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HORMAD1 expression is usually restricted to germline cells, but it becomes mis-expressed in epithelial cells in ~60% of triple-negative breast cancers (TNBCs), where it is associated with elevated genomic instability (1). HORMAD1 expression in TNBC is bimodal with HORMAD1-positive TNBC representing a biologically distinct disease group. Identification of HORMAD1-driven genetic dependencies may uncover novel therapies for this disease group. To study HORMAD1-driven genetic dependencies, we generated a SUM159 cell line model with doxycycline-inducible HORMAD1 that replicated genomic instability phenotypes seen in HORMAD1-positive TNBC (1). Using small interfering RNA screens, we identified candidate genes whose depletion selectively inhibited the cellular growth of HORMAD1-expressing cells. We validated five genes (ATR, BRIP1, POLH, TDP1 and XRCC1), depletion of which led to reduced cellular growth or clonogenic survival in cells expressing HORMAD1. In addition to the translesion synthesis (TLS) polymerase POLH, we identified a HORMAD1-driven dependency upon additional TLS polymerases, namely POLK, REV1, REV3L and REV7. Our data confirms that out-of-context somatic expression of HORMAD1 can lead to genomic instability and reveals that HORMAD1 expression induces dependencies upon replication stress tolerance pathways, such as translesion synthesis. Our data also suggest that HORMAD1 expression could be a patient selection biomarker for agents targeting replication stress.

Background Esophageal growth using the Foker process (FP) for long-gap esophageal atresia (LGEA) has evolved over time. Methods Contemporary LGEA patients treated from 2014–2020 were compared to historical controls (2005 to Results 102 contemporary LGEA patients (type A 50%, B 18%, C 32%; 36% prior anastomotic attempt; 20 with esophagostomy) underwent either primary repair (n=23), jejunal interposition (JI; n = 14), or Foker process (FP; n = 65; 49 primary [p], 16 rescue [r]). The contemporary p-FP cohort experienced significantly fewer leaks on traction (4% vs 22%), bone fractures (2% vs 22%), anastomotic leak (12% vs 37%), and Foker failure (FP→JI; 0% vs 15%), when compared to historical p-FP patients (n = 27), all p ≤ 0.01. Patients who underwent a completely (n = 11) or partially (n = 11) minimally invasive FP experienced fewer median days paralyzed (0 vs 8 vs 17) and intubated (9 vs 15 vs 25) compared to open FP patients, respectively (all p ≤ 0.03), with equivalent leak rates (18% vs 9% vs 26%, p = 0.47). At one-year post-FP, most patients (62%) are predominantly orally fed. Conclusion With continued experience and technical refinements, the Foker process has evolved with improved outcomes, less morbidity and maximal esophageal preservation.

The existing networking dynamics in climate city networks are hierarchical as a few global cities are viewed as the leaders to be followed by other cities due to their higher visibility. Achieving ambitious climate goals requires expanding the knowledge of a diverse range of cities and networking opportunities. To expand knowledge of diverse cities, we provide evidence of cities’ similarity patterns based on their mitigation actions by a large-scale clustering method. Applying K-means clustering to Carbon Disclosure Project’s mitigation data, we find five clusters of cities based on two measures. Nature of actions indicates cities’ similarity based on their actions’ sectoral combinations, and finance profile indicates the commonality of their actions’ financial arrangements. Using these measures, we present a novel way to render socio-spatially diverse cities similar. Intersecting these two measures in a matrix, we offer ways to reimagine networking between cities and illuminate the complexity of cities’ climate actions.

Previous research has hypothesized default interpretive biases for three types of ambiguities with English logical words and, or, and not. First, disjunction (A or B) is hypothesized to be biased towards an exclusive interpretation in upward-entailing environments and an inclusive interpretation in downward-entailing environments (Levinson 2000, Chierchia 2004, Breheny et al. 2005). A negated disjunction (not A or B) is claimed to be biased towards a “neither-nor” interpretation (i.e. wide scope negation: ¬[A ∨ B]) and a negated conjunction is said to be biased towards an “either-not” interpretation (i.e. wide-scope negation: ¬[A ∧ B]) (Szabolcsi 2002, Szabolcsi & Haddican 2004). We tested these hypotheses within the same experimental paradigm with 149 English-speaking participants and found disjunction to be biased towards an inclusive interpretation across three different entailment environments: episodic declaratives, questions, and conditional antecedents. Our results also confirmed that English negated disjunction is biased towards a “neither-nor” (wide scope negation) interpretation but the results did not show an “either-not” bias (wide scope negation) for negated conjunction.

