Realist evaluation - promise, problems and practicalities

Realist evaluation is an innovative, multi-method approach to evaluating the effectiveness of complex health care interventions that is having an increasing impact on the research community. Drawing on their experience doing four realist evaluations in diverse areas of healthcare, the authors offer a comprehensive overview and critique of essential theory and practice. The first paper (Realist review and realist evaluation: an introduction) introduces the main components of the approach and shows how realist review can support realist evaluation. The second paper (Concepts and methodology for realist evaluation: help or hindrance?) provides further detail on the key concepts, shows how they can be operationalised, and discusses the advantages and difficulties of using these ideas. Following these two papers introducing and illustrating the major concepts, the third paper (Realist Evaluation: a critical realist critique) takes a step back to re-consider realist evaluation in relation to its critical realist roots, asking whether it leads to evaluators abandoning the attempt to understand (and if necessary challenge) the underlying values of health care interventions and contenting themselves merely with explicating the factors that help or hinder implementation. The fourth and final paper (Data analysis and theory development in realist evaluation) plunges back into the tangled undergrowth of multiple-method data collection and shows how disparate forms of data can be synthesised for theory development, and the results presented in a form that is useful to practitioners and policy-makers.

The Promise of Peace:Revisiting the Northern Irish Model

The Northern Ireland peace process is often eulogized as a successful model of conflict transformation. Although the process exhibited many of the problems that beset other societies seeking to move from conflict to a negotiated peace (including disagreements over the functioning of institutions and the meanings of cultural symbols, unresolved issues relating to the effects of political violence on victims and survivors and society at large; and the residual presence of violent and political ‘spoiler’ groups), the resilience of political dialogue has proven remarkable.
This collection revisits the promise of ‘a truly historic opportunity for a new beginning’ a decade and a half on from the signing of the Belfast/Good Friday Agreement in 1998. The book will bring together academics from across a number of disciplines, including management and organizational behaviour, law, politics, sociology, archaeology and literature.

The different contributions aim to assess what impact it has made in the legal, policy, and institutional areas it specifically targeted: political reform, human rights and equality provision, working through legacies of the past (including police reform, prisoner release and victims' rights) and the building of new relationships within the island of Ireland and between Ireland and Britain. With the emergence of first-time voters who had no direct experience of the violence the book explores what the Agreement offers for future generations.

The book is the culmination of a 12-month research project sponsored by the British Academy and Leverhulme that addressed the following aspects of the peace process:
Peace walls: The euphemistically named peace walls remain one of the most visible reminders of Northern Ireland’s divisions and they are famously the only material manifestations of the conflict that have grown in number and extent since the 1998 Agreement. They were originally placed between antagonistic neighbouring communities – often at their request – at times of heightened tensions. Research under this theme explored the lack of ongoing engagement with their continuing presences, evolving meanings and impact on the communities that reside beside them needs to be overtly addressed.
Cultural division: Cultural differences have often been seen as lying at the heart of the ‘Irish problem’. Despite this, art and artists have increasingly been seen as having the potential to develop new discourses. Research explored the following questions: What role can the arts play in re-imagining the spaces opened up by the promises of the 1998 Agreement? What implication does the confrontation with the legacies of conflict have for artistic practices? What impact do the arts have on constructions of identity, on narratives of history, and on electoral politics?
Institutional transformation: This strand of research explored the significance of the process of organizational change which followed the establishment of the 1998 on political and other public policy institutions such as the police and prison services. It suggested that the experience and lessons learned from such periods of transition have much to contribute to how Northern Ireland begins to address political polarization in other areas of public service infrastructure, chiefly around the sectarian monoliths of education and housing.
Working through the past: ‘Legacy’ issues have gained increasing prominence since 1998: issues to do with public symbolism (particularly relating to the flying of flags and parading), defining victimhood, securing victims’ rights, recovery of the ‘disappeared’, reintegrating ex- prisoners back into society, and the possibilities for truth recovery and reconciliation have all acquired salient and emotive force. Although the 1998 Agreement promised to ‘honour the dead’ through a ‘new beginning’, it is increasingly unclear as to whether an agreed narrative about the past is possible – or even worthwhile pursuing. Research under this theme looked at the complex relationship between memory, commemoration and violence; how commemorative events are performed, organized, policed and represented. It also addressed the fraught issue of how to come to terms with Northern Ireland’s divided and bloodied past.

