Improved serodetection of Mycobacterium bovis infection in badgers (Meles meles) using multiantigen test formats

Despite attempts to control bovine tuberculosis, the incidence of disease in Great Britain continues to rise. In GB, the European badger (Meles meles) is a reservoir of infection with Mycobacterium bovis. In an effort to improve the serodetection of badger tuberculosis, we examined sera from M. bovis culture-positive and culture-negative badgers for their ability to recognize M. bovis antigens, using a multi-antigen print immunoassay (MAPIA). Depending on the antigens used in the MAPIA, the assay had a sensitivity of 49-59% and a specificity of 84-88% Results from the MAPIA were used to select antigens for the development of a lateral-flow immunoassay. This so-called 'Rapid Test' used 5microl of serum and gave unambiguous results within 10 min. When applied to 178 badger sera, the Rapid Test had a sensitivity of 53% and a specificity of 95%. This represented an improvement over the performance of the existing ELISA Test, which had a sensitivity of 47% and a specificity of 89% on the same sera. This is the first report of a diagnostic test for badger tuberculosis that can be performed alongside the captive animal.     

Implicit location encoding via stored representations of familiar objects: neuropsychological evidence

We report data on the visual localisation ability of a patient with Balint's syndrome, GK. We show that, with relatively long exposures of displays, GK is better able to judge the spatial relations between separate objects (a "between-object judgement") than the spatial relations between a part and a whole object (a "within-object judgement") (Experiments 1-3). This dissociation occurred even when the same stimulus was used for both judgements, and the task instructions biased GK to parse the stimulus as either a single or as two separate objects (Experiments 2 and 6). However, when he could use a stored representation to make a within-object judgement, then performance was better than on a comparable spatial judgement of the relations between two separate objects (Experiments 4-7). The data demonstrate that stored representations of objects can support the spatial coding of parts to perceptual wholes. In the absence of stored representations, part-whole relations must be explicitly coded by attention, a process that is impaired in this patient.     

Stigma revisited,disclosure of emotional problems in primary care consultations in Wales

The nature and effects of stigma have been widely discussed in the context of mental illness, and references to stigma are commonly used to explain a wide array of social processes. For example, it is often claimed that stigmatisation affects aspects of personal identity, that it underpins unjust and discriminatory behaviour, and that it is responsible for a reluctance among members of the lay public to disclose the presence of treatable psychiatric symptoms and problems to health professionals. A widespread reluctance to disclose symptoms of 'emotional problems' to health professionals is in fact well documented. Yet the reasons for such patterns of behaviour are far from clear. However, in this paper, on the basis of qualitative data collected from primary care attendees in Wales (N=127), the authors suggest that appeals to stigma are inadequate to explain the phenomenon. More likely, it seems, is that members of the lay public have markedly different images from health professionals of what constitutes a mild to moderate psychiatric problem. Consequently, it is argued that the phenomenon of non-disclosure could be viewed more accurately as a problem of alternative taxonomic systems than of fear of stigma. The implications of the argument for health practice and theory are outlined.     

Shared decision-making in cardiology: Do patients want it and do doctors provide it?

Objective

Doctors should involve their patients in making decisions about their care. We studied patients with heart disease to assess if shared decision-making occurs and to study factors that predict patients’ choices or influence cardiologists’ behaviour.

Methods

85 patients attending for arteriography were assessed to elicit preferred involvement in decision-making, perception of involvement, and confidence in the decision.

Results

40% of patients wished to be involved in decisions. Preferences were unrelated to demographic factors. Cardiologists involved patients more in decisions concerning severe disease (p = 0.056). Involvement varied between cardiologists (p = 0.001). The mean duration of consultations was 5.5 min. Patients’ confidence in decisions correlated with duration (p = 0.001), explicit reference to a decision that needed to be made (p = 0.0026), and perceived, but not observed, involvement in decision-making (p = 0.05).

Conclusion

This study highlighted the complexity of doctor–patient communication. Irrespective of preferences for involvement, patients were more confident in decisions in which they perceived more involvement or which were the products of longer consultations.

Practice implications

Patients’ confidence in clinical decisions can be increased by increasing consultation length and increasing their perception of involvement. Patients perceive more involvement in decisions when doctors specifically identify the need for treatment decisions early in the consultation.     

The Rapid Recovery Progression Measure: A Brief Assessment of Biopsychosocial Functioning During Substance Use Disorder Recovery

Background: There is debate in the literature around how to measure outcomes in treatment and recovery from substance use disorder (SUD). Various constructs have been suggested as appropriate including “recovery capital” and “treatment progression.” To contribute to this debate, the construct of “recovery progression” has been suggested by the authors, and a psychometric assessment, the Recovery Progression Measure (RPM). Although published psychometrics data have demonstrated the RPM to be reliable, at 36-item long, it may be too lengthy to complete in clinic environments. Therefore, a shorter version has been developed, the Rapid RPM. Objectives: To examine reliability, validity, sensitivity and specificity of the Rapid RPM via data from 9208 service users. Methods: Data were collected from service users accessing the Breaking Free Online (BFO) treatment and recovery program, which has within its baseline assessment the six-item, 11-point Likert scale Rapid RPM. Psychometric properties were examined. Results: Internal reliability of the Rapid RPM was excellent, α =.92. The Rapid RPM also had good concurrent and predictive validity, with baseline scores, and changes in scores to follow-up, being significantly associated with scores on standardized measures of common mental health sequela, severity of substance dependence and quality of life, and changes in self-reported substance use. The Rapid RPM was also able to differentiate between participants scoring above thresholds on these measures for clinically relevant substance dependence and mental health difficulties. Conclusions: This study provides data to support reliability, validity, sensitivity and specificity of the Rapid RPM, indicating potential as a clinical tool.