Alarming signs and symptoms in febrile children in primary care: An observational cohort study in The Netherlands

__Abstract__ Context: Febrile children in primary care have a low risk for serious infection. Although several alarming signs and symptoms are proposed to have predictive value for serious infections, most are based on research in secondary care. The frequency of alarming signs/symptoms has not been established in primary care; however, in this setting differences in occurrence may influence their predictive value for serious infections. Objective: To determine the frequency of alarming signs/symptoms in febrile children in primary care. Design: Observational cohort study. Clinical information was registered in a semi-structured way and manually recoded. Setting: General practitioners' out-of-hours service. Subjects: Face-to-face patient contacts concerning children (aged ≤16 years) with fever were eligible for inclusion. Main outcome measures: Frequency of 18 alarming signs and symptoms as reported in the literature. Results: A total of 10,476 patient contacts were included. The frequency of alarming signs/symptoms ranged from n = 1 (ABC instability; 40°C as reported by the parents; 12.9%) to 8,647 contacts (parental concern; 82.5%). Conclusion: Although the prevalence of specific alarming signs/symptoms is low in primary care, ≥50% of children have one or more alarming signs/symptoms. There is a need to determine the predictive value of alarming signs/symptoms not only for serious infections in primary care, but as well for increased risk of a complicated course of the illness

Een jaar Wet open overheid (Woo): Hoe doet de overheid het volgens journalisten?: onderzoek in opdracht van het Adviescollege Openbaarheid en Informatiehuishouding (ACOI)

Journalisten zijn niet tevreden over de afhandeling van Woo-verzoeken. Deze duurt vaak lang, levert soms weinig op en de communicatie kan volgens hen beter. Dit blijkt uit een onderzoek waaraan 256 journalisten deelnamen. Uit het onderzoek wordt duidelijk dat veel winst valt te behalen wanneer nauwer wordt samengewerkt tussen Woo-behandelaars en journalisten. Vertrouwen en tijdig (open) overleg zijn daarbij basisvoorwaarden.Het onderzoek is uitgevoerd door het onderzoeksinstituut Centerdata, in opdracht van het Adviescollege Openbaarheid en Informatiehuishouding (ACOI) en in samenwerking met de Nederlandse Vereniging van Journalisten (NVJ) en de Vereniging van Onderzoeksjournalisten (VVOJ). Onderdeel van het onderzoek was een dialoogtafel met journalisten en Woo-behandelaars. Daaruit is gebleken dat ook ambtenaren behoefte hebben aan beter contact én een beter resultaat.De belangrijkste bevindingen:Actieve openbaarmaking is nog niet verbeterd volgens journalisten.Journalisten zien de meerwaarde van de Woo, maar hebben niet altijd vertrouwen in een zorgvuldige afhandeling van hun informatieverzoeken.Onderzoeken hoe besluitvorming achter de schermen tot stand is gekomen, is de voornaamste reden van een informatieverzoek.Journalisten zijn niet tevreden over de medewerking van de overheid bij de afhandeling van het verzoek.Journalisten vermoeden bewuste, politiek gemotiveerde vertragingen wanneer de wettelijke termijn om een verzoek af te handelen niet wordt gehaald zonder vervolgafspraken.Journalisten denken dat de overheid uitzonderingsgronden niet altijd terecht toepast.Journalisten zien vooral verbetermogelijkheden in een nauwe samenwerking met Woo-behandelaars bij de overheid.Op basis van het onderzoek concludeert het Adviescollege dat veel winst valt te halen uit een nauwere samenwerking die is gebaseerd op vertrouwen en praktische afspraken tussen behandelaars van Woo-verzoeken en journalisten. Het Adviescollege doet op dit punt alvast vijf concrete aanbevelingen voor overheidsorganisaties:Voer tijdig en open overleg met de journalist.Geef Woo-behandelaars mandaat en vertrouwen om afspraken te maken met verzoekers.Zorg voor ondersteuning door informatie- en dataspecialisten.Volg een transparante werkwijze voor de behandeling van Woo-verzoeken.Organiseer de dialoog ook los van Woo-verzoeken.Het onderzoeksrapport is gepubliceerd op de website van het ACOI.The Legitimacy and Effectiveness of Law & Governance in a World of Multilevel Jurisdiction

"It Takes Two To Tango", A Research About The Risks And Control Measures For The Management Of A Performance Contract For Regular Maintenance Of Rail Infrastructure.

A research about the risks and the administrative measures during the management of a performance contract for the regular maintenance of rail infrastructure. In the sector of rail infrastructure output-contracts, in which the contractor is judged on achieved performances, are getting more in use. The assumption is that this will lead to a more efficient and innovative execution of the maintenance, because the parties involved in the contract have less contact and thus need to take more responsibilities for their proper tasks. Unknown however is how to manage such a contract: What are the risks a contracting partner is confronted with during the term of the contract and how could these risks be managed? This article will discuss a method that will provide answers to these questions. The method consists of a matrix of the possible risks and control measures that the management level of both the sourcing partner and the contractor should discuss. These are cooperation risks and not the safety and availability risks. Within HTM, the bus and tram company of The Hague, this method is used to give direction for a new maintenance contract. It was concluded that management based on performances not always means that contracting partner and contractor have less contact but that it resulted in another behavior and cooperation both for the contracting partner as the contracting party.Institute of Transport and Logistics Studies. Faculty of Economics and Business. The University of Sydne

