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Introduction Multipass membrane proteins cross lipid bilayers multiple times with specific topologies essential for their function. The multipass membrane proteins that contain a lumenal N-terminus require the endoplasmic reticulum (ER) [...], Multipass membrane proteins have a myriad of functions, including transduction of cell-cell signals, ion transport, and photoreception. Insertion of these proteins into the membrane depends on the endoplasmic reticulum (ER) membrane protein complex (EMC). Recently, birth defects have been observed in patients with variants in the gene encoding a member of this complex, EMC1. Patient phenotypes include congenital heart disease, craniofacial malformations, and neurodevelopmental disease. However, a molecular connection between EMC1 and these birth defects is lacking. Using Xenopus, we identified defects in neural crest cells (NCCs) upon emcl depletion. We then used unbiased proteomics and discovered a critical role for emcl in WNT signaling. Consistent with this, readouts of WNT signaling and Frizzled (Fzd) levels were reduced in emcl-depleted embryos, while NCC defects could be rescued with [beta]-catenin. Interestingly, other transmembrane proteins were mislocalized upon emcl depletion, providing insight into additional patient phenotypes. To translate our findings back to humans, we found that EMC1 was necessary for human NCC development in vitro. Finally, we tested patient variants in our Xenopus model and found the majority to be loss-of-function alleles. Our findings define molecular mechanisms whereby EMC1 dysfunction causes disease phenotypes through dysfunctional multipass membrane protein topogenesis.

Aphasia is one of the most common and debilitating consequences of stroke affecting the dominant hemisphere. Most individuals with aphasia experience some degree of recovery of language function after a [...], Purpose: Recovery from aphasia after stroke has a decelerating trajectory, with the greatest gains taking place early and the slope of change decreasing over time. Despite its importance, little is known regarding evolution of language function in the early postonset period. The goal of this study was to characterize the dynamics and nature of recovery of language function in the acute and early subacute phases of stroke. Method: Twenty-one patients with aphasia were evaluated every 2-3 days for the first 15 days after onset of acute ischemic or hemorrhagic stroke. Language function was assessed at each time point with the Quick Aphasia Battery (Wilson, Eriksson, Schneck, & Lucanie, 2018), which yields an overall summary score and a multidimensional profile of 7 different language domains. Results: On a 10-point scale, overall language function improved by a mean of 1.07 points per week, confidence interval [0.46, 1.71], with 19 of 21 patients showing positive changes. The trajectory of recovery was approximately linear over this time period. There was significant variability across patients, and patients with more impaired language function at Day 2 poststroke experienced greater improvements over the subsequent 2 weeks. Patterns of recovery differed across language domains, with consistent improvements in word finding, grammatical construction, repetition, and reading, but less consistent improvements in word comprehension and sentence comprehension. Conclusion: Overall language function typically improves substantially and steadily during the first 2 weeks after stroke, driven mostly by recovery of expressive language. Information on the trajectory of early recovery will increase the accuracy of prognoses and establish baseline expectations against which to evaluate the efficacy of interventions. Supplemental Material: https://doi.org/10.23641/asha. 7811876

Abstract Among downtowns of North American metropolitan regions, two have performed especially well in terms of the presence of employment, residential development and diversity of land uses over the last [...]

Author(s): Alexander W. Charney [sup.1] , Nicole W. Simons [sup.1] , Konstantinos Mouskas [sup.1] , Lauren Lepow [sup.1] , Esther Cheng [sup.1] , Jessica Le Berichel [sup.1] , Christie Chang [...]

CAN ANDROIDS PLEAD AUTOMATISM? A REVIEW OF WHEN ROBOTS KILL: ARTIFICIAL INTELLIGENCE UNDER THE CRIMINAL LAW BY GABRIEL HALLEVY Humans have long feared the darker side of artificial intelligence (AI). [...]

