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]

Economic cost of age-related macular degeneration: a review of recent research

As the population of most developed countries ages so the prevalence of diseases such as age-related macular degeneration (AMD) are likely to increase. To facilitate planning and informed debate regarding making provisions for this disease it is important that we have a clear understanding of the economic impact of visual impairment associated with AMD. In this paper we assess the state of current knowledge based on a review of published evidence in scientific journals. Based on our assessment of the evidence we argue that the paucity of research studies on the subject and wide variation in estimates produced from the few studies available make it difficult to assess with confidence the likely average direct cost-of-illness associated with AMD. We further argue that significant gaps in our understanding of the costs of AMD (particularly in respect of indirect costs) also exist. Current research should be augmented by more comprehensive studies.

Emission lines of Fe X in active region spectra obtained with the Solar Extreme-ultraviolet Research Telescope and Spectrograph

Fully relativistic calculations of radiative rates and electron impact excitation cross-sections for Fe X are used to derive theoretical emission-line ratios involving transitions in the 174-366 angstrom wavelength range. A comparison of these with solar active region observations obtained during the 1989 and 1995 flights of the Solar Extreme-ultraviolet Research Telescope and Spectrograph (SERTS) reveals generally very good agreement between theory and experiment. Several Fe X emission features are detected for the first time in SERTS spectra, while the 3s(2)3p(5) P-2(3/2)-3s(2)3p(4)(S-1)3d D-2(3/2) transition at 195.32 angstrom is identified for the first time (to our knowledge) in an astronomical source. The most useful Fe X electron density (N-e) diagnostic line ratios are assessed to be 175.27/174.53 and 175.27/177.24, which both involve lines close in wavelength and free from blends, vary by factors of 13 between N-e = 10(8) and 10(11) cm(-3), and yet show little temperature sensitivity. Should these lines not be available, then the 257.25/345.74 ratio may be employed to determine N-e, although this requires an accurate evaluation of the instrument intensity calibration over a relatively large wavelength range. However, if the weak 324.73 angstrom line of Fe X is reliably detected, the use of 324.73/345.74 or 257.25/324.73 is recommended over 257.25/345.74. Electron densities deduced from 175.27/174.53 and 175.27/177.24 for the stars Procyon and alpha Cen, using observations from the Extreme-Ultraviolet Explorer (EUVE) satellite, are found to be consistent and in agreement with the values of N-e determined from other diagnostic ratios in the EUVE spectra. A comparison of several theoretical extreme-ultraviolet Fe X line ratios with experimental values for a theta-pinch, for which the plasma parameters have been independently determined, reveals reasonable agreement between theory and observation, providing some independent support for the accuracy of the adopted atomic data.

Discourses and Strategic Visions: The U.S. Research University as an Institutional Manifestation of Neoliberalism in a Global Era

It is argued widely that the academy today is in the process of significant change—in the institutional assumptions of what constitutes the university and the construction of knowledge and in its relations with the city and the world. This article addresses the evolution of the modern university in the context of the discourses of contemporary globalizing institutions. Further, it empirically assesses the organizational priorities of U.S. research universities in light of the application of these discourses to their objectives and practices, finding that they are playing a key role in the formal representation of the institutional direction, goals, and values of American higher education.

Researcher and Employee: Reflections on Reflective Practice in Rural Development Research

This article describes an ethnographic study that was used to critically assess the links between rural development policy and practice. It does so from the novel perspective of the researcher as an employee in the organisation where the ethnography study was conducted. The article argues that this distinctive position gives rise to specific methodological issues. Particular attention is paid in the analysis to marginalised issues in reflexive practice literature, namely, the structural context. In so doing this research places at centre stage the importance of reflexivity in the field of rural sociology, an area in which to date it has had limited acceptance.