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Pediatric Early Warning Scores are advocated to assist health professionals to identify early signs of serious illness or deterioration in hospitalized children. Scores are derived from the weighting applied to recorded vital signs and clinical observations reflecting deviation from a predetermined "norm." Higher aggregate scores trigger an escalation in care aimed at preventing critical deterioration. Process errors made while recording these data, including plotting or calculation errors, have the potential to impede the reliability of the score. To test this hypothesis, we conducted a controlled study of documentation using five clinical vignettes. We measured the accuracy of vital sign recording, score calculation, and time taken to complete documentation using a handheld electronic physiological surveillance system, VitalPAC Pediatric, compared with traditional paper-based charts. We explored the user acceptability of both methods using a Web-based survey. Twenty-three staff participated in the controlled study. The electronic physiological surveillance system improved the accuracy of vital sign recording, 98.5% versus 85.6%, P < .02, Pediatric Early Warning Score calculation, 94.6% versus 55.7%, P < .02, and saved time, 68 versus 98 seconds, compared with paper-based documentation, P < .002. Twenty-nine staff completed the Web-based survey. They perceived that the electronic physiological surveillance system offered safety benefits by reducing human error while providing instant visibility of recorded data to the entire clinical team.

This article examines the musical structural processes used in songs invented by 32 children over a period of 18 months. It takes the view that the organisation and relationships of musical events in time are fundamental to music's meaning, and that we should expect structural considerations to be important as soon as a child begins to be musically articulate.I have been continuing my study of young children's invented songs (Davies, 1986), analysing them in the light of recent writings on music as mind. If music is an activity of mind, the question arises, what are musical thought processes, and can we find them in the musical inventions of young children ?

Recent publications, such as Music from 5 to 16 (D.E.S., 1985a) and the National Criteria for Music for GCSE (D.E.S., 1985b) reflect the now established view that composition should be a normal part of the music curriculum for all children. There is still some work to be done infurthering our understanding of children's compositions. Much of the material published so far (e.g. Loane, 1984) has concentrated on children of secondary school age. The present article offers some reflections prompted by work with younger children.

This article concentrates upon two areas which the editors are conscious of neglecting in the journal: music teaching and nursery education. It is a specific and personal account of a teaching project undertaken within the Cleveland Education Authority, “Young Children Exploring Sound”. There could be some powerful messages here about how “practice is improved” generally. By observing carefully (and interpreting through discussion with colleagues) what young children naturally do , we're often better able to plan subsequent teaching.