Introduction While fear is a short-duration defensive response to clearly identifiable impending danger, anxiety is a more sustained feeling of apprehension or dread about uncertain future threat. (1) A wealth [...], Background: Neuroimaging research has traditionally explored fear and anxiety in response to discrete threat cues (e.g., during fear conditioning). However, anxiety is a sustained aversive state that can persist in the absence of discrete threats. Little is known about mechanisms that maintain anxiety states over a prolonged period. Here, we used a robust translational paradigm (threat of shock) to induce sustained anxiety. Recent translational work has implicated an amygdala-prefrontal cortex (PFC) circuit in the maintenance of anxiety in rodents. To explore the functional homologues of this circuitry in humans, we used a novel paradigm to examine the impact of sustained anticipatory anxiety on amygdala-PFC intrinsic connectivity. Methods: Task-independent fMRI data were collected in healthy participants during long-duration periods of shock anticipation and safety. We examined intrinsic functional connectivity. Results: Our study involved 20 healthy participants. During sustained anxiety, amygdala activity was positively coupled with dorsomedial PFC (DMPFC) activity. High trait anxiety was associated with increased amygdala-DMPFC coupling. In addition, induced anxiety was associated with positive coupling between regions involved in defensive responding, and decreased coupling between regions involved in emotional control and the default mode network. Limitations: Inferences regarding anxious pathology should be made with caution because this study was conducted in healthy participants. Conclusion: Findings suggest that anticipatory anxiety increases intrinsic amygdala-DMPFC coupling and that the DMPFC may serve as a functional homologue for the rodent prefrontal regions by sustaining anxiety. Future research may use this defensive neural context to identify biomarkers of risk for anxious pathology and target these circuits for therapeutic intervention.

Sustainability is a fast evolving movement in higher education demonstrated by a proliferation of academic programs, co-curricular initiatives, and campus projects. Sustainability is now viewed as vital to the mission of many institutions of higher education, creating a paradigm shift that librarians can help advance with their collective interdisciplinary expertise. A review of LibGuides (online resource guides) showed that academic librarians are involved with sustainability efforts on many campuses and have a role in shaping curriculum-related activities. The author administered a survey to creators of sustainability LibGuides during the spring of 2011, posting the survey on library listservs as well. Librarians returned 112 survey responses that illustrated their engagement in sustainability activities through the forging of campus partnerships with administrators, faculty, staff from the Office of Sustainability, and library colleagues. Telephone interviews conducted with 24 of the respondents showed librarians' wide-ranging professional interest in sustainability, and their initiatives to promote its cause, including creating resources, collections, exhibits, and events; library instruction; co-teaching with faculty; serving on sustainability committees; and collaborating with sustainability faculty and staff. However, both the survey and the interviews suggest that librarians would benefit from increased collaboration and knowledge of work undertaken elsewhere. Moreover, as the needs of students and faculty studying sustainability increase, libraries need to appoint librarians with special responsibilities in this field. Included is the author's experience as the Sustainability Studies Librarian at the University of Massachusetts Amherst and her engagement in professional development activities related to sustainability. Best practices for librarians to advance sustainability efforts are offered. Keywords: Sustainability; Curriculum; Partnerships, Introduction As of March 2014, 680 presidents of universities and colleges have signed the American College and University President's Climate Commitment (ACUPCC) which both promotes sustainable facilities management and drives [...]

