Ventilator-associated respiratory infection in a resource-restricted setting: impact and etiology.

BACKGROUND: Ventilator-associated respiratory infection (VARI) is a significant problem in resource-restricted intensive care units (ICUs), but differences in casemix and etiology means VARI in resource-restricted ICUs may be different from that found in resource-rich units. Data from these settings are vital to plan preventative interventions and assess their cost-effectiveness, but few are available. METHODS: We conducted a prospective observational study in four Vietnamese ICUs to assess the incidence and impact of VARI. Patients ≥ 16 years old and expected to be mechanically ventilated > 48 h were enrolled in the study and followed daily for 28 days following ICU admission. RESULTS: Four hundred fifty eligible patients were enrolled over 24 months, and after exclusions, 374 patients' data were analyzed. A total of 92/374 cases of VARI (21.7/1000 ventilator days) were diagnosed; 37 (9.9%) of these met ventilator-associated pneumonia (VAP) criteria (8.7/1000 ventilator days). Patients with any VARI, VAP, or VARI without VAP experienced increased hospital and ICU stay, ICU cost, and antibiotic use (p < 0.01 for all). This was also true for all VARI (p < 0.01 for all) with/without tetanus. There was no increased risk of in-hospital death in patients with VARI compared to those without (VAP HR 1.58, 95% CI 0.75-3.33, p = 0.23; VARI without VAP HR 0.40, 95% CI 0.14-1.17, p = 0.09). In patients with positive endotracheal aspirate cultures, most VARI was caused by Gram-negative organisms; the most frequent were Acinetobacter baumannii (32/73, 43.8%) Klebsiella pneumoniae (26/73, 35.6%), and Pseudomonas aeruginosa (24/73, 32.9%). 40/68 (58.8%) patients with positive cultures for these had carbapenem-resistant isolates. Patients with carbapenem-resistant VARI had significantly greater ICU costs than patients with carbapenem-susceptible isolates (6053 USD (IQR 3806-7824) vs 3131 USD (IQR 2108-7551), p = 0.04) and after correction for adequacy of initial antibiotics and APACHE II score, showed a trend towards increased risk of in-hospital death (HR 2.82, 95% CI 0.75-6.75, p = 0.15). CONCLUSIONS: VARI in a resource-restricted setting has limited impact on mortality, but shows significant association with increased patient costs, length of stay, and antibiotic use, particularly when caused by carbapenem-resistant bacteria. Evidence-based interventions to reduce VARI in these settings are urgently needed

The Impact of Operant Resources on the Task Performance of Learners via Knowledge Management Process

In human resource management, training is considered one of the most effective ways to improve employees’ task performance. However, the effectiveness of training depends mostly on the resources and effort of learners, especially the operant resources. This study investigates the influence of operant resources on individual task performance within the framework of knowledge management. Building on existing research, a quantitative model was developed and tested using data from 296 Vietnamese managers and senior employees. Data analysis employed SPSS 21 and AMOS 24 software. The findings provide strong support for all nine proposed hypotheses, demonstrating a positive impact of operant resources on both learner behavior and subsequent task performance. The research highlights the significant role of individual operant resources in enhancing learning outcomes and employee effectiveness. Managerial implications are derived from these results, offering practical guidance for businesses to improve training activities and ultimately boost employee task performance

The "human visceral homunculus" to pain evoked in the oesophagus, stomach, duodenum and sigmoid colon

the oesophagus, stomach, duodenum and sigmoid colon were electrically stimulated in 12 healthy volunteers with a thin nasal endoscope. the painful cortical evoked potentials (EPs) were recorded from 64 surface electrodes. the early EPs with latencies &lt; 200 ms were studied and the corresponding dipole sources were calculated. the electrical current intensities needed to evoke pain were highest in the stomach and duodenum, compared to the other segments (F = 7.8; P &lt; 0.001; post hoc analysis P &lt; 0.05). The EP latencies after stimulation of the stomach and sigmoid colon were shorter compared with those to stimulation of the oesophagus and duodenum (all P values &lt; 0.001). the EP amplitudes were higher to oesophagus stimulation (all P values &lt; 0.001 except for the early positivity). the potential fields obtained after stimulation of the most distal segments (duodenum and sigmoid colon) were in general distributed more posteriorly compared to those recorded in the more proximal regions. the EP topographies to stimulation of all gut tracts were explained by a bilateral source in the second somatosensory (SII) area, by a dipole in the anterior cingulate cortex (ACC), and by a bilateral generator in the insular cortex. however, the position of the sources significantly changed depending on the stimulated gut tract. moreover, while the SII and ACC sources were initially activated to oesophagus and stomach stimulation, the ACC and insular activities were the earliest ones after stimulation of the lower gut segments. the findings reflect differences in pathways and brain processing of visceral nociceptive inputs coming from either upper or lower gut and may improve our understanding of the brain-gut axis in health and disease

Ordonnance du roi, pour l'établissement d'une compagnie de maréchaussée en Corse . Du 27 décembre 1769

[Acte royal. 1769-12-27. Versailles]Appartient à l’ensemble documentaire : RCorse1Avec mode text