Etiologic predictive value of a rapid immunoassay for detection of group A streptococcus antigen from throat swabs in patients presenting with a sore throat

Context: A sore throat is a common symptom mainly caused by virus but also by a variety of bacteria such as group A betahaemolytic streptococci (GAS) often resulting in unnecessary antibiotic prescribing. Combinations of symptoms and scores are not specific enough to accurately sort out aetiology. Rapid diagnostic antigen tests (RADT) have demonstrated high sensitivity and specificity in detecting presence of GAS. Objective: Establish the probability that finding of GAS in a RADT shows a true link between symptoms and GAS while considering carriers of GAS ill from a virus. Design: Cross-sectional study comparing two groups. Setting: Emergency department (ED) also managing primary health care cases in a remote rural town with 22,000 residents. Patients/Participants: 101 consecutive children aged 3-15 years attending for a sore throat as the main complaint and 147 consecutive children of the same age attending the same ED for other reasons than an infection. Main And Secondary Outcome Measures: Positive and negative Etiologic Predictive Value (EPV). Results: Positive EPV was 98% (88-100%). Negative EPV was 98% (97-99%). The positive EPV depends on setting and findings in this study and may not be transferable to other settings. It was mathematically shown that negative EPV found in this study is valid in all other reasonable settings and hence can be transferred to any other setting. Conclusions: The evaluated RADT (Alere Test Pack+Plus With OBC Strep A) is always useful to rule out GAS infection in patients with an uncomplicated sore throat. It is often, depending on setting, useful to rule in a GAS infection in these patients

Etiologic predictive value of a rapid immunoassay for detection of group A streptococcus antigen from throat swabs in patients presenting with a sore throat

Context: A sore throat is a common symptom mainly caused by virus but also by a variety of bacteria such as group A betahaemolytic streptococci (GAS) often resulting in unnecessary antibiotic prescribing. Combinations of symptoms and scores are not specific enough to accurately sort out aetiology. Rapid diagnostic antigen tests (RADT) have demonstrated high sensitivity and specificity in detecting presence of GAS. Objective: Establish the probability that finding of GAS in a RADT shows a true link between symptoms and GAS while considering carriers of GAS ill from a virus. Design: Cross-sectional study comparing two groups. Setting: Emergency department (ED) also managing primary health care cases in a remote rural town with 22,000 residents. Patients/Participants: 101 consecutive children aged 3-15 years attending for a sore throat as the main complaint and 147 consecutive children of the same age attending the same ED for other reasons than an infection. Main And Secondary Outcome Measures: Positive and negative Etiologic Predictive Value (EPV). Results: Positive EPV was 98% (88-100%). Negative EPV was 98% (97-99%). The positive EPV depends on setting and findings in this study and may not be transferable to other settings. It was mathematically shown that negative EPV found in this study is valid in all other reasonable settings and hence can be transferred to any other setting. Conclusions: The evaluated RADT (Alere Test Pack+Plus With OBC Strep A) is always useful to rule out GAS infection in patients with an uncomplicated sore throat. It is often, depending on setting, useful to rule in a GAS infection in these patients

Expectations and realities: an exploration in teaching planning ethics to university students

Upon graduation, planning students move into a diverse world, ranging from development assessment to policy development and public consultation. Furthermore, students are often thrust into a darker reality of balancing conflicting interests, power struggles and the search for the multi-layered and contentious ‘public interest’ (Tait, 2011). When entering the ‘real world’ of planning practice, the need for students to be adequately prepared for a range of challenges – practical, professional and ethical – is vital (Gurran et al., 2008; Nagy, 2012). This paper presents a preliminary theoretical discussion of current state of planning ethics at tertiary, or university, level and its role in the development of the ethically aware, practising planner. It considers the role of neoliberalism in academia, stressing both the teachers' and students’ roles in understanding the highly political nature of the planning environment. Two case studies – the University of South Australia (UniSA), Australia and the University of Auckland, New Zealand are investigated. Finally, the paper provides a short overview of the need for ethics education in the current environment and its role in developing the ethically sensitive student. This includes discussion of ‘job preparedness/employability’, ‘approachability of teachers and education’, ‘approachability of moral philosophy’ and ‘the importance of self-reflexivity/reflection and positionality’. This desk-top analysis provides a valuable insight into the current state of planning ethics education at two intercontinental universities. In understanding the differences and similarities between these courses, one can begin to appreciate how the nature of assessments, assigned readings and teaching staff contribute to developing the ethically aware professional planner. Both the University of South Australia and the University of Auckland ethics courses enable students to not only begin to understand their role as part of the greater collective of planning and society, but also towards being increasingly self-aware in their own decision-making skills.Anna Marie Leditschke, Jon Kellett, Mathew W. Rofe and Rowena Butlan

The Rhodococcus equi virulence protein VapA disrupts endolysosome function and stimulates lysosome biogenesis

Rhodococcus equi (R. equi) is an important pulmonary pathogen in foals that often leads to the death of the horse. The bacterium harbors a virulence plasmid that encodes numerous virulence-associated proteins (Vaps) including VapA that is essential for intracellular survival inside macrophages. However, little is known about the precise function of VapA. Here, we demonstrate that VapA causes perturbation to late endocytic organelles with swollen endolysosome organelles having reduced Cathepsin B activity and an accumulation of LBPA, LC3 and Rab7. The data are indicative of a loss of endolysosomal function, which leads cells to upregulate lysosome biogenesis to compensate for the loss of functional endolysosomes. Although there is a high degree of homology of the core region of VapA to other Vap proteins, only the highly conserved core region of VapA, and not VapD of VapG, gives the observed effects on endolysosomes. This is the first demonstration of how VapA works and implies that VapA aids R. equi survival by reducing the impact of lysosomes on phagocytosed bacteria