Admission screening and cohort care decrease carbapenem resistant enterobacteriaceae in Vietnamese pediatric ICU's.

OBJECTIVES: To assess if admission screening for Carbapenem Resistant Enterobacteriaceae (CRE) and cohort care can reduce CRE acquisition (CRE colonization during hospital stay), Hospital Acquired Infections (HAI), hospital-stay, mortality, and costs in three Intensive Care Units (ICU's) at the Vietnamese National Children's Hospital. METHOD: CRE screening using rectal swabs and ChromIDCarbas elective culture at admission and if CRE negative, once weekly. Patients were treated in cohorts based on CRE colonization status. RESULTS: CRE colonization at baseline point-prevalence screening was 76.9% (103/134). Of 941 CRE screened at admission, 337 (35.8%) were CREpos. 694 patients met inclusion criteria. The 244 patients CRE negative at admission and screened > 2 times were stratified in 8 similar size groups (periods), based on time of admission. CRE acquisition decreased significant (OR - 3.2, p < 0.005) from 90% in period 2 (highest) to 48% in period 8 (last period). Patients with CRE acquisition compared to no CRE acquisition had a significantly higher rate of culture confirmed HAI, n = 20 (14%) vs. n = 2 (2%), longer hospital stays, 3.26 vs. 2.37 weeks, and higher total treatment costs, 2852 vs. 2295 USD. CONCLUSION: Admission CRE screening and cohort care in pediatric ICU's significantly decreased CRE acquisition, cases of HAI and duration of hospital-stay.

Motor Conflict: Revealing Involuntary Conditioned Motor Preparation Using Transcranial Magnetic Stimulation.

Preparing actions to achieve goals, overriding habitual responses, and substituting actions that are no longer relevant are aspects of motor control often assumed to be driven by deliberate top-down processes. In the present study, we investigated whether motor control could come under involuntary control of environmental cues that have been associated with specific actions in the past. We used transcranial magnetic stimulation (TMS) to probe corticospinal excitability as an index of motor preparation, while participants performed a Go/No-Go task (i.e., an action outcome or no action outcome task) and rated what trial was expected to appear next (Go or No-Go). We found that corticospinal excitability during a warning cue for the upcoming trial closely matched recent experience (i.e., cue-outcome pairings), despite conflicting with what participants expected would appear. The results reveal that in an action-outcome task, neurophysiological indices of motor preparation show changes that are consistent with participants learning to associate a preparatory warning cue with a specific action, and are not consistent with the action that participants explicitly anticipate making. This dissociation with conscious expectancy ratings reveals that conditioned responding and motor preparation can operate independently of conscious expectancies about having to act.