Short-term effects of air pollution on childhood respiratory symptoms in general practice:a time-series analysis

Objective:To study the association between air pollutant concentrations and daily general practitioner (GP) consultations for respiratory problems in children in Rotterdam, Netherlands. Design: A time-series study. Setting: General practices in greater Rotterdam. Patients: Children aged 0–17 years registered with participating GPs. Exposure:Daily nitrogen dioxide (NO2), ozone (O3), particulate matter ≤2.5 µg/m3 (PM2.5) and particulate matter ≤10 µg/m3 (PM10) concentrations at GP addresses. Main outcomes measured:Relative risk of respiratory consultations per 10 µg/m3 in pollutant concentration, adjusted for seasonality, pollen, day of the week and temperature. Results; Over 100 000 consultations were analysed between 2015 and 2019. The baseline daily consultation rate was 18.12 per 1000 person-years. Children consulted their GP most frequently for acute upper respiratory infections (AURIs) (4.69 consultations per 1000 person-years), followed by asthma (3.68 consultations per 1000 person-years) and cough (2.31 consultations per 1000 person-years). Our results indicated that exposure to NO2 was predominantly associated with a decreased risk of GP consultations across most lag periods for all respiratory diseases (ARD), AURIs and asthma. In contrast, exposure to NO2 was generally associated with increased risk of GP consultations for cough. Conversely, exposure to O3 was associated with statistically significant increases in risk for ARD across all lag periods. Exposure to PM2.5 and PM10 showed opposite trends, with reduced risks in GP consultations for ARD and increased risks in consultations for AURI, asthma and cough. Conclusions: Our findings expose a critical paradox on the impact of air pollution. For clinicians counselling families, these results emphasise that ‘good’ overall air quality days may still pose risks, although effects are small. High O3 increases total respiratory visits while particulate matter, though appearing protective overall, specifically exacerbates AURIs, asthma and cough. This divergence between total and specific respiratory effects indicates that comprehensive air quality policies must consider pollutant-specific impacts rather than assuming uniform effects.</p

What are the prospects for intensifying soil fertility management in the Sahel? A case study from Sanmatenga, Burkina Faso

Available from British Library Document Supply Centre-DSC:5359.2826(no 22) / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo

Distinguishing glioblastoma progression from treatment-related changes using DTI directionality growth analysis

Background It is difficult to distinguish between tumor progression (TP) and treatment-related abnormalities (TRA) in treated glioblastoma patients via conventional MRI, but this distinction is crucial for treatment decision making. Glioblastoma is known to exhibit an invasive growth pattern along white matter architecture and vasculature. This study quantified lesion development patterns in treated glioblastoma lesions and their relation to white matter microstructure to distinguish TP from TRA. Materials and methods Glioblastoma patients with confirmed TP or TRA with T1-weighted contrast-enhanced and DTI MR scans from two posttreatment follow-up timepoints were reviewed. The contrast-enhancing regions were segmented, and the regions were coregistered to the DTI data. Lesion increase vectors were categorized into two groups: parallel (0–20 degrees) and perpendicular (70–90 degrees) to white matter. FA-values were also extracted. To test for a statistically significant difference between the TP and TRA groups, a Mann‒Whitney U test was performed. Results Of 73 glioblastoma patients, fifteen were diagnosed with TRA, whereas 58 patients suffered TP. TP had a 25.8% (95% CI 24.1%-27.6%) increase in parallel lesions, and TRA had a 25.4% (95% CI 20.9%-29.9%) increase in parallel lesions. The perpendicular increase was 14.7% for TP (95% CI 13.0%-16.4%) and 18.0% (95% CI 13.5%-22.5%) for TRA. These results were not significantly different (p = 0.978). FA value for TP showed to be 0.248 (SD = 0.054) and for TRA it was 0.231 (SD = 0.075), showing no statistically significant difference (p = 0.121). Conclusions Based on our results, quantifying posttreatment contrast-enhancing lesion development directionality with DTI in glioblastoma patients does not appear to effectively distinguish between TP and TRA.publishedVersio

Becoming original: effects of strategy instruction

Visual arts education focuses on creating original visual art products. A means to improve originality is enhancement of divergent thinking, indicated by fluency, flexibility and originality of ideas. In regular arts lessons, divergent thinking is mostly promoted through brainstorming. In a previous study, we found positive effects of an explicit instruction of metacognition on fluency and flexibility in terms of the generation of ideas, but not on the originality of ideas. Therefore, we redesigned the instruction with a focus on building up knowledge about creative generation strategies by adding more complex types of association, and adding generation through combination and abstraction. In the present study, we examined the effects of this intervention by comparing it with regular brainstorming instruction. In a pretest-posttest control group design, secondary school students in the comparison condition received the brainstorm lesson and students in the experimental condition received the newly developed instruction lesson. To validate the effects, we replicated this study with a second cohort. The results showed that in both cohorts the strategy instruction of 50 min had positive effects on students' fluency, flexibility and originality. This study implies that instructional support in building up knowledge about creative generation strategies may improve students' creative processes in visual arts education