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]

The contribution of visual feedback to visuomotor adaptation: How much and when?

We investigated the role of visual feedback in adapting to novel visuomotor environments. Participants produced isometric elbow torques to move a cursor towards visual targets. Following trials with no rotation, participants adapted to a 60 degrees rotation of the visual feedback before returning to the non-rotated condition. Participants received continuous visual feedback (CF) of cursor position during task execution or post-trial visual feedback (PF). With training, reductions of the angular deviations of the cursor path occurred to a similar extent and at a similar rate for CF and PF groups. However, upon re-exposure to the non-rotated environment only CF participants exhibited post-training aftereffects, manifested as increased angular deviation of the cursor path, with respect to the pre-rotation trials. These aftereffects occurred despite colour cues permitting identification of the change in environment. The results show that concurrent feedback permits automatic recalibration of the visuomotor mapping while post-trial feedback permits performance improvement via a cognitive strategy. (C) 2008 Elsevier B.V. All rights reserved.

Presbyterians and science in the north of Ireland before 1874

In his presidential address to the Belfast meeting of the British Association for the Advancement of Science in 1874, John Tyndall launched what David Livingstone has called a ‘frontal assault on teleology and Christian theism’. Using Tyndall's intervention as a starting point, this paper seeks to understand the attitudes of Presbyterians in the north of Ireland to science in the first three-quarters of the nineteenth century. The first section outlines some background, including the attitude of Presbyterians to science in the eighteenth century, the development of educational facilities in Ireland for the training of Presbyterian ministers, and the specific cultural and political circumstances in Ireland that influenced Presbyterian responses to science more generally. The next two sections examine two specific applications by Irish Presbyterians of the term ‘science’: first, the emergence of a distinctive Presbyterian theology of nature and the application of inductive scientific methodology to the study of theology, and second, the Presbyterian conviction that mind had ascendancy over matter which underpinned their commitment to the development of a science of the mind. The final two sections examine, in turn, the relationship between science and an eschatological reading of the signs of the times, and attitudes to Darwinian evolution in the fifteen years between the publication of The Origin of Species in 1859 and Tyndall's speech in 1874.

Identifying strategies to maximise recruitment and retention of practices and patients in a multicentre randomised controlled trial of an intervention to optimise secondary prevention for coronary heart disease in primary care.

Background Recruitment and retention of patients and healthcare providers in randomised controlled trials (RCTs) is important in order to determine the effectiveness of interventions. However, failure to achieve recruitment targets is common and reasons why a particular recruitment strategy works for one study and not another remain unclear. We sought to describe a strategy used in a multicentre RCT in primary care, to report researchers’ and participants’ experiences of its implementation and to inform future strategies to maximise recruitment and retention. Methods In total 48 general practices and 903 patients were recruited from three different areas of Ireland to a RCT of an intervention designed to optimise secondary prevention of coronary heart disease. The recruitment process involved telephoning practices, posting information, visiting practices, identifying potential participants, posting invitations and obtaining consent. Retention involved patients attending reviews and responding to questionnaires and practices facilitating data collection. Results We achieved high retention rates for practices (100%) and for patients (85%) over an 18-month intervention period. Pilot work, knowledge of the setting, awareness of change in staff and organisation amongst participant sites, rapid responses to queries and acknowledgement of practitioners’ contributions were identified as being important. Minor variations in protocol and research support helped to meet varied, complex and changing individual needs of practitioners and patients and encouraged retention in the trial. A collaborative relationship between researcher and practice staff which required time to develop was perceived as vital for both recruitment and retention. Conclusions Recruiting and retaining the numbers of practices and patients estimated as required to provide findings with adequate power contributes to increased confidence in the validity and generalisability of RCT results. A continuous dynamic process of monitoring progress within trials and tailoring strategies to particular circumstances, whilst not compromising trial protocols, should allow maximal recruitment and retention.

Placing political economy: organising opposition to free trade before the abolition of the Corn Laws

The unfurling of global capitalism – and its attendant effects – has long been fertile intellectual terrain for geographers. But whilst studies of the processes and mechanisms of globalisation undoubtedly assume a talismanic importance in the discipline, geographers, with few exceptions, have left examinations of early economic liberalism to historians. One such critically important episode in the evolution of the liberal economic project was the repeal of the so-called 'Corn Laws' in 1846. Whilst the precise impact of the Manchester-based Anti-Corn Law League (ACLL) continues to be a matter of conjecture, Eric Sheppard has asserted that their particular take on political economy managed to assume a 'truth-like status' and worldwide universality. But the ACLL's campaign represents only one, albeit decisive, stage in the long intellectual and practical struggle between 'protectionists' and the disciples of free trade. Studies of the non-'Manchester' components have tended to focus squarely upon national politics. This paper examines a pivotal attempt in 1838 by Lord Melbourne's Government to experiment with the effective elimination of import duties on fresh fruit. Unlike most agricultural commodities, table fruit was produced in a tightly defined area, thus allowing the Government's experiment to play out, in theory, without national political fallout. Whilst the Government's clandestine actions left little time for a concerted opposition to develop, Kentish fruit growers soon organised. A formidable lobby was forged that drew wide local support yet also evolved beyond the original 'epistemic community'. Whilst the coalition failed in their efforts to reintroduce protective duties, their actions allow us to see how protectionist ideologies and policies were vivified through practices at many different spatial scales and to better understand the complex spatiality of protectionist takes on political economy. Their campaign also changed – at least in the short term – the course of British mercantile policy.