In the last decade, there has been a marked growth in formalised city networks. City networks of late have transcended beyond municipal collaborations towards more complex networked governance arrangements. City networks are noted also to raise the level of ambition among cities learning from and competing with each other with regard to the deployment of low-carbon technologies and policies. Over the last two decades, at least nine urban climate networks have been established around the world. This article consolidates the academic literature on C40 within the context of three key themes that are drawn upon from earlier work of Davidson et al. with the goal of drawing out the key implications of researching, and putting into practice, urban studies in an age of increasingly networked urban governance and the role of city networks. We conclude the paper with articulating a new research agenda that places a focus on the effects of city networks on institutional relevance of traditional planning in ways that have not yet been considered in practice and scholarship. We argue a key challenge is to align and potentially synthesise these traditional and new forms of city shaping in an urban age era of rapidly unfolding endangerment.

The responses by Acuto, Frantzeskaki, Gordon & Johnson, Pinault and Smeds all draw attention to the need to situate C40 in a wider political and economic context. Global city networks such as C40 facilitate, orchestrate, test and diffuse critical innovations for urban climate action through processes of experimentation. How these processes of on-the-ground experimentation in networked cities relate to global climate action and governance remains however poorly understood. Further research is needed to disclose and unpack the hidden politics, knowledge dynamics and institutional reconfigurations of such experiments curtailed by seemingly inclusive but rather opaque concepts such as living labs, co-creation and co-production.

The concept of resilience is progressively capturing the interest of scholars and practitioners in the field of urban policy. This increase in interest is directed towards the need for a better understanding of the conditions for effective and legitimate governance in a complex, interconnected, and volatile world fraught with a new class of poorly understood systematic risk. We are progressively observing resilience as a component of sustainability as the dominant organising frame in the field of urban planning. The application of the adapted Wilkinson (2011) framework, which we situate within a broader framework for evaluating metropolitan plans (Nguyen, Davidson & Gleeson, 2018), reveals the extent to which newly released metropolitan plans are incorporating strategies for social-ecological resilience. Our point is to offer an early assessment of the framing of social-ecological resilience within the embedded understanding of metropolitan planning practice. Our research has revealed that social-ecological resilience thinking has been incorporated only to a limited extent into metropolitan planning strategies worldwide, as demonstrated through the evaluation of our two sites—OneNYC and Plan Melbourne. We have argued that OneNYC incorporates the strategies of social-ecological resilience to a greater extent than Plan Melbourne, possibly pointing to a strengthening governing system by incorporating processes of social learning and adaptation. We conclude by acknowledging the critical insights into the limitations of the reality of implementing these ideas of social-ecological resilience within policy settings (see Duit, 2016), and which requires urgent consideration within a fuller institutional study that must in any case await the fuller roll-out of social-ecological resilience in sustainability agendas within city strategic planning. Refereed/Peer-reviewed

Bimodal bilinguals sometimes use code-blending, simultaneous production of (parts of) an utterance in both speech and sign. We ask what spoken language material is blended with entity and handling depicting signs (DS), representations of action that combine discrete components with iconic depictions of aspects of a referenced event in a gradient, analog manner. We test a semantic approach that DS may involve a demonstration, involving a predicate which obligatorily includes a modificational demonstrational component, and adopt a syntactic analysis which crucially distinguishes between entity and handling DS. Given the model of bilingualism we use, we expect both DS can be produced with speech that occurs in the verbal structure, along with vocal gestures, but speech that includes a subject is only expected to be blended with handling DS, not entity. The data we report from three Codas, native bimodal bilinguals, from the United States and one from Brazil conform with this prediction.