Human immunodeficiency virus (HIV)-1-associated nephropathy (HIVAN) is characterized by proliferation of glomerular and tubular epithelial cells. We studied the role of epithelial mesenchymal transdifferentiation (EMT) in the development of HIVAN phenotype. Renal cortical sections from six FVB/N (control) and six Tg26 (HIVAN) mice were immunolabeled for PCNA, [alpha]-smooth muscle actin ([alpha]-SMA), fibroblast-specific protein-1 (FSP1), CD3, and F4/80. Since periglomerular cells (PGCs) and peritubular cells (PTCs) did not show any labeling for CD3 and F4/80 but showed labeling for [alpha]-SMA or FSP1, it appears that these were myofibroblasts that migrated from either glomerular or tubular sites, respectively. Occurrence of EMT was also supported by diminished expression of E-cadherin by renal epithelial cells in Tg26 mice. Interestingly, Tg26 mice also showed enhanced renal tissue expression of ZEB2; henceforth, it appears that transcription of molecules required for maintenance of de novo renal epithelial cell phenotype was suppressed. To evaluate the role of ANG II, Tg26 mice in groups of three were administered either normal saline or telmisartan (an [AT.sub.1] receptor blocker) for 2 wk, followed by evaluation for renal cell EMT. Renal cortical section of Tg26 mice showed a sevenfold increase (P < 0.001) in parietal epithelial cell (PEC)-PGC and a threefold increase (P < 0.01) in tubular cell (TC)-PTC proliferation (PCNA-positive cells). Similarly, both PECs-PGCs and TCs-PTCs in Tg26 mice showed enhanced expression of [alpha]-SMA and FSP1. Both PECs and podocytes contributed to the glomerular proliferative phenotype, but the contribution of PECs was much greater. Telmisartan-receiving Tg26 mice (TRM) showed attenuated number of proliferating PECs-PGCs and TCs-PTCs compared with saline-receiving Tg26 mice (SRM). Similarly, TRM showed diminished expression of [alpha]-SMA and FSP1 by both PECs-PGCs and TCs-PTCs compared with SRM. We conclude that EMT contributes to the manifestation of the proliferative phenotype in HIVAN mice. human immunodeficiency virus-1-associated nephropathy; renal epithelial cells; smooth muscle actin doi:10.1152/ajprenal.00415.2009

Fire lines are complex phenomena with a broad range of scales of cross-line dimension, undulations, and along-line variation in heating rates. While some earlier studies have examined parcel processes in two-dimensional simulations, the complexity of fire lines in nature motivates a study in which the impact of three-dimensional fire line details on parcel processes is examined systematically. This numerical modeling study aims to understand how fundamental processes identified in 2D simulations operate in 3D simulations where the fire line is neither straight nor uniform in intensity. The first step is to perform simulations in a 3D model, with no fire line undulations or inhomogeneity. In general, convective modes simulated in the 2D model are reproduced in the 3D model. In one particular case with strong vertical wind shear, new convection develops separate from the main line of convection as a result of local changes to parcel speed and heating. However, in general the processes in the 2D and 3D simulations are identical. The second step is to examine 3D experiments wherein fire line shape and along-line inhomogeneity are varied. Parcel heating, as well as convective mode, is shown to exhibit sensitivity to fire line shape and along-line inhomogeneity. DOI: 10.1175/2009JAS3226.1

Wildfires are capable of inducing atmospheric circulations that result predominantly from large temperature anomalies produced by the fire. The fundamental dynamics through which a forest fire and the atmosphere interact to yield different convective regimes is still not well understood. This study uses the Advanced Regional Prediction System (ARPS) model to investigate the impact of the environmental (i.e., far upstream, undisturbed by fire) wind profile on dry convection above a prescribed heat source of an intensity and spatial scale comparable to a wildfire. Dimensional analysis of the fire-atmosphere problem provides two relevant parameters: a surface buoyancy parameter that addresses the amount of heat a parcel of air receives in transiting above the fire and an advection parameter that addresses the degree to which the environmental wind advects updrafts away from the fire. Two-dimensional simulations are performed in which the upstream surface wind speed and mixed layer mean wind speed are varied independently to better understand the fundamental processes governing the organizational mode and updraft strength. The result of these experiments is the identification of two primary classes of dry convection: plume and multicell. Simulated plume cases exhibit weak advection by the mean wind and are subdivided into intense plume and hybrid classes based on the degree of steadiness within the convection column. Hybrid cases contain columns of largely discrete updrafts versus the more continuous updraft column associated with the intense plume mode. Multicell cases develop with strong mixed layer advection and are subdivided into strong and weak classes based on the depth of convection. Intense plume and strong multicell (hybrid and weak multicell) cases occur when the surface buoyancy is large (small). Parcel analyses are performed to more closely examine the forcing of convection within different areas of the parameter space. The multicell (strong and weak) and intense plume modes are forced by a combination of buoyancy and dynamic pressure gradient forcing associated with the perturbation wind field, whereas the hybrid mode is forced by a combination of buoyancy and dynamic pressure gradient forcing associated with the strong background shear. The paper concludes with a discussion of the degree of nonlinearity that is likely to exist at the fire front for each of the convective modes; nonlinear fire behavior is most likely for the hybrid mode and least likely for the weak multicell mode. Knowledge of the sensitivity of the convective mode to upstream conditions can provide information about the degree of nonlinear or erratic fire behavior expected for a given wind profile upstream of the fire.

