The postmodernist war on evidence-based practice

In this paper, we examine the war of words between those who contend that health care practice, including nursing, should primarily be informed by research (the evidence-based practice movement), and those who argue that there should be no restrictions on the sources of knowledge used by practitioners (the postmodernists). We review the postmodernist interventions of Dave Holmes and his colleagues, observing that the postmodernist style to which they adhere, which includes the use of continental philosophy, metaphors, and acerbic delivery, tends to obscure their substantive arguments. The heated nature of some responses to them has tended to have the same effect. However, the substantive arguments are important. Five main postmodernist charges are identified and discussed. The first argument, that the notion of ‘best evidence’ implies a hierarchical and exclusivist approach to knowledge, is persuasive. However, the contention that this hierarchy is maintained by the combined pressures of capitalism and vested interests within academia and the health services, is less well founded. Nevertheless, postmodernist contentions that the hierarchy embraced by the evidence-based practice movement damages health care because it excludes other forms of evidence that are needed to understand the complexity of care, it marginalizes important aspects of clinical knowledge, and it fails to take account of individuals or their experience, are all seen to be of some merit. However, we do not share the postmodernist conclusion that this adds up to a fascist order. Instead, we characterize evidence-based practice as a necessary but not sufficient component of health care knowledge.

SuperWASP observations of the 2007 outburst of Comet 17P/Holmes

We present wide-field imaging of the 2007 outburst of Comet 17P/Holmes obtained serendipitously by SuperWASP-North on 17 nights over a 42-night period beginning on the night (2007 October 22-23) immediately prior to the outburst. Photometry of 17P's unresolved coma in SuperWASP data taken on the first night of the outburst is consistent with exponential brightening, suggesting that the rapid increase in the scattering cross-section of the coma could be largely due to the progressive fragmentation of ejected material produced on a very short time-scale at the time of the initial outburst, with fragmentation time-scales decreasing from tfrag ~ 2 × 103 to ~1 × 103 s over our observing period. Analysis of the expansion of 17P's coma reveals a velocity gradient suggesting that the outer coma was dominated by material ejected in an instantaneous, explosive manner. We find an expansion velocity at the edge of the dust coma of vexp = 0.55 +/- 0.02 kms -1 and a likely outburst date of t0 = 2007 October 23.3 +/- 0.3, consistent with our finding that the comet remained below SuperWASP's detection limit of mV ~ 15mag until at least 2007 October 23.3. Modelling of 17P's gas coma indicates that its outer edge, which was observed to extend past the outer dust coma, is best explained with a single pulse of gas production, consistent with our conclusions concerning the production of the outer dust coma.