Background An endotracheal tube cuff pressure between 20 and 30 cmH2O is recommended to prevent ventilator-associated respiratory infection (VARI). We aimed to evaluate whether continuous cuff pressure control (CPC) was associated with reduced VARI incidence compared with intermittent CPC. Methods We conducted a multicenter open-label randomized controlled trial in intensive care unit (ICU) patients within 24 hours of intubation in Vietnam. Patients were randomly assigned 1:1 to receive either continuous CPC using an automated electronic device or intermittent CPC using a manually hand-held manometer. The primary endpoint was the occurrence of VARI, evaluated by an independent reviewer blinded to the CPC allocation. Results We randomized 600 patients; 597 received the intervention or control and were included in the intention to treat analysis. Compared with intermittent CPC, continuous CPC did not reduce the proportion of patients with at least one episode of VARI (74/296 [25%] vs 69/301 [23%]; odds ratio [OR] 1.13; 95% confidence interval [CI] .77–1.67]. There were no significant differences between continuous and intermittent CPC concerning the proportion of microbiologically confirmed VARI (OR 1.40; 95% CI .94–2.10), the proportion of intubated days without antimicrobials (relative proportion [RP] 0.99; 95% CI .87–1.12), rate of ICU discharge (cause-specific hazard ratio [HR] 0.95; 95% CI .78–1.16), cost of ICU stay (difference in transformed mean [DTM] 0.02; 95% CI −.05 to .08], cost of ICU antimicrobials (DTM 0.02; 95% CI −.25 to .28), cost of hospital stay (DTM 0.02; 95% CI −.04 to .08), and ICU mortality risk (OR 0.96; 95% CI .67–1.38). Conclusions Maintaining CPC through an automated electronic device did not reduce VARI incidence. Clinical Trial Registration NCT02966392.
Multimedia resources in the twenty-first century primarily consist of verbal and audio-visual representations that, if properly processed, make it possible to create an integrated mental model of learning. Although these tools are commonly used in language education, successful use of multimedia learning resources in second language teaching and learning contexts remains a challenge. In particular, although much of how learners learn from verbal representations is understood, there is less insight into visual knowledge processing, either alone or in conjunction with texts in language teaching. This chapter aims to provide a set of theoretical frameworks and a realistic planning structure designed to inform the planning and design of more efficient digital content integration into language teaching and learning contexts. Based on a cognitive linguistics view aligned with dual coding and cognitive load theory, the chapter critically reviews and presents the differences in the way verbal and visual texts and pictures represent knowledge to second language learners. The next segment addresses issues in building a multimedia learning culture. Also, the role of individual differences in the processing of multimedia resources is highlighted. The chapter concludes with methodological recommendations on the crucial part of interdisciplinary analysis and evaluation methods in this field.
Virtual Learning Environment (VLE) systems have been widely used in higher education as an effective e-learning platform. With its large user community and virtual facilities in various disciplines, including education, recreation, tourism, business, etc. Second Life (SL) has become one of the most dominant VLE systems for hospitality and tourism training. With better student devices and a faster internet connection, language education in Vietnam recently saw soaring interest in using SL for training, especially in an ESP area like English for hospitality and tourism. However, there is still very little research on the effectiveness of SL VLE for language training in hospitality and tourism. This fifteen-week quasi-experimental study was conducted on two classes (n = 81) in order to investigate the effectiveness of SL VLE for language training in hospitality and tourism with a focus on speaking skills. The instruments included English speaking tests, an attitudinal questionnaire, and a semi-structured interview. The findings of the study indicated that language training activities in SL positively contributed to students' language proficiency progress. Besides, students have positive perceptions about the use of SL VLE in their training. It is recommended that language training programs in hospitality and tourism make more substantial use of virtual restaurants, hotels, resorts, and entertainment places in SL to enrich students' learning experience. Hospitality and tourism training institutions should spend resources on formal SL VLE training for teachers and students and build their SL facilities.
Research on idioms from the point of view of cognitive linguistics, in particular through conceptual metaphor and conceptual metonymy in cognitive semantics, has been steadily growing. While there have been quite a few investigations into the role of conceptual metaphors in meaning formation, conceptual metonymies are still left underexplored. This article examines the role of metonymic conceptualization of personality in English and Vietnamese idioms containing "head", "face" and “eyes” from the conceptual metonymy theory of cognitive linguistics. With analyzed examples from 713 English languages and 947 Vietnamese idioms of body parts collected, the article shows that metonymic conceptualization plays an essential part in the formation of meaning. There are many similarities in the way "head", "face" and “eyes” are conceptualized for personality in both English and Vietnamese cultures. However, why Vietnamese body part idioms use a lot of symbolic pairs, English idioms do not. The study suggests more attention to conceptual metonymy in teaching idioms in order to help students infer idiomatic meanings. Rather than asking students to learn by heart the composite meaning of idioms, teachers should encourage them to guess the idiomatic meaning. Besides, conceptual metonymy should be explained to students since it helps language learners infer idiomatic meaning and retain it longer.
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