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A noncontingent experience affects the subsequent detection of positive and negative contingencies between the same events, Experiments 1 and 2 showed that such preexposure can produce both an impainnent in the detection of subsequent positive contingency and a facilitation of a negative one, independent of the level of contingency during the contingent phase. Experiment 3 raised difficulties for a model that assumes that associations to the context can explain this asymmetrical effect. Experiment 4 suggested that the different weights usually assigned to the different types of trials when computing the contingency between events can change as a result of a noncontingent experience with the same events. This change supports an account of the asymmetrical effect by a belief revision model based on a mechanism that updates the weights of the different trial types as a function of previous experience. More generally, the belief revision model is a statistical (i.e., nonassociative) model of learning that is capable of accounting for trial-order effects, which have long posed problems for statistical models.

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Background:The ABCDE bundle is a set of evidence-based practices to systematically reduce the risks of sedation, delirium, and immobility in intensive care patients.Implementing the bundle improves clinical outcome. Aims andObjectives: To investigate the association between patient outcomes and compliance with bundle components ABC (analgosedation algorithms), D (delirium protocol), and E (early mobilization protocol). Design: A Spanish multicentre cohort study of adult patients receiving invasive mechanical ventilation (IMV) for ≥48 h until extubation. Methods: The primary outcome was pain level, cooperation to permit Medical Research Council Scale administration, patient days of delirium, and mobility. The secondary outcome was cumulative drug dosing by IMV days. Tertiary outcomes (ICU days, IMV days, bed rest days, ICU mortality, ICUAW) and independent variables (analgosedation, delirium, early mobilization protocols) were also studied. Results: Data were collected from 605 patients in 80 ICUs and 5214 patient days with IMV. Two-thirds of the ICUs studied applied no protocols. Pain was not assessed on 83.6% of patient days. Patient cooperation made scale administration feasible on 20.7% of days. Delirium and immobility were found on 4.2% and 69.9% of days, respectively. Patients had shorter stays in ICUs with bundle protocols and fewer days of IMV in ICUs with delirium and mobilization bundle components (P = 0.006 and P = 0.03, respectively). Analgosedation protocols were associated with more opioid dosing