This study has employed both observational data and numerical simulation results to diagnose the synoptic-scale and mesoscale environments conducive to forest fires during the October 2003 extreme fire event in southern California. A three-stage process is proposed to illustrate the coupling of the synoptic-scale forcing that is evident from the observations, specifically the high pressure ridge and the upper-level jet streak, which leads to meso-[alpha]-scale subsidence in its exit region, and the mesoscale forcing that is simulated by the numerical model, specifically the wave breaking and turbulence as well as the wave-induced critical level, which leads to severe downslope (Santa Ana) winds. Two surges of dry air were found to reach the surface in southern California as revealed in the numerical simulation. The first dry air surge arrived as a result of moisture divergence and isallobaric adjustments behind a surface cold front. The second dry air surge reached southern California as the meso-[alpha]- to meso-[beta]-scale subsidence and the wave-induced critical level over the coastal ranges phased to transport the dry air from the upper-level jet streak exit region toward the surface and mix the dry air down to the planetary boundary layer on the lee side of the coastal ranges in southern California. The wave-breaking region on the lee side acted as an internal boundary to reflect the mountain wave energy back to the ground and created severe downslope winds through partial resonance with the upward-propagating mountain waves.

This study examined posttraumatic growth in 30 male veterans captured and held as prisoners of war during the Vietnam War. Participants were assessed with structured diagnostic interviews administered by trained clinicians as well as with the Posttraumatic Growth Inventory (PTGI) and other questionnaires measuring dispositional optimism, religious coping, social supports, and purpose in life. Mean age (standard deviation-SD) of participants was 66.7 (6.0) years. Mean total PTGI score (SD) was 66.3 (17.5), indicating a moderate degree of posttraumatic growth. The most strongly endorsed items corresponded to the Appreciation of Life and Personal Strength factors. The group as a whole was optimistic and reported moderate use of positive religious coping. Posttraumatic growth did not significantly differ in repatriates with and without psychopathology, but it was significantly positively correlated with dispositional optimism. In the final regression model, length of captivity and optimism were significant predictors of posttraumatic growth. Our findings confirm that it is possible to achieve long-lasting personal growth even in the face of prolonged extreme adversity. Prospective studies are needed to further evaluate whether pre-existing traits such as optimism can predict growth after trauma.

BACKGROUND: The World Trade Center (WTC) attacks exposed thousands of workers to hazardous environmental conditions and psychological trauma. In 2002, to assess the health of these workers, Congress directed the [...]

Cold rolled Cu-24 wt% Ag composite and the effects of crystallographic structure and defect anisotropy and microstructure refinement on properties of the composite are analyzed. The curved lamellae seen in the rolling direction (RD) are attributed to the development of shear bands during rolling, where both the texture and shear bands are related to the anisotropy of the properties.

