Blood Pressure in Acute Stroke and Secondary Stroke Prevention.

PURPOSE OF REVIEW: Hypertension is common in patients presenting with stroke and is independently associated with unfavorable outcomes. This article reviews current guidelines for early management of blood pressure (BP) and highlights the findings of recent investigative works. RECENT FINDINGS: Intensive blood pressure reduction after receiving alteplase has not been shown to improve outcomes. Patients with large vessel occlusions may benefit from lower blood pressure targets post-intervention. Retrospective analyses of large intracerebral hemorrhage trials suggest that specific subgroups of patients may disproportionately benefit from or be harmed by intensive BP reduction. Robust data for management of blood pressure in subarachnoid hemorrhage patients is lacking and expert consensus continues to guide decision-making. Despite the impact of hypertension on outcomes, most prospective trials assessing efficacy of blood pressure reduction have yielded neutral or inconclusive results. Further trials are necessary to determine which patient populations are most likely to benefit from blood pressure control.

The Role of BDNF-TrkB Signaling in the Pathogenesis of PTSD.

Posttraumatic Stress Disorder (PTSD) is a prevalent, chronic, and disabling anxiety disorder that may develop following exposure to a traumatic event. The majority of individuals with PTSD often have comorbid psychiatric conditions such as major depression, generalized anxiety disorder, and substance use disorders, and are at increased risk for suicide. Despite the public health significance of PTSD, relatively little is known about the etiology or pathophysiology of this disorder, and pharmacotherapy development to date has been largely opportunistic instead of mechanism-based. One promising target for modulation is Tropomyosin Receptor Kinase B (TrkB), the receptor for Brain-Derived Neurotrophic Factor (BDNF), a signaling pathway important for neuronal plasticity, survival, and growth. The following discusses how genetic and environmental alterations to this signaling pathway may contribute to anatomical and functional changes in the hippocampus, amygdala, anterior cingulate cortex, ventromedial prefrontal cortex, and the nucleus accumbens. Changes in these brain regions may in turn contribute to the predisposition to or maintenance of some of the clinical manifestations of PTSD, including intrusive memories, hyperarousal, increased fear, and emotional numbing.

The coronal fricative problem.

This paper examines a range of predicted versus attested error patterns involving coronal fricatives (e.g. [s, z, θ, ð]) as targets and repairs in the early sound systems of monolingual English-acquiring children. Typological results are reported from a cross-sectional study of 234 children with phonological delays (ages 3 years; 0 months to 7;9). Our analyses revealed different instantiations of a putative developmental conspiracy within and across children. Supplemental longitudinal evidence is also presented that replicates the cross-sectional results, offering further insight into the life-cycle of the conspiracy. Several of the observed typological anomalies are argued to follow from a modified version of Optimality Theory with Candidate Chains (McCarthy, 2007).

On the interaction of deaffrication and consonant harmony.

Error patterns in children's phonological development are often described as simplifying processes that can interact with one another with different consequences. Some interactions limit the applicability of an error pattern, and others extend it to more words. Theories predict that error patterns interact to their full potential. While specific interactions have been documented for certain pairs of processes, no developmental study has shown that the range of typologically predicted interactions occurs for those processes. To determine whether this anomaly is an accidental gap or a systematic peculiarity of particular error patterns, two commonly occurring processes were considered, namely Deaffrication and Consonant Harmony. Results are reported from a cross-sectional and longitudinal study of twelve children (age 3 ; 0-5 ; 0) with functional phonological delays. Three interaction types were attested to varying degrees. The longitudinal results further instantiated the typology and revealed a characteristic trajectory of change. Implications of these findings are explored.

On the anatomy of a chain shift.

Phonological chain shifts have been the focus of many theoretical, developmental, and clinical concerns. This paper considers an overlooked property of the problem by focusing on the typological properties of the widely attested 's > θ > f' chain shift involving the processes of Labialization and Dentalization in early phonological development. Findings are reported from a cross-sectional study of 234 children (ages 3 years; 0 months-7;9) with functional (nonorganic) phonological delays. The results reveal some unexpected gaps in the predicted interactions of these processes and are brought to bear on the evaluation of recent optimality theoretic proposals for the characterization of phonological interactions. A developmental modification to the theory is proposed that has the desired effect of precluding certain early-stage grammars. The proposal is further evaluated against the facts of another widely cited developmental chain shift known as the 'puzzle > puddle > pickle' problem (Smith 1973).

On the interaction of velar fronting and labial harmony.

This article documents the typological occurrence and interactions of two seemingly independent error patterns, namely Velar Fronting and Labial Harmony, in a cross-sectional investigation of the sound systems of 235 children with phonological delays (ages 3;0 to 7;9). The results revealed that the occurrence of Labial Harmony depends on the occurrence of Velar Fronting, and that, when these processes co-occurred, all three predicted types of interactions were attested. A constrained version of Optimality Theory is put forward that offers a unified explanation for the implicational relationship between these error patterns and their observed interactions. The findings are compared with the results from other studies and are considered for their theoretical and clinical implications.

EMERGENT SYLLABLE COMPLEXITY IN COLLOQUIAL BAMANA.

Data from two varieties of Bamanankan, or Bambara, a Mande language spoken in Mali and surrounding nations, illustrate differences in permissible syllable shapes between the variants. A comparison of the Classic variety of the language spoken in Ségou and that spoken by a younger cohort of individuals in the Malian capital reveals that the latter variety is synchronically developing complex CCV and CVC syllable shapes primarily through vocalic syncope, whereas the classical variety permits only maximal CV syllables. Data presented in this study show that this complexification of syllables in Bamako Bamana is one manifestation of the overall drive towards word minimization in this variety of the language. These data illustrate that this variety of Bamana has preferential patterns of deletion that are largely dependent on phonotactic constraints and permissible syllable contact that results from syncope. Additionally, other processes that interact with syncope or prevent it from occurring are explored.