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ObjectiveAcute infection is the most common presentation of children to hospital. A minority of these infections are serious, but early recognition and adequate management are essential. We aimed to develop improved tools to assess children attending ambulatory hospital care, integrating clinical features with point-of-care C reactive protein (CRP).DesignProspective observational diagnostic study.Setting and patients5517 acutely ill children (1 month–16 years) presenting to 106 paediatricians at six outpatient clinics and six emergency departments in Belgium.Index testPoint-of-care CRP alongside vital signs and objective symptoms measurements.Main outcomeHospital admission for >24 hours with a serious infection ResultsAn algorithm was developed consisting of clinical features and CRP. This achieved 97.1% (95% CI 94.3% to 98.7%) sensitivity and 99.6% (95% CI 99.2% to 99.8%) negative predictive value, excluding serious infections in 36.4% of children. It stratifies patients into three groups based on CRP level: high-risk group with CRP >75 mg/L (26.8% risk of infection), intermediate-risk group with CRP 20–75 mg/L and at least one of seven clinical features (8.1%), and lower risk group with CRP ConclusionsConducting a CRP test may first enable children to be stratified into three risk groups, guiding assessment of clinical features that could be performed by junior doctors or nurses. In one-third of acutely ill children, the algorithm could exclude serious infection. Prospective validation of the algorithm is needed.Clinical trial registrationNCT02024282(post-results).

Cet article théorique présente une analyse comparative des propriétés métrologiques de trois instruments d’observation de la qualité éducative dans leur version préscolaire. En premier lieu, les étapes permettant de développer la validité et la fidélité d’un instrument de mesure sont présentées. Puis, une analyse comparative des trois instruments est proposée au sujet des procédures pour : 1) valider les construits mesurés, 2) valider le contenu des items, 3) valider leur structure interne, et 4) établir leur validité convergente et discriminante. La conclusion aborde les implications de cette analyse au regard de l’observation de la qualité éducative. This paper presents a comparative analysis of the psychometric properties of three preschool educational quality observation scales. After describing the criteria for fidelity and validity of observation scales, three scales are compared, with regards to: 1) construct validity, 2) content validity, 3) internal validity, and 4) convergent and discriminatory validity. The conclusion addresses implications for observing educational quality in childcare settings.

Objective: The de-institutionalizing process came to an end before the millennium shift by closing mental hospitals. After that some of the most ill patients are cared for in sheltered housing (SH). There is no in-house psychiatric competence and the staff on the floor usually lacks such knowledge and training. Observation instruments may improve this by making it possible to assess and monitor patients. Method: FAST-O is a simple twelve-item observation scale. Staff at eight SH units were trained in using the instrument and then assessed a total of 67 patients once, twice or three times at monthly intervals. Results: Ten items formed two highly homogenous subscales reflecting Social skills (Soc) and Excitation/Aggression (E/A). Depression and Clinical Global Impression (CGI) items were considered separately. The correlation pattern suggested that the ratings had construct validity. A cluster analysis identified three patient subgroups, of which one had very high E/A scores. Comparisons with reference data suggested that the average symptom level was on par with acutely admitted in-patients for this subgroup. In all groups, E/A symptoms varied considerably over time, the other symptoms were more stable. There were marked differences among the eight SH units with respect to the level of patient problems. Conclusions: The SH staff was able to produce valid FAST-O assessments. There are reference data which makes it possible to characterize individual patients as well as SH units with respect to treatment needs and safety aspects (for instance risk of violence).

This article is to investigate the theoretical claim settlement dynamics of the territory, located in the southwestern Cauca River Valley (Quilichao, Buenos Aires, and Suárez), by the black slaves and other social groups in the centuries XVIII-century, when initially formed in peasant societies through various strategies of occupying territory around the actual mines and colonial estates, whose owners did not exercise all social control on their properties. This allowed the creation of physical and symbolic borders, pop of resistance and appropriation, and constant struggle for social mobility, and family formation. Este artículo describe las dinámicas de poblamiento del territorio localizado en el suroccidente del valle del río Cauca (Quilichao, Buenos Aires y Suárez) por los esclavizados afros y demás grupos sociales durante los siglos XIX-XX, agrupados en sociedades campesinas que utilizaron diversas estrategias de ocupación del territorio alrededor de los reales de minas y las haciendas coloniales, cuyos propietarios no ejercían la totalidad del control, permitiendo de esta manera la creación de fronteras físicas y simbólicas que se constituyeron en elementos emergentes de resistencia, apropiación y lucha por la movilidad social y construcción de familia. Universidad de San Buenaventura - Cali