This paper investigates the consequence of using Rayleigh proportional damping in the analysis of inelastic structural systems. The discussion is presented theoretically, as well as by example through the analysis of a simple five-story structure. It is shown that when the stiffness portion of the system damping matrix is based on the original system stiffness, artificial damping is generated when the structure yields. When the damping matrix is based on the tangent stiffness but the Rayleigh proportionality constants are based on the initial stiffness, a significant but reduced amplification of damping occurs. When the damping is based on the tangent stiffness and on updated frequencies based on this stiffness, virtually no artificial damping occurs. The paper also investigates the influence on effective damping when localized yielding occurs in areas of concentrated inelasticity. In such cases, it is possible to develop artificial viscous damping forces that are extremely high, but that are not easy to detect. Such artificial damping forces may lead to completely invalid analysis. The paper ends with recommendations for performing analysis where the artificial damping is eliminated, or at least controlled. DOI: 10.1061/(ASCE)0733-9445(2008)134:4(581) CE Database subject headings: Damping; Nonlinear analysis; Structural analysis; Structural dynamics.

This study investigates the impact of wind speed and critical level height on dry convection above a prescribed heat source. This is done using the Advanced Regional Prediction System (ARPS) model in its two-dimensional form with an imposed 400-K soil potential temperature perturbation. The result of these experiments is the identification of three modes of convective plumes. The first, termed multicell convective plumes, is analogous to multicell convection generated from squall-line cold pools in the moist atmosphere. The second mode, a deep wave mode, consists of disturbances with wavelengths of 7-10 km and results from the multicell plumes perturbing the dynamically unstable shear flow centered at the critical level. The third mode, termed the intense fire plume, has stronger updrafts than the multicell mode and is marked by quasi-stationary movement and substantial low-level inflow and upper-level outflow. The presence of a critical level is shown to be crucial to the development of both the deep wave and intense plume modes. The intense fire plume mode is most consistent with the so-called fire storm, or conflagration phenomenon, in which strong updrafts and low-level indrafts can produce mesocyclones and tornadic fire whirls capable of significant damage. This study marks an important step in understanding the dynamics behind the fire storm phenomenon, as well as other types of convection (multicell and deep wave) that may be generated by a fire.

Objective: The purpose of this study is to examine processing of facial emotions in a sample of maltreated children showing high rates of post-traumatic stress disorder (PTSD). Maltreatment during childhood has been associated independently with both atypical processing of emotion and the development of PTSD. However, research has provided little evidence indicating how high rates of PTSD might relate to maltreated children's processing of emotions. Method: Participants' reaction time and labeling of emotions were measured using a morphed facial emotion identification task. Participants included a diverse sample of maltreated children with and without PTSD and controls ranging in age from 8 to 15 years. Maltreated children had been removed from their homes and placed in state custody following experiences of maltreatment. Diagnoses of PTSD and other disorders were determined through combination of parent, child, and teacher reports. Results: Maltreated children displayed faster reaction times than controls when labeling emotional facial expressions, and this result was most pronounced for fearful faces. Relative to children who were not maltreated, maltreated children both with and without PTSD showed enhanced response times when identifying fearful faces. There was no group difference in labeling of emotions when identifying different facial emotions. Conclusions: Maltreated children show heightened ability to identify fearful faces, evidenced by faster reaction times relative to controls. This association between maltreatment and atypical processing of emotion is independent of PTSD diagnosis. Keywords: Maltreatment; Emotional processing; PTSD; Children

Three analysis methods are compared for determining the equivalent viscous damping ratios in a simple one-story, one-bay system with three different added damping configurations. The analysis methods are modal strain energy using the undamped mode shapes, free vibration log decrement, and complex eigenvalue-eigenvector analysis. The damping configurations include a diagonal configuration, a horizontal configuration, and a toggle-braced system. For each of these systems, a variety of linkage stiffness and damper capacities are considered. In all cases the structure, exclusive of the dampers, is assumed to remain elastic. A brief discussion is provided for the behavior of systems with nonlinear viscous dampers. The results of the study show that significantly different values may be obtained for the effective viscous damping in the same system when different analysis approaches are used. For the toggle-braced system with relatively flexible linkages, it was shown that the modal strain energy approach consistently produced increasing effective damping with increased damper capacity, while the other two methods indicated the opposite results. Subsequent analysis of the toggle-braced structure using the complex eigenvalue-eigenvector approach showed that the effective system damping was indeed decreasing with an increased device damping constant, and that the behavior could be attributed to the axial flexibility of the toggle brace linkage. The analysis indicated that the greater the flexibility of the linkage relative to the damping constant of the device, the greater the phase difference between the deformational velocity in the device and the relative horizontal velocity of the story containing the device. While the phase shift is evident from response history analysis, the most efficient visualization tool is a plot of the damped mode shapes on a complex plane. DOI: 10.1061/(ASCE)0733-9445(2008)134:1(32) CE Database subject headings: Damping; Passive control; Seismic effects; Structural analysis; Structural dynamics; Computation.