OBJECTIVES To determine if children with laryngeal penetration on videofluoroscopic swallow study (VFSS) who received feeding interventions (thickened liquids, change in liquid flow rate, and/or method of liquid delivery) had improved symptoms and decreased hospitalizations compared with those without intervention. METHODS We performed a retrospective cohort study of children under 2 years with laryngeal penetration on VFSS at our institution in 2015 to determine initial and follow-up VFSS findings, symptom improvement at follow-up, and hospitalization risk before and after VFSS. Proportions were compared with Fisher exact test and hospitalizations with paired t tests. RESULTS We evaluated 137 subjects with age 8.93 ± 0.59 months who had laryngeal penetration without aspiration on VFSS. Fifty-five percent had change in management, with 40% receiving thickening and 15% a change in flow rate. There was significant improvement in symptoms for children that had feeding intervention and this improvement was the greatest with thickening (OR 41.8, 95% CI 12.34-141.69, P

Networked urban governance is emerging as a major feature of metropolitan strategy and activity. The field of urban studies is yet to deeply engage in the debates on the new forms of cross national networking that are potentially framing and reframing urban governance and strategy. Yet this dimension of urban governance can no longer go unnoticed. In this article we draw together insights from the extant literature into a research agenda on reconfiguring urban governance. We propose a research agenda centred on three themes: the political economy of ‘new-gen’ networks, especially in relation to the role of economic power in determining participation and influence; the knowledge dynamics in city networks in understanding the socio-spatial configurations that are underpinning the decision-making processes and outcomes; and the implications of city networks for traditional institutions that have in the past shaped cities’ strategies, development and government. Our commentary considers and links these emergent themes, noting how these bear serious and urgent consideration for mainstream urban studies.

Objectives/hypothesis To describe the prevalence of aspiration in children with unilateral vocal fold paralysis who underwent objective assessment of swallow function. Study design Retrospective chart review. Methods A study of patients presenting to our institution with unilateral vocal fold paralysis in 2015 was conducted. All patients were diagnosed using flexible laryngoscopy. Patients were included if they underwent at least one modified barium swallow (MBS) study for evaluation of their swallowing function due to recurrent respiratory issues and/or feeding difficulty. Results Twenty-eight patients diagnosed with unilateral vocal fold paralysis underwent an MBS study at our institution in 2015. Median age at the time of MBS study was 1.7 years (interquartile range: 0.4-4.3). Twenty-six patients (92.9%) had dysphagia. Sixteen patients were found to aspirate on MBS study. All patients who aspirated did so without overt signs (silent aspiration). Eighteen patients had congenital heart disease (64.3%) and nine had a history of prematurity (32.1%). Eight patients (28.6%) presented with developmental delays. Conclusions Patients who present with unilateral vocal fold paralysis and recurrent respiratory and/or feeding issues may be affected by prominent issues such as swallowing dysfunction and silent aspiration. Clinicians should be aware of this risk and evaluate patients for any signs of feeding or swallowing difficulties. Level of evidence 4 Laryngoscope, 129:569-573, 2019.

In the new millennium, cities have become an emerging force among new forms of subnational climate governance. Of interest is how cities act unilaterally and directly in this new climate politics via the provision of relevant tools. Since metropolitan planning strategies have been considered as important mechanisms for achieving urban sustainability in this period, this research has sought to investigate the importance of these master plans in the delivery of urban responses to climate change. For this purpose, the study has employed a qualitative research methodology with the application of a comparative case study and the progression of a conceptual framework for evaluating climate policies in metropolitan plans of two selected cities—London and Melbourne. The study's results suggest that both the ‘London Plan’ and ‘Plan Melbourne’ incorporate critical elements to enhance climate governance, including the promotion of coordination principles, innovative technologies, a participatory planning approach and a long‐term planning scale. However, the review identified a consistent omission of key principles as identified through the proposed matrix for analysing the climate policies of a city's government, which include risk assessment tools, monitoring systems, distribution, impact frame and accountability. Moreover, the research also revealed the lack of vertical integration in policy formulation and implementation of ‘Plan Melbourne’. Our study suggests that a city's governance structure influences the way it undertakes its climate actions and the potential efficacy of these on a metropolitan scale. [ABSTRACT FROM AUTHOR]

