Spasticity is most commonly defined as an inappropriate, velocity dependent, increase in muscle tonic stretch reflexes, due to the amplified reactivity of motor segments to sensory input. It forms one component of the upper motor neuron syndrome and often leads to muscle stiffness and disability. Spasticity can, therefore, be measured through electrophysiological, biomechanical and clinical evaluation, the last most commonly using the Ashworth scale. None of these techniques incorporate the patient experience of spasticity, nor how it affects people's daily lives. Consequently, we set out to construct a rating scale to quantify the perspectives of the impact of spasticity on people with multiple sclerosis. Qualitative methods (in-depth patient interviews and focus groups, expert opinion and literature review) were used to develop a conceptual framework of spasticity impact, and to generate a pool of items with the potential to convert this framework into a rating scale with multiple dimensions. This item pool was administered, in the form of a questionnaire, to a sample of people with multiple sclerosis and spasticity. Guided by Rasch analysis, we constructed and validated a rating scale for each component of the conceptual framework. Decisions regarding item selection were based on the integration and assimilation of seven specific analyses including clinical meaning, ordering of thresholds, fit statistics and differential item functioning. The qualitative phase (17 patient interviews, 3 focus groups) generated 144 potential scale items and a conceptual model with eight components addressing symptoms (muscle stiffness, pain and discomfort and muscle spasms,), physical impact (activities of daily living, walking and body movements) and psychosocial impact (emotional health, social functioning). The first postal survey was sent to 272 people with multiple sclerosis and had a response rate of 88%. Findings supported the development of scales for each component but demonstrated that five item response options were too many. The 144-item questionnaire, reformatted with four-item response options, was administered with four validating instruments to an independent sample of 259 people with multiple sclerosis (response rate 78%). From the responses, an 88-item instrument with eight subscales was developed that satisfied criteria for reliable and valid measurement. Correlations with other measures were consistent with predictions. The 88-item Multiple Sclerosis Spasticity Scale (MSSS-88) is a reliable and valid, patient-based, interval-level measure of the impact of spasticity in multiple sclerosis. It has the potential to advance outcomes measurement in clinical trials and clinical practice, and provides a new perspective in the clinical evaluation of spasticity.

International differences in practices and attitudes regarding pet cats' interactions with wildlife were assessed by surveying citizens from at least two cities in Australia, New Zealand, the UK, the USA, China and Japan. Predictions tested were: (i) cat owners would agree less than non-cat owners that cats might threaten wildlife, (ii) cat owners value wildlife less than non-cat owners, (iii) cat owners are less accepting of cat legislation/restrictions than non-owners, and (iv) respondents from regions with high endemic biodiversity (Australia, New Zealand, China and the USA state of Hawaii) would be most concerned about pet cats threatening wildlife. Everywhere non-owners were more likely than owners to agree that pet cats killing wildlife were a problem in cities, towns and rural areas. Agreement amongst non-owners was highest in Australia (95%) and New Zealand (78%) and lowest in the UK (38%). Irrespective of ownership, over 85% of respondents from all countries except China (65%) valued wildlife in cities, towns and rural areas. Non-owners advocated cat legislation more strongly than owners except in Japan. Australian non-owners were the most supportive (88%), followed by Chinese non-owners (80%) and Japanese owners (79.5%). The UK was least supportive (non-owners 43%, owners 25%). Many Australian (62%), New Zealand (51%) and Chinese owners (42%) agreed that pet cats killing wildlife in cities, towns and rural areas was a problem, while Hawaiian owners were similar to the mainland USA (20%). Thus high endemic biodiversity might contribute to attitudes in some, but not all, countries. Husbandry practices varied internationally, with predation highest where fewer cats were confined. Although the risk of wildlife population declines caused by pet cats justifies precautionary action, campaigns based on wildlife protection are unlikely to succeed outside Australia or New Zealand. Restrictions on roaming protect wildlife and benefit cat welfare, so welfare is a better rationale.

While it is undeniable that owned domestic cats Felis catus (Mammalia: Felidae) kill large numbers of wildlife, it is contentious if this has significant impacts on wildlife populations. Under the precautionary principle such uncertainty does not preclude measures to reduce putative risk, but action should follow consultation with stakeholders. To initiate such consultation for the City of Armadale, Western Australia, we surveyed urban and rural residents to determine their opinions regarding putative impacts of owned cats on wildlife and the acceptability of proposed regulations. Key statements accepted by 70% or more of respondents, irrespective of their residence, gender or cat ownership status, included: (i) there is a need to regulate owned domestic cats; (ii) the presence of cats in nature reserves is harmful to wildlife; (iii) cats not owned by licensed breeders should be desexed; and (iv) local councils should be empowered to restrict the maximum number of cats per household. Seventy per cent or more of owners agreed to keep their cats on their property from sunset to sunrise and to register them if these measures became compulsory. All groups except urban men also indicated 70% or greater willingness to keep their cats on their property constantly if required. However, fewer than 40% of owners supported empowering local councils to enforce cat-free zones. In this community, cat regulation excluding catfree zones should enjoy support. Similar approaches should be effective wherever the environmental impacts of owned domestic cats are debated, because compliance with such regulations should be high.

Although patient empowerment is widely acknowledged as important by health professionals it remains a somewhat nebulous concept. An initial empowerment measure has been developed through an extensive review of literature combined with a series of in-depth interviews of cancer patients concerning their use of coping strategies. The results were analysed for major themes in relation to sense of control over the illness. A set of twenty-eight statements were formulated from themes into a Likert-type scale for self-completion by 100 cancer patients. The scale could be used in assessing level of empowerment amongst cancer patients thereby establishing through this information, the patient's ability to make decisions about coping with their illness.

Cat legislation that avoids or educates about the contentious issue of cat-free zones should receive solid community support.