This paper presents a summary of current practice and recent developments in the application of passive energy dissipation systems for seismic protection of structures. The emphasis is on the application of passive energy dissipation systems within the framing of building structures. Major topics that are presented include basic principles of energy dissipation systems, descriptions of the mechanical behavior and mathematical modeling of selected passive energy dissipation devices, advantages and disadvantages of these devices, development of guidelines and design philosophy for analysis and design of structures employing energy dissipation devices, and design considerations that are unique to structures with energy dissipation devices. A selection of recent applications of passive energy dissipation systems is also presented. DOI: 10.1061/(ASCE)0733-9445(2008)134:1(3) CE Database subject headings: Damping; Earthquake resistant structures; Seismic effects; Seismic tests; Vibration; Energy.

THIS WAS before everything changed. Before the death of Generalissimo Franco and the sweeping reforms that followed, when Spain was just another poverty-stricken country with a temperate climate--the kind of [...]

Grass fires, although not as intense as forest fires, present a major threat to life and property during periods of drought in the Great Plains of the United States. Recently, major wildland grass fires in Texas burned nearly 1.6 million acres and destroyed over 730 homes and 1320 other buildings. The fires resulted in the death of 19 people, an estimated loss of 10,000 head of livestock, and more than $628 million in damage, making the 2005/06 fire season the worst on record for the state of Texas. As an aid to fire management, various models have been developed to describe fire behavior. However, these models strongly emphasize fuels and fail to adequately consider the role of convective dynamics within the atmosphere and its interaction with the fire due to the lack of observational data. To fill this gap, an intensive field measurement campaign called FireFlux was conducted during February 2006 near Houston, Texas. The campaign employed a variety of instrument platforms to collect turbulence data at multiple levels within and immediately downwind of a 155 acre tall-grass prairie burn unit. This paper presents some first-time observations of atmospheric turbulent structures/fluxes associated with intense grass fires and provides a basis to further our understanding of the dynamics of grass fires and their interactions with the atmosphere.

Abstract: Before using a fluid dynamics physically based wildfire model to study wildfire, validation is necessary and model results need to be systematically and objectively analyzed and compared to real [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jada.2006.05.320 Byline: Kendra K. Kattelmann, Mary Hise, Mary Russell, Pam Charney, Milton Stokes, Charlene Compher Abstract: The objective of this study was to evaluate the evidence behind specific but common patient care decisions in support of enteral feedings for patients admitted to intensive care units. Six specific questions were developed and refined to address clinical outcomes specific to clinical practice decisions pertinent to enteral feeding of critically ill patients. The data sources consisted of an intensive literature review from five databases, using standardized search terms. Randomized controlled clinical trials, meta-analyses, consensus statements, reviews, US Food and Drug Administration alerts, and case reports were selected for study. Research reports were abstracted in detail and evaluated for research quality using the criteria developed by the American Dietetic Association. Consensus statements regarding the influence of specific enteral feeding methods on key clinical outcomes (ie, infectious complications, cost, length of hospital stay, and mortality) were developed and graded based on the quality of the available evidence. The data support the use of enteral over parenteral nutrition to reduce infectious complications and cost, and the initiation of enteral feedings within 24 to 48 hours of injury or admission to an intensive care unit to reduce infectious complications and length of hospital stay in head injury and trauma patients. Postpyloric tube placement is associated with reduced gastric residual volume and reflux, but adequately powered trials are not available to support prevention of aspiration pneumonia. Acceptance of gastric residual volumes of up to 250 mL may increase volume of formula delivered. Promotility agents are associated with reduced gastric residual volume. Feeding patients in the semirecumbent rather than supine position is associated with reduced aspiration pneumonia and pharyngoesophageal formula reflux. Actual delivery of 14 to 18 kcal/kg/day or 60% to 70% of goal is associated with improved outcomes, whereas greater intake may not be in some populations. Blue food coloring should not be used with enteral feedings due to its limited sensitivity for aspiration and some risk of mortality. Well-designed, adequately powered, randomized controlled clinical trials are needed to evaluate any benefit of tube tip position on aspiration pneumonia or mortality, and of early enteral feedings on mortality.

The objective of this study was to evaluate the evidence behind specific but common patient care decisions in support of enteral feedings for patients admitted to intensive care units. Six specific questions were developed and refined to address clinical outcomes specific to clinical practice decisions pertinent to enteral feeding of critically ill patients. The data sources consisted of an intensive literature review from five databases, using standardized search terms. Randomized controlled clinical trials, meta-analyses, consensus statements, reviews, US Food and Drug Administration alerts, and case reports were selected for study. Research reports were abstracted in detail and evaluated for research quality using the criteria developed by the American Dietetic Association. Consensus statements regarding the influence of specific enteral feeding methods on key clinical outcomes (ie, infectious complications, cost, length of hospital stay, and mortality) were developed and graded based on the quality of the available evidence. The data support the use of enteral over parenteral nutrition to reduce infectious complications and cost, and the initiation of enteral feedings within 24 to 48 hours of injury or admission to an intensive care unit to reduce infectious complications and length of hospital stay in head injury and trauma patients. Postpyloric tube placement is associated with reduced gastric residual volume and reflux, but adequately powered trials are not available to support prevention of aspiration pneumonia. Acceptance of gastric residual volumes of up to 250 mL may increase volume of formula delivered. Promotility agents are associated with reduced gastric residual volume. Feeding patients in the semirecumbent rather than supine position is associated with reduced aspiration pneumonia and pharyngoesophageal formula reflux. Actual delivery of 14 to 18 kcal/kg/day or 60% to 70% of goal is associated with improved outcomes, whereas greater intake may not be in some populations. Blue food coloring should not be used with enteral feedings due to its limited sensitivity for aspiration and some risk of mortality. Well-designed, adequately powered, randomized controlled clinical trials are needed to evaluate any benefit of tube tip position on aspiration pneumonia or mortality, and of early enteral feedings on mortality.

While several studies have found high rates of trauma exposure there is limited information on posttraumatic stress disorder (PTSD) and its relationship to depression in the African American population. The prevalence and/or expression of psychiatric disorders can differ between racial/ethnic groups. The authors review literature addressing trauma exposure, prevalence, and expression of PTSD in the African American population. Risk factors that may be of specific significance to the development of PTSD in African Americans are also reviewed. Additionally, treatment issues and potential directions for future research of PTSD in the African American population are discussed. Keywords: posttraumatic stress disorder; African Americans; prevalence; trauma exposure

The genetic predictors of treatment outcome in 1,953 patients with major depressive disorder who were treated with the antidepressant citalopram in the Sequenced Treatment Alternatives for Depression (STAR*D) study is presented. When considered along with the previous neurobiological findings, the new genetic data make a compelling case for a key role of the HTR2A in the mechanism of antidepressant action.

By and large, the downtowns of Canada's largest cities have remained important business nodes within their metropolitan regions, even though they have experienced some dimensions of decline. This fact can be ascribed to political, economic and social factors. The focus of this paper is on the property dimension: the structure of property ownership and the role of property developers. Large and powerful property developers and owners (property development firms, banks, life insurance companies and, more recently, pension funds) control a substantial stake in downtown top-quality commercial properties. These agents attempt to reinforce the prominence of downtowns to keep the outstanding performance of their assets. Developers consider Canadian downtowns sale investment outlets in which they hold core assets. Through proactive measures they sustain the health of downtowns., En general, c'est dans le centre-ville des plus grandes cites canadiennes que se deroule la vie industrielle et economique de la region bien qu'ils aient subi dernierement un certain declin. [...]

Suburban city centres and office parks are among the prominent forms of suburban development in the Toronto region. Suburban city centres combine civic and business functions whereas office parks were designed to accommodate business requirements. Drawing on the largest suburban municipality in the Toronto region, the City of Mississauga, this paper examines two cases: Mississauga City Centre and Heartland Business Community. Suburban city centres wish to replicate some urban qualities that generate big-city identity whereas other parts of the suburban realm remain driven primarily by corporate considerations. Les centres-villes de banlieue et les centres commerciaux sont les formes les plus importantes caracterisant le developpement peripherique de la region de Toronto. Les centres-villes de banlieue combinent a la fois des fonctions civiques et commerciales, alors que les centres commerciaux sont supposes repondre a des besoins exclusivement commerciaux. Se penchant sur l'etude de la plus grande municipalite de banlieue de la region de Toronto, la ville de Mississauga, ce travail examinera deux cas: celui du centre ville de Mississauga et celui de la communaute commerciale de Heartland. Les centres-villes de banlieue voudraient appliquer a leur profit certaines caracteristiques urbaines qui ont permis la creation d'une identite de grande ville (metropolitaine) alors que d'autres oeloements de la vie de banlieue continuent s'en tenir comme par le passe a des considerations de collectif., During the past several decades, many observers have attempted to define and classify the dynamic form of commercial functions across suburban areas. Exploring dimensions like size, function, density and accessibility, [...]

The mortality of chronic heart failure (CHF) doubles either when CHF patients are depressed or when their plasma norepinephrine (NE) level exceeds those of controls by [approximately equal to] 40%. We hypothesized that patients with major depression had centrally driven, sustained, stress-related, and treatment-reversible increases in plasma NE capable of increasing mortality in CHF patients with depression. We studied 23 controls and 22 medication-free patients with melancholic depression. In severely depressed patients before and after electroconvulsive therapy (ECT), we measured cerebrospinal fluid (CSF) NE, plasma NE, plasma epinephrine (EPI), and plasma cortisol hourly for 30 h. In mildly-to-moderately depressed melancholic patients, we assessed basal and stress-mediated arterial NE appearance. Severely depressed patients had significant increases in mean around-the-clock levels of CSF NE (P < 0.02), plasma NE (P < 0.02), plasma EPI (P < 0.02), and plasma cortisol (P < 0.02). CSF NE, plasma NE, and cortisol all rose together throughout the night and peaked in the morning. Each fell to control values after ECT. Mildly-to-moderately melancholic patients also had increased basal (P < 0.05) and stress-related (P < 0.03) arterial NE-appearance rates. Severely melancholic depressed, medication-free patients had around-the-clock increases in plasma NE levels capable of increasing mortality in CHF. Twenty-four-hour indices of central noradrenergic, adrenomedullary, and adrenocortical secretion were also elevated. Concurrent diurnal rhythms of these secretions could potentiate their cardiotoxicity. Even mildly-to-moderately depressed melancholic patients had clinically relevant increases in the arterial NE-appearance rate. These findings will not apply to all clinical subtypes of major depression. cerebrospinal fluid | epinephrine | major depression | cardiovascular disease | chronic heart failure

Previous studies have shown that a single dose of methyl-naltrexone, a unique peripheral opioid antagonist, reverses opioid-induced gut hypomotility in humans. Because repeated drug doses are likely to be needed [...]

Author(s): Alexander W. Charney [sup.1] , Nicole W. Simons [sup.1] , Konstantinos Mouskas [sup.1] , Lauren Lepow [sup.1] , Esther Cheng [sup.1] , Jessica Le Berichel [sup.1] , Christie Chang [...], A Correction to this paper has been published: https://doi.org/10.1038/s41591-021-01247-3.