Objective: Early recognition and treatment of febrile children with serious infections (SI) improves prognosis, however, early detection can be difficult. We aimed to validate the predictive rule-in value of the National Institute for Health and Clinical Excellence (NICE) most severe alarming signs or symptoms to identify SI in children.Design, Setting and Participants: The 16 most severe ("red") features of the NICE traffic light system were validated in seven different primary care and emergency department settings, including 6,260 children presenting with acute illness.Main Outcome Measures: We focussed on the individual predictive value of single red features for SI and their combinations.Results were presented as positive likelihood ratios, sensitivities and specificities. We categorised "general" and "disease-specific" red features. Changes in pre-test probability versus post-test probability for SI were visualised in Fagan nomograms. Results: Almost all red features had rule-in value for SI, but only four individual red features substantially raised the probability of SI in more than one dataset: "does not wake/stay awake", "reduced skin turgor", "non-blanching rash", and "focal neurological signs". The presence of >= 3 red features improved prediction of SI but still lacked strong rule-in value as likelihood ratios were below 5.Conclusions: The rule-in value of the most severe alarming signs or symptoms of the NICE traffic light system for identifying children with SI was limited, even when multiple red features were present. Our study highlights the importance of assessing the predictive value of alarming signs in clinical guidelines prior to widespread implementation in routine practice.

Background Diagnosing serious infections in children is challenging, because of the low incidence of such infections and their non-specific presentation early in the course of illness. Prediction rules are promoted as a means to improve recognition of serious infections. A recent systematic review identified seven clinical prediction rules, of which only one had been prospectively validated, calling into question their appropriateness for clinical practice. We aimed to examine the diagnostic accuracy of these rules in multiple ambulatory care populations in Europe. Methods Four clinical prediction rules and two national guidelines, based on signs and symptoms, were validated retrospectively in seven individual patient datasets from primary care and emergency departments, comprising 11,023 children from the UK, the Netherlands, and Belgium. The accuracy of each rule was tested, with pre-test and post-test probabilities displayed using dumbbell plots, with serious infection settings stratified as low prevalence (LP; 20%) . In LP and IP settings, sensitivity should be >90% for effective ruling out infection. Results In LP settings, a five-stage decision tree and a pneumonia rule had sensitivities of >90% (at a negative likelihood ratio (NLR) of < 0.2) for ruling out serious infections, whereas the sensitivities of a meningitis rule and the Yale Observation Scale (YOS) varied widely, between 33 and 100%. In IP settings, the five-stage decision tree, the pneumonia rule, and YOS had sensitivities between 22 and 88%, with NLR ranging from 0.3 to 0.8. In an HP setting, the five-stage decision tree provided a sensitivity of 23%. In LP or IP settings, the sensitivities of the National Institute for Clinical Excellence guideline for feverish illness and the Dutch College of General Practitioners alarm symptoms ranged from 81 to 100%. Conclusions None of the clinical prediction rules examined in this study provided perfect diagnostic accuracy. In LP or IP settings, prediction rules and evidence-based guidelines had high sensitivity, providing promising rule-out value for serious infections in these datasets, although all had a percentage of residual uncertainty. Additional clinical assessment or testing such as point-of-care laboratory tests may be needed to increase clinical certainty. None of the prediction rules identified seemed to be valuable for HP settings such as emergency departments.

Towards current environmental issues, car using is questioned and new ways of moving seem to emerge. Inferring from such a statement, this thesis aims to evaluate the social impact of these “altermobilities” and the way they are appropriated by individuals, especially for their travels to work. Two perspectives are thus envisaged. Through a meso-social scale, the one gives an account of the legislative frame and of the actors involved in altermobilities. The second one is rather based on micro-individual scale thanks to in-depths interviews centred on modal choice. It allows to build the biographic paths of “altermobile” people and reveals processes and determiners of such mobility choices. The conclusions of this work put the emphasis on the conditions that make change possible. It suggest some new approaches to deal with modal change., Face aux grands enjeux environnementaux du 21ème siècle, les pratiques de déplacements automobiles se trouvent questionnées ; parallèlement des usages alternatifs à la voiture individuelle semblent émerger. Cette thèse cherche à évaluer la place sociale de ces « altermobilités » (covoiturage, vélo, transports en commun) et la manière dont elles sont réappropriées par les individus, principalement sur le trajet domicile-travail. Deux perspectives sont ainsi envisagées. Tout d'abord, à une échelle méso-sociale, il s'agit de rendre compte du cadre législatif et des acteurs qui portent ces altermobilités. Puis, le cœur de ce travail a été réalisé à l'échelle micro-individuelle. La méthode qualitative choisie, qui procède d'entretiens de vie centrés sur les modes de déplacements, permet de reconstruire les parcours biographiques des altermobilistes. L'analyse de ces parcours rend compte des processus et des déterminants des choix de mobilité ainsi effectués. Les résultats mettent en lumière des leviers d'action pour favoriser des usages altermobiles et propose des pistes de réflexion pour amener à des changements d'habitude de déplacements.