Using the IRAP to explore natural language statements

This study explored a modification to the typical presentation of label and target stimuli on Implicit Relational Assessment Procedure (IRAP) effects. We asked whether combining the labels and targets into a single phrase would influence performances. The key purpose of the study was to determine the feasibility of altering the way in which stimuli are presented within the IRAP, so as to potentially employ more complex natural language-like statements in future research. In the Typical IRAP employed here, labels and targets were presented as separate words, while in the Natural Language IRAP they were combined to form a single statement. The results demonstrated no substantive differences in the effects recorded on both types of IRAP, thus supporting the future use of a Natural Language version

The on-going search for perspective-taking IRAPs : exploring the potential of the natural language-IRAP

Under a Relational Frame Theory (RFT) framework, researchers have investigated the role of deictic relational responding (perspective-taking) in the analysis of self in relation to others, place, and time. The aim of the current research was to develop IRAPs that targeted deictic relational responding with regard to the mental states of self and others. This was pursued in a series of experiments that employed a novel version of the IRAP, known as the Natural Language-IRAP (NL-IRAP). The use of the NL-IRAP allowed for the presentation of relatively complex statements that required participants to infer the thoughts or beliefs of others on a trial-by-trial basis within the IRAP. Across a sequence of six experiments, a self-focused IRAP required participants to respond to both positive and negative statements about themselves, whereas an other-focused IRAP required participants to respond to similar statements about others. Experiments 1 and 2 investigated perspective-taking with regard to an unspecified other. Experiments 3-6 investigated perspective-taking with regard to a specified other, with the specified relationship between self and other manipulated across experiments. The results of Experiments 1 and 2 indicated that the other-focused IRAP produced overall bias scores that were significantly stronger than responding to the self-focused IRAP. It is interesting that nonsignificant differences were recorded across Experiments 3-6 when other was specified. The findings obtained across the six studies highlight potentially important limitations in the use of the NL-IRAP as a measure of perspective-taking

Development and implementation of an ultralow-dose CT protocol for the assessment of cerebrospinal shunts in adult hydrocephalus

Background: Cerebrospinal fluid shunts in the treatment of hydrocephalus, although associated with clinical benefit, have a high failure rate with repeat computed tomography (CT) imaging resulting in a substantial cumulative radiation dose. Therefore, we sought to develop a whole-body ultralow-dose (ULD) CT protocol for the investigation of shunt malfunction and compare it with the reference standard, plain radiographic shunt series (PRSS). Methods: Following ethical approval, using an anthropomorphic phantom and a human cadaveric ventriculoperitoneal shunt model, a whole-body ULD-CT protocol incorporating two iterative reconstruction (IR) algorithms, pure IR and hybrid IR, including 60% filtered back projection and 40% IR was evaluated in 18 adult patients post new shunt implantation or where shunt malfunction was suspected. Effective dose (ED) and image quality were analysed. Results: ULD-CT permitted a 36% radiation dose reduction (median ED 0.16 mSv, range 0.07–0.17, versus 0.25 mSv (0.06–1.69 mSv) for PRSS (p = 0.002). Shunt visualisation in the thoracoabdominal cavities was improved with ULD-CT with pure IR (p = 0.004 and p = 0.031, respectively) and, in contrast to PRSS, permitted visualisation of the entire shunt course (p < 0.001), the distal shunt entry point and location of the shunt tip in all cases. For shunt complications, ULD-CT had a perfect specificity. False positives (3/22, 13.6%) were observed with PRSS. Conclusions: At a significantly reduced radiation dose, whole body ULD-CT with pure IR demonstrated diagnostic superiority over PRSS in the evaluation of cerebrospinal fluid shunt malfunction

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570