The editors are in the process of guiding contributors to adapt their papers, which were presented to a series of workshops on the above themes, to the purposes of the book. In particular, the contributors will be guided to focus on the related aims of assessing the extent of change that has occurred and providing an assessment of what remains to be done. To that end, contributors are asked to engage directly with the questions that close the ‘Introduction’, namely: To what extent has the ‘promise’ of the 1998 Agreement been fulfilled? To what extent has the 1998 Agreement given rise to forms of exclusion? To what extent has the 1998 Agreement shaped new forms of debate, dispute and engagement? In the absence of that guidance having been sent out yet, the outlines below are, for the time being, the abstracts of their original papers.

Abortion and Nation: The Politics of Reproduction in Contemporary Ireland

Abortion politics are contentious and divisive in many parts of the world, but nowhere more so than in Ireland. Abortion and Nation examines the connection between abortion politics and hegemonic struggles over national identity and the nation-state in the Irish Republic. Situating the abortion question in the global context of human rights politics, as well as international social movements, Lisa Smyth analyses the formation and transformation of abortion politics in Ireland from the early 1980s to the present day. She considers whether or not the shifting connections between morality, rights and nationhood promise a new era of gender equality in the context of nation-state citizenship.
The book provides a new sociological framework through which the significance of conflict over abortion and reproductive freedom is connected to conflict over national identity. It also offers a distinctive in-depth consideration of the connection between gender and nationhood, particularly in terms of its impact on women's status as citizens; within the nation-state; within the European Union; and as members of a global civil society.

Examination of surface properties and in vitro biological performance of amorphous diamond-like carbon-coated polyurethane

Despite the emerging use of diamond-like carbon (DLC) as a coating for medical devices, few studies have examined the resistance of DLC coatings onto medical polymers to both microbial adherence and encrustation. In this study, amorphous DLC of a range of refractive indexes (1.7-1.9) and thicknesses (100-600 nm) was deposited onto polyurethane, a model polymer, and the resistance to microbial adherence (Escherichia coli; clinical isolate) and encrustation examined using in vitro models. In comparison to the native polymer, the advancing and receding contact angles of DLC-coated polyurethane were lower, indicating greater hydrophilic properties. No relationship was observed between refractive index, thickness, and advancing contact angle, as determined using multiple correlation analysis. The resistances of the various DLC-coated polyurethane films to encrustation and microbial adherence were significantly greater than that to polyurethane; however, there were individual differences between the resistances of the various DLC coatings. In general, increasing the refractive index of the coatings (100 nm thickness) decreased the resistance of the films to both hydroxyapatite and struvite encrustation and to microbial adherence. Films of lower thicknesses (100 and 200 nm; of defined refractive index, 1.8), exhibited the greatest resistance to encrustation and to microbial adherence. In conclusion, this study has uniquely illustrated both the microbial antiadherence properties and resistance to urinary encrustation of DLC-coated polyurethane. The resistances to encrustation and microbial adherence were substantial, and in light of this, it is suggested that DLC coatings of low thickness and refractive index show particular promise as coatings of polymeric medical devices. (c) 2006 Wiley Periodicals, Inc.

Effect of excitation wavelength on the Raman spectroscopy of the porcine photoreceptor layer from the area centralis.

Raman microscopy, based upon the inelastic scattering (Raman) of light by molecular species, has been applied as a specific structural probe in a wide range of biomedical samples. The purpose of the present investigation was to assess the potential of the technique for spectral characterization of the porcine outer retina derived from the area centralis, which contains the highest proportion of cone:rod cell ratio in the pig retina. METHODS: Retinal cross-sections, immersion-fixed in 4% (w/v) PFA and cryoprotected, were placed on salinized slides and air-dried prior to direct Raman microscopic analysis at three excitation wavelengths, 785 nm, 633 nm, and 514 nm. RESULTS: Raman spectra of each of the photoreceptor inner and outer segments (PIS, POS) and of the outer nuclear layer (ONL) of the retina acquired at 785 nm were dominated by vibrational features characteristic of proteins and lipids. There was a clear difference between the inner and outer domains in the spectroscopic regions, amide I and III, known to be sensitive to protein conformation. The spectra recorded with 633 nm excitation mirrored those observed at 785 nm excitation for the amide I region, but with an additional pattern of bands in the spectra of the PIS region, attributed to cytochrome c. The same features were even more enhanced in spectra recorded with 514 nm excitation. A significant nucleotide contribution was observed in the spectra recorded for the ONL at all three excitation wavelengths. A Raman map was constructed of the major spectral components found in the retinal outer segments, as predicted by principal component analysis of the data acquired using 633 nm excitation. Comparison of the Raman map with its histological counterpart revealed a strong correlation between the two images. CONCLUSIONS: It has been demonstrated that Raman spectroscopy offers a unique insight into the biochemical composition of the light-sensing cells of the retina following the application of standard histological protocols. The present study points to the considerable promise of Raman microscopy as a component-specific probe of retinal tissue.