Whether predicates describe events as inherently bounded (telic) or unbounded (atelic) is usually understood to be an emergent property that depends on several factors; few, if any, spoken languages have dedicated morphology to mark the distinction. It is thus surprising that sign languages have been proposed to have dedicated morphology for telicity, and moreover that it takes a form which iconically reflects the underlying event structure – this is known as the “Event Visibility Hypothesis” (EVH) (Wilbur 2008). The EVH has been extended with claims about its universality in sign languages (Wilbur 2008; Malaia & Wilbur 2012), its gradient nature (Kuhn 2017), and its iconic transparency (Strickland et al. 2015). However, in this paper we argue that the status of this relationship between form and meaning remains an open question due to (a) lack of independent tests for telicity, (b) lack of lexical coverage, (c) lack of demonstration that formal expressions of telicity are morphological in nature, rather than a lexical property, and (d) inability to sufficiently dissociate telicity and perfectivity. We present new data coming from verbs that alternate in both form and meaning in ASL that is in line with the EVH, and conclude that while there is evidence supporting a morphological marker, the proposed form and telicity are not isomorphic in their distribution, significantly limiting the “visibility” of the event structure. We further propose that much of the related iconicity is the result of several independent factors also found in spoken languages, so that sign languages may be more similar to spoken languages than typically implied in this domain.

Please view the video clip (Video 1) showing the results of a videofluoroscopic swallow study (also known as a modified barium swallow study). Video 1. Click here to view the video. The most likely clinical scenario of the infant in this video is a: The videofluoroscopic swallow study (VFSS), also known as a modified barium swallow study , is a form of instrumental assessment of swallow function. It is conducted in the radiology department by a speech-language pathologist in collaboration with a radiologist; thus, the patient needs to be stable to allow transfer to this location. The infant’s caregivers and …

Objective To determine whether the use of acid suppression and thickened feeds impact laryngomalacia outcomes in infants, including supraglottoplasty risk, time to supraglottoplasty, and hospitalization risk. Study design We performed a retrospective cohort study to compare risk and time with supraglottoplasty and frequency and duration of hospitalizations for infants diagnosed with laryngomalacia at Boston Children's Hospital between January 1 and December 31, 2017. The primary outcomes were supraglottoplasty requirement, time to supraglottoplasty, and hospitalization risk. Multivariate analyses were performed to determine predictors of supraglottoplasty and hospitalization risk after adjusting for laryngomalacia severity and comorbidities in addition to propensity score adjustment. Kaplan–Meier curves were created to determine the impact of acid suppression use on time to supraglottoplasty. Results In total, 236 subjects with mean age 62.6 ± 4 days were included in the analysis; 55% were treated with acid suppression. Subjects treated with acid suppression had a greater risk of supraglottoplasty (hazard ratio 3.36, 95% CI 1.36-8.29, P = .009), shorter time to supraglottoplasty (5.64 ± 0.92 vs 7.98 ± 1.92 months, P = .006), and increased respiratory hospitalization risk (relative risk 1.97, 95% CI 1.01-3.85, 0.047), even after adjustment for covariates. Subjects receiving thickening had fewer respiratory hospitalization nights and longer time to supraglottoplasty (9.3 ± 1.7 vs 4.56 ± 0.73 months, P = .004), even after adjustment. Conclusions Acid suppression use does not reduce the frequency of supraglottoplasty and related hospitalizations compared with untreated subjects. However, patients treated with thickening have decreased hospitalization and longer time to supraglottoplasty, suggesting that thickening of feeds may be a preferred intervention over acid suppression.

A difficult learning problem for both children and artificial language learning systems is knowing what is intended to be conveyed based on what is literally said. For example, adults usually take "Some teas contain caffeine" to also convey that "Not all teas contain caffeine", an inference known as a scalar implicature. The present work investigates the role of language-specific knowledge in such inferences through three studies on scalar implicatures in American Sign Language (ASL). The first study illustrates a new experimental paradigm and compares prototypical scalar implicatures in ASL and English. The second study includes the first investigation of general use coordinators in ASL that can be interpreted as either conjunction ("and") or disjunction ("or"). This provides a test case for the role of language-specific lexical contrast in scalar implicatures, with results showing that lexically non-contrastive scales (i.e., lexical scales whose items differ in meaning but not in form) trigger less scalar implicatures than prototypical lexically contrastive scales, which are based on contrasting lexical items. In the third study, both lexically contrastive and non-contrastive scales are interpreted by deaf native signers and also deaf signers who learned ASL at later ages. Result show that later ASL learners calculated less implicatures than early learning signers, but only on the lexically contrastive scale. Together, these studies support a view that despite their context dependence, scalar implicatures are most likely to be triggered by lexical items which contrast with each other in form to create a context-independent "scale", and that there may even be advantages to learning scales early in life. The dissertation concludes with suggestions for incorporating lexical contrast into theