A randomized controlled trial of tea tree oil (5%) body wash versus standard body wash to prevent colonization with methicillin-resistant Staphylococcus aureus (MRSA) in critically ill adults: research protocol

Background
Over the past ten years MRSA has become endemic in hospitals and is associated with increased healthcare costs. Critically ill patients are most at risk, in part because of the number of invasive therapies that they require in the intensive care unit (ICU). Washing with 5% tea tree oil (TTO) has been shown to be effective in removing MRSA on the skin. However, to date, no trials have evaluated the potential of TTO body wash to prevent MRSA colonization or infection. In addition, detecting MRSA by usual culture methods is slow. A faster method using a PCR assay has been developed in the laboratory, but requires evaluation in a large number of patients.

Methods/Design
This study protocol describes the design of a multicentre, phase II/III prospective open-label randomized controlled clinical trial to evaluate whether a concentration of 5% TTO is effective in preventing MRSA colonization in comparison with a standard body wash (Johnsons Baby Softwash) in the ICU. In addition we will evaluate the cost-effectiveness of TTO body wash and assess the effectiveness of the PCR assay in detecting MRSA in critically ill patients. On admission to intensive care, swabs from the nose and groin will be taken to screen for MRSA as per current practice. Patients will be randomly assigned to be washed with the standard body wash or TTO body wash. On discharge from the unit, swabs will be taken again to identify whether there is a difference in MRSA colonization between the two groups.

Discussion
If TTO body wash is found to be effective, widespread implementation of such a simple colonization prevention tool has the potential to impact on patient outcomes, healthcare resource use and patient confidence both nationally and internationally.

Trial Registration
[ISRCTN65190967]

Spontaneous transitions in the coordination of a whole body task

This paper describes an example of spontaneous transitions between qualitatively different coordination patterns during a cyclic lifting and lowering task. Eleven participants performed 12 trials of repetitive lifting and lowering in a ramp protocol in which the height of the lower shelf was raised or lowered I cm per cycle between 10 and 50 cm. Two distinct patterns of coordination were evident: a squat technique in which moderate range of hip, knee and ankle movement was utilised and ankle plantar-flexion occurred simultaneously with knee and hip extension; and a stoop technique in which the range of knee movement was reduced and knee and hip extension was accompanied by simultaneous ankle dorsi-flexion. Abrupt transitions from stoop to squat techniques were observed during descending trials, and from squat to stoop during ascending trials. Indications of hysteresis was observed in that transitions were more frequently observed during descending trials, and the average shelf height at the transition was 5 cm higher during ascending trials. The transitions may be a consequence of a trade-off between the biomechanical advantages of each technique and the influence of the lift height on this trade-off. (C) 2001 Elsevier Science B.V. All rights reserved.

Integrating Ballymun? Flawed progress in Ireland's largest estate regeneration scheme

Urban regeneration in the Republic of Ireland takes place in the context of the rapid, ‘Celtic Tiger’ economic growth of the 1990s. The boom transformed Irish society and led to greater affluence for many people, along with continuing and arguably worsening inequality for those excluded from its opportunities. In particular, Ireland’s small social rented sector has become the focus of the country’s most concentrated poverty and social exclusion. The Ballymun regeneration programme in North Dublin aims to facilitate physical, social and economic change in order to integrate the area more closely with the
more affluent surrounding suburbs. This article reviews the issues involved in restructuring such a large area of social exclusion within a rapidly changing European capital city, using a framework that disaggregates the concept of integration into three elements: market, citizenship and reciprocity. With just over half the physical refurbishment complete, progress has been made but some fundamental issues remain. The article concludes that although substantial advancement has been made with physical regeneration, progress with wider economic and social integration has been uneven and in some cases flawed.

Deactivation and regeneration of ruthenium on silica in the liquid-phase hydrogenation of butan-2-one

A Ru/SiO2 catalyst was investigated for the liquid-phase hydrogenation of butan-2-one to butan-2-ol with water as a medium. Although excellent reactivity was observed, a gradual deactivation of the catalyst was found on recycle of the catalyst. The spent catalyst was characterized by using XRD, XPS, TEM, TPR, CO chemisorption, FTIR and ICP analyses. Formation of Ru(OH)(x) surface species is proposed to be the main cause of catalyst deactivation with no significant Ru leaching into the reaction mixture. Following catalyst regeneration, up to 85% of the initial catalytic activity could be recovered successfully. Moreover, adsorption of secondary aliphatic alcohols on the catalyst was found to significantly reduce the formation of Ru(OH)(x) during the reaction, thus protecting the catalyst from deactivation.

Community Regeneration: An Elite or a ‘Real’ Community Space?

Identifying community interests in the processes of planning and regeneration is less than straightforward. By their very nature programmes encourage the development of particular projects, typically relying on experience from past initiatives to inform current practice. One of the difficulties for partners is juggling the need to comply with administrative demands while engaging in a meaningful way with their community. This article uses empirical evidence to examine power relations within structures of governance. It argues that current processes are unable to identify real community interests and consequently create space that favour elite interests, all of which restrain the impact of governance.

Measurements, modeling and simulation of the off-body radio channel for the implementation of bodyworn antenna diversity at 868 MHz

This paper presents a systematic measurement campaign of diversity reception techniques for use in multiple-antenna wearable systems operating at 868 MHz. The experiments were performed using six time-synchronized bodyworn receivers and considered mobile off-body communications in an anechoic chamber, open office area and a hallway. The cross-correlation coefficient between the signal fading measured by bodyworn receivers was dependent upon the local environment and typically below 0.7. All received signal envelopes were combined in post-processing to study the potential benefits of implementing receiver diversity based upon selection combination, equal-gain and maximal-ratio combining. It is shown that, in an open office area, the 5.7 dB diversity gain obtained using a dual-branch bodyworn maximal-ratio diversity system may be further improved to 11.1 dB if a six-branch system was used. First-and second-order theoretical equations for diversity reception techniques operating in Nakagami fading conditions were used to model the postdetection combined envelopes. Maximum likelihood estimates of the Nakagami-parameter suggest that the fading conditions encountered in this study were generally less severe than Rayleigh. The paper also describes an algorithm that may be used to simulate the measured output of an M-branch diversity combiner operating in independent and identically-distributed Nakagami fading environments.