The SuperWASP wide-field exoplanetary transit survey: candidates from fields 23 h <RA <03 h

Photometric transit surveys promise to complement the currently known sample of extra-solar planets (ESPs) by providing additional information on the planets and especially their radii. Here, we present ESP candidates from one such survey called, the Wide Angle Search for Planets (WASP) obtained with the SuperWASP wide-field imaging system. Observations were taken with SuperWASP North located in La Palma during the 2004 April to October observing season. The data cover fields between 23 and 03 h in RA at declinations above +12. This amounts to over ~400000 stars with V magnitudes 8-13.5. For the stars brighter than 12.5, we achieve better than 1 per cent photometric precision. Here, we present 41 sources with low-amplitude variability between ~1 and 10 mmag, from which we select 12 with periods between 1.2 and 4.4 d as the most promising ESP candidates. We discuss the properties of these ESP candidates, the expected fraction of transits recovered for our sample and implications for the frequency and detection of hot-Jupiters.

Synthesis of Peptidyl Ene Diones: Selective Inactivators of the Cysteine Proteinases

A series of synthetic peptides in which the C-terminal carboxyl grouping (-CO2H) of each has been chemically converted into a variety of ene dione derivatives (-CO-CH CH-CO-X; X -H, -Me, -OBut, - OEt, -OMe, -CO-OMe), have been prepared and tested as inactivators against typical members of the serine and cysteine protease families. For example, the sequences Cbz-Pro-Phe-CH CH-CO-OEt (I) which fulfils the known primary and secondary specificity requirements of the serine protease chymotrypsin, and Cbz-Phe-Ala-CH CH-CO-OEt (II) which represents a general recognition sequence for cysteine proteases such as cathepsins B, L and S, have been tested as putative irreversible inactivators of their respective target proteases. It was found that, whereas II, for example, functioned as a time-dependent, irreversible inactivator of each of the cysteine proteases, I behaved only as a modest competitive reversible inhibitor of chymotrypsin. Within the simple ester sequences Cbz- Phe-Ala-CH CH-CO-R, the rank order of inhibitor effectiveness decreases in the order R -OMe > - OEt >> -OBut. It was also found that the presence of both an unsaturated double bond and an ester (or a-keto ester) moiety were indispensable for obtaining irreversible inactivators. Of the irreversible inactivators synthesized, Cbz-Phe-Ala-CH CHCO- CO-OEt (which contains a highly electrophilic a-keto ester grouping) was found to be the most effective exhibiting, for example, second-order rate constants of approximately 1.7 106/M/min and approximately 4.9 104/M/min against recombinant human cathepsin S and human spleenic cathepsin B, respectively. This initial study thus holds out the promise that this class of inactivator may well be specific for the cysteine protease subclass.

Robust Speaker Recognition in Noisy Conditions

This paper investigates the problem of speaker identi-fication and verification in noisy conditions, assuming that speechsignals are corrupted by environmental noise, but knowledgeabout the noise characteristics is not available. This research ismotivated in part by the potential application of speaker recog-nition technologies on handheld devices or the Internet. Whilethe technologies promise an additional biometric layer of securityto protect the user, the practical implementation of such systemsfaces many challenges. One of these is environmental noise. Due tothe mobile nature of such systems, the noise sources can be highlytime-varying and potentially unknown. This raises the require-ment for noise robustness in the absence of information about thenoise. This paper describes a method that combines multicondi-tion model training and missing-feature theory to model noisewith unknown temporal-spectral characteristics. Multiconditiontraining is conducted using simulated noisy data with limitednoise variation, providing a “coarse” compensation for the noise,and missing-feature theory is applied to refine the compensationby ignoring noise variation outside the given training conditions,thereby reducing the training and testing mismatch. This paperis focused on several issues relating to the implementation of thenew model for real-world applications. These include the gener-ation of multicondition training data to model noisy speech, thecombination of different training data to optimize the recognitionperformance, and the reduction of the model’s complexity. Thenew algorithm was tested using two databases with simulated andrealistic noisy speech data. The first database is a redevelopmentof the TIMIT database by rerecording the data in the presence ofvarious noise types, used to test the model for speaker identifica-tion with a focus on the varieties of noise. The second database isa handheld-device database collected in realistic noisy conditions,used to further validate the model for real-world speaker verifica-tion. The new model is compared to baseline systems and is foundto achieve lower error rates.

Validity, trustworthiness and rigour:reasserting realism in qualitative research

Aim The aim of this paper is to challenge recent sceptical approaches to the possibility of validating qualitative research and to underline the benefits of adopting a realist approach to validity. Background In recent discussion about the methodological bases for qualitative research it has been argued that, because different methodologies take different approaches to validity, attempts to develop a common set of validation criteria are futile. On the basis of this sceptical view, a number of strategies for judging qualitative research have been proposed. These include suggestions that: it should be judged according to aesthetic or rhetorical criteria, rather than epistemological validity; responsibility for appraisal should move from researchers to readers; each methodology should be assessed individually according to its own merits. Discussion None of these suggestions provide a viable alternative to validity, defined as the extent to which research reflects accurately that to which it refers. Because the form of research does not determine its content, replacement of epistemology by aesthetics is unsustainable. Because research reports mediate between writer and reader, a one-sided approach to this relationship constitutes a false dichotomy. If we accept the criterion of practitioner confidence as a means of judging methodological approaches, this involves rejection of judgement according to a methodology�s own merits. Conclusion If qualitative research is actually about something, and if it is required to provide beneficial information, then a realist approach to validity holds out greatest promise.

Evaluation of predicted network modules in yeast metabolism using NMR-based metabolite profiling

Genome-scale metabolic models promise important insights into cell function. However, the definition of pathways and functional network modules within these models, and in the biochemical literature in general, is often based on intuitive reasoning. Although mathematical methods have been proposed to identify modules, which are defined as groups of reactions with correlated fluxes, there is a need for experimental verification. We show here that multivariate statistical analysis of the NMR-derived intra- and extracellular metabolite profiles of single-gene deletion mutants in specific metabolic pathways in the yeast Saccharomyces cerevisiae identified outliers whose profiles were markedly different from those of the other mutants in their respective pathways. Application of flux coupling analysis to a metabolic model of this yeast showed that the deleted gene in an outlying mutant encoded an enzyme that was not part of the same functional network module as the other enzymes in the pathway. We suggest that metabolomic methods such as this, which do not require any knowledge of how a gene deletion might perturb the metabolic network, provide an empirical method for validating and ultimately refining the predicted network structure.

3D Simulations of Surface Harmonic Generation with few-cycle laser pulses

The mechanism of harmonic generation in the interaction of short laser pulses with solid targets holds the promise for the production of intense attosecond pulses. Using the three dimensional code ILLUMINATION we have performed simulations pertaining to an experimentally realizable parameter range by high power laser systems to become available in the near future. The emphasis of the investigation is on the coherent nature of the emission. We studied the influence of the plasma scale length on the harmonic efficiency, angular distribution and the focusability using a post processing scheme in which the far-field of the emission is calculated. It is found that the presence of an extended density profile reduces significantly the transverse coherence length of the emitted XUV light. The different stages of the interaction for two particular cases can be followed with the help of movies.

Proteasome inhibitors: a therapeutic strategy for haematological malignancy

The proteasome is a multicatalytic enzyme complex responsible for the regulated degradation of intracellular proteins. In recent years, inhibition of proteasome function has emerged as a novel anti-cancer therapy. Proteasome inhibition is now established as an effective treatment for relapsed and refractory multiple myeloma and offers great promise for the treatment of other haematological malignancies, when used in combination with conventional therapeutic agents. Bortezomib is the first proteasome inhibitor to be used clinically and a second generation of proteasome inhibitors with differential pharmacological properties are currently in early clinical trials. This review summarises the development of proteasome inhibitors as therapeutic agents and describes how novel assays for measuring proteasome activity and inhibition may help to further delineate the mechanisms of action of different proteasome inhibitors. This will allow for the optimized use of proteasome inhibitors in combination therapies and provide the opportunity to design more potent and therapeutically efficacious proteasome inhibitors.

Cyanopolyynes in hot cores: modelling G305.2+0.2

We present results from a time-dependent gas-phase chemical model of a hot core based on the physical conditions of G305.2+0.2. While the cyanopolyyne HC3N has been observed in hot cores, the longer chained species, HC5N, HC7N and HC9N, have not been considered as the typical hot-core species. We present results which show that these species can be formed under hot core conditions. We discuss the important chemical reactions in this process and, in particular, show that their abundances are linked to the parent species acetylene which is evaporated from icy grain mantles. The cyanopolyynes show promise as ‘chemical clocks’ which may aid future observations in determining the age of hot core sources. The abundance of the larger cyanopolyynes increases and decreases over relatively short time-scales, ~10^2.5 yr. We present results from a non-local thermodynamic equilibrium statistical equilibrium excitation model as a series of density, temperature and column density dependent contour plots which show both the line intensities and several line ratios. These aid in the interpretation of spectral-line data, even when there is limited line information available. In particular, non-detections of HC5N and HC7N in Walsh et al. are analysed and discussed.