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Early diagnosis of serious bacterial infections (SBI) is important for improving outcome of morbidity and mortality in children. A systematic review was conducted to examine if shivering had any value in diagnosing serious bacterial infection. We split our population (0-18 years old) into two categories depending on the presence of a known malignancy. The databases of Medline, Embase, Cinahl, and Web of Science were searched from inception until July 2019. The quality was assessed with the QUADAS-2 tool. Two by two tables were created, extracting the number of true positive (TP), true negative (TN), false positive (FP), and false negative (FN) regarding shivering and SBI, by 2 authors independently. Sensitivity, specificity, likelihood ratios, and their 95% confidence intervals were calculated using the MetaDATA Shiny app. In a population with known malignancy, we found a +LR of 3.47 (95% CI 2.58-4.36) for a serious bacterial infection when shivering was present, implying an increase of 25-30% possibility for a serious bacterial infection. In children without malignancy, diagnostic accuracy of shivering was poor.Conclusion: Shivering is of limited use to diagnose serious bacterial infection in children without malignancy. Nevertheless, in children with known malignancy, it can be useful as an alarm signal. What is Known: • In the NICE guidelines for febrile illness in children, "shivering" is considered as an intermediate risk factor ("amber" sign) for a serious illness. • A systematic literature search conducted in 2007 investigating the correlation between shivering in a febrile child and the presence of a serious bacterial infection could include only one study. What is New: • Based on the results of this systematic review, shivering has little diagnostic value in children without malignancy but can be useful as an alarm sign of serious bacterial infection in children with known malignancy. • In case of absence of shivering, serious bacterial infection cannot be ruled out.

Primary Objective: The objective of this study was to design an instrument to screen for burden in the daily life of both the client with acquired brain injury (ABI) and their nonprofessional caregiver., Research Design: Exploratory research Methods and Procedures: Based on a survey amongst stakeholder organizations, the FINAH-instrument is designed as a digital self-assessment questionnaire, based on ICF-framework. A test survey of the FINAH instrument is conducted on both clients, nonprofessional caregivers and healthcare professionals., Main Outcomes and Results: The relative burden per item for clients and nonprofessional caregivers is most prominent in the domains of fatigue, cognitive and emotional consequences, self-care and mobility. The estimation of burden for clients and nonprofessional caregiver by healthcare professionals showed an overall 65% correct estimation by the healthcare professional. 19% of the items showed underestimation of burden, while 16% showed overestimation., Conclusions: These results show that FINAH can ameliorate the estimation of the health care professional on the self-assessed burden of clients and nonprofessional caregivers, thus substantiating a more client-centred approach.

Background: The psychological health in obese women during pregnancy has been poorly studied., Objective: To compare levels of anxiety and depressed mood during pregnancy in obese versus normal-weight women., Methods: 63 obese pregnant women and 156 normal-weight controls were included prospectively before 15 weeks of gestation. Levels of state and trait anxiety and depressed mood were measured during the first, second and third trimester of pregnancy. A linear mixed-effect model with repeated measures was used to evaluate group differences., Results: The levels of state anxiety significantly increased from trimester 1 to trimester 3 in obese pregnant women (beta = 3.70; p = 0.007), while this parameter remained constant throughout pregnancy in normal-weight women. Levels of trait anxiety and depressed mood significantly decreased from trimester 1 to trimester 2 in controls, but not in obese pregnant women. Variables such as maternal education, ethnicity, marital state, psychological history and miscarriages, parity and smoking behaviour had significant effects on anxiety and/or depressed moods during pregnancy. Obese pregnant women show higher levels of anxiety and depressive symptomatology compared to normal-weight pregnant women., Conclusion: Interventional programmes aiming at preventing the deleterious influence of maternal obesity on perinatal outcomes should include a psycho-educational program specifically tailored to this high-risk group., (Copyright © 2013 S. Karger GmbH, Freiburg.)

The severity of 1491 crashes on 148 roundabouts in Flanders-Belgium was examined in order to investigate which factors might explain the severity of crashes or injuries and to relate these factors to the existing knowledge about contributing factors for injury severity in traffic. Logistic regression and hierarchical binomial logistic regression techniques were used. A clear externality of risk appeared to be present in the sense that vulnerable road user groups (pedestrians, bicyclists, moped riders and motorcyclists) are more severely affected than others. Fatalities or serious injuries in multiple-vehicle crashes for drivers of four-wheel vehicles are much rarer. Injury severity increases with higher age. Crashes at night and crashes outside built-up areas are more severe. Single-vehicle crashes seem to have more severe outcomes than multiple-vehicle crashes. However, systematic differences in the reporting rate of crashes are likely to exist and may have affected the stated results. Correlations with important, but unobserved variables like the impact speeds in the crashes might exist as well and could provide an alternative explanation for some results., (2010 Elsevier Ltd. All rights reserved.)

The conversion of an intersection into a roundabout has been proven to reduce generally the number of crashes with injuries or fatalities. However, evaluation studies frequently showed considerable individual differences in safety performance of roundabouts or particular groups of roundabouts. The main purpose in the present study was to explain the variance in safety performance of roundabouts through the use of state-of-the-art cross-sectional risk models based on crash data, traffic data and geometric data of a sample of 90 roundabouts in Flanders-Belgium. Poisson and gamma modelling techniques were used, the latter one since underdispersion in the crash data was observed. The results show that the variation in crash rates is relatively small and mainly driven by the traffic exposure. Vulnerable road users are more frequently than expected involved in crashes at roundabouts and roundabouts with cycle lanes are clearly performing worse than roundabouts with cycle paths. Confirmation is found for the existence of a safety in numbers-effect for bicyclists, moped riders and - with less certainty - for pedestrians at roundabouts., (Copyright 2009 Elsevier Ltd. All rights reserved.)

Problem: Previous research indicated that conversions of intersections into roundabouts appear to increase the number of injury crashes with bicyclists. However, it was assumed that the effectiveness of roundabouts could vary according to some differences in design types of cycle, facilities and other geometrical factors., Method: Regression analyses on effectiveness-indices resulting from a before-and-after study of injury crashes with bicyclists at 90 roundabouts in Flanders, Belgium., Results: Regarding all injury crashes with bicyclists, roundabouts with cycle lanes appear to perform significantly worse compared to three other design types (mixed traffic, separate cycle paths, and grade-separated cycle paths). Nevertheless, an increase of the severest crashes was noticed, regardless of the design type of the cycle facilities. Roundabouts that are replacing signal-controlled intersections seem to have had a worse evolution compared to roundabouts on other types of intersections., Impact on Industry: The results might affect design guidelines for roundabouts, particularly for the accommodation of bicyclists.

A before-and-after study was carried out of injury accidents involving bicyclists on 91 roundabouts in Flanders-Belgium. The study design accounted for the effects of general safety trends and regression-to-the-mean, but could not take into account the possibility of specific changes in traffic volume at roundabouts. The conversion of intersections into roundabouts produces a significant 27% increase in the number of injury accidents involving bicyclists on or nearby the roundabouts. The increase is even higher for accidents involving fatal or serious injuries (41-46%). Compared to the proven favourable effects of roundabouts on safety in general, this result is unexpectedly poor. However, the effects of roundabouts on bicycle accidents differ depending on whether these roundabouts are built inside or outside built-up areas. When inside built-up areas, the construction of roundabouts increased the number of injury accidents involving bicyclists by 48%. For accidents causing fatal or serious injuries inside built-up areas, an average increase of 77% was found. However, outside built-up areas the zero-hypothesis of 'no safety effect for bicyclists' cannot be rejected (best estimate: +1% accidents, not significant). Roundabouts that replace traffic signals perform worse when compared to roundabouts at other types of intersections.

Introduction: This paper analyzes the effect on road safety of 95 roundabouts that were built in Flanders between 1994 and 1999., Results: The study shows that the effect on the number and severity of road accidents adjusted for the trend and regression to the mean is significant, but varies considerably in accordance with the speed limit regime on the intersection. Roundabouts are most effective on intersections of a main road with a high speed limit (90 km/h) and an adjacent road with a lower speed limit (50 or 70 km/h). The empirical analysis reveals a reduction of 34% (varying between 15% and 59%) for the total number of injury accidents, 30% (7%-45%) for light injury accidents, and 38% (27%-72%) for serious injury accidents. This study also takes a closer look at the impact of different post-implementation periods using accident data of 1-, 3-, or 6-years after the construction of a roundabout on the calculated effectiveness results and warns for a severe underestimation when a one-year period is used., Impact on Industry: An effective traffic safety policy based on scientific results thus requires some patience from the policy-makers.