Discordant identification of pediatric severe sepsis by research and clinical definitions in the SPROUT international point prevalence study

Introduction: Consensus criteria for pediatric severe sepsis have standardized enrollment for research studies. However, the extent to which critically ill children identified by consensus criteria reflect physician diagnosis of severe sepsis, which underlies external validity for pediatric sepsis research, is not known. We sought to determine the agreement between physician diagnosis and consensus criteria to identify pediatric patients with severe sepsis across a network of international pediatric intensive care units (PICUs). Methods: We conducted a point prevalence study involving 128 PICUs in 26 countries across 6 continents. Over the course of 5 study days, 6925 PICU patients <18 years of age were screened, and 706 with severe sepsis defined either by physician diagnosis or on the basis of 2005 International Pediatric Sepsis Consensus Conference consensus criteria were enrolled. The primary endpoint was agreement of pediatric severe sepsis between physician diagnosis and consensus criteria as measured using Cohen's ?. Secondary endpoints included characteristics and clinical outcomes for patients identified using physician diagnosis versus consensus criteria. Results: Of the 706 patients, 301 (42.6 %) met both definitions. The inter-rater agreement (? ± SE) between physician diagnosis and consensus criteria was 0.57 ± 0.02. Of the 438 patients with a physician's diagnosis of severe sepsis, only 69 % (301 of 438) would have been eligible to participate in a clinical trial of pediatric severe sepsis that enrolled patients based on consensus criteria. Patients with physician-diagnosed severe sepsis who did not meet consensus criteria were younger and had lower severity of illness and lower PICU mortality than those meeting consensus criteria or both definitions. After controlling for age, severity of illness, number of comorbid conditions, and treatment in developed versus resource-limited regions, patients identified with severe sepsis by physician diagnosis alone or by consensus criteria alone did not have PICU mortality significantly different from that of patients identified by both physician diagnosis and consensus criteria. Conclusions: Physician diagnosis of pediatric severe sepsis achieved only moderate agreement with consensus criteria, with physicians diagnosing severe sepsis more broadly. Consequently, the results of a research study based on consensus criteria may have limited generalizability to nearly one-third of PICU patients diagnosed with severe sepsis

The quality of options in strategic decision making: a study about creativity and completeness in business decision making

A qualidade das decisões estratégicas dos empresários está diretamente relacionada à capacidade que eles demonstram para encontrar alternativas criativas quando enfrentam os problemas de suas empresas. Essas alternativas podem ser geradas intuitivamente, utilizando heurísticas. As pesquisas sobre geração de alternativas têm indicado consistentemente que as pessoas não são eficientes nessa atividade. As explicações para esse fato, contidas na literatura sobre decisão, não são conclusivas e permitem especulações a respeito. Para explorar essa questão e relacioná-la ao administrador brasileiro, foi idealizado um experimento com 174 alunos de quatro cursos de MBA para avaliar a originalidade e a completude das alternativas. O experimento e a respectiva análise basearam-se na confluência da pesquisa experimental, oriunda da psicologia cognitiva da decisão, com as visões da ciência da decisão organizacional tradicional e o novo campo de estudo das decisões intuitivas ou naturalísticas. Para mensurar a criatividade das alternativas apresentadas durante o experimento, empregou-se o conceito de árvore hierárquica, que demonstrou ser uma poderosa ferramenta para a tipologia de alternativas. O resultado desse experimento confirmou o baixo desempenho em geração de alternativas dos gerentes e, ao mesmo tempo, indicou que, provavelmente, a etapa de geração de alternativas isolada da etapa de escolha pode melhorar a qualidade das alternativas. A heurística, por sua vez, não demonstrou influenciar o conjunto de alternativas geradas. _________________________________________________________________________________________ ABSTRACT: The quality of strategic decisions of executives is directly related to the ability they have to find creative alternatives when facing business problems. These alternatives could be generated intuitively, using heuristics. On the other hand, the researches on alternatives generation have consistently indicated that people are not efficient on this duty. The argument for that, contained in the decision’s literature, is not conclusive and it allows speculation about it. To explore this issue and relate it to the Brazilian Administration, an experiment was designed for 174 students of four courses of MBA. The experiment and the analysis were resulted from the confluence between the experimental research from decision cognitive psychology with science’s vision of the traditional organizational decision and the new field of study on naturalistic or intuitive decisions. To measure the creativity of the alternatives presented during the experiment, the concept of hierarchical tree was utilized and it has proved a powerful tool to the typology of alternatives. The result of this experiment confirmed the poor performance in alternatives generation by managers and at the same time, indicated that probably, the generation of options isolated of analysis can produce better quality of alternatives. The heuristic, do not demonstrated any influence on options generated

Children and Their Parents: A Comparative Study of the Legal Position of Children with Regard to Their Intentional and Biological Parents in English and Dutch Law

This is a book about children and their parents. There are many different kinds of children and at least about as many different kinds of parents. In addition to the many different disciplines that study children and their parents, such as sociology, psychology, child studies and gender studies, to name but a few, this study concerns a legal question with regard to the parent-child relationship, namely how the law assigns parents to children. This subject is approached in a comparative legal perspective and covers England and The Netherlands. The book contains a detailed comparison and analysis of the manner in which the law in the two jurisdictions assigns the status of legal parent and/or attributes parental responsibility to the child’s biological and intentional parents. The concept ‘procreational responsibility’, which is introduced in the concluding chapter of the book, may be used as a tool to assess and reform existing regulations on legal parent-child relationships. The structure of the book, which is based on a categorisation of different family types in a ‘family tree’, enables the reader to have easy access to family-specific information.FdR – Publicaties zonder aanstelling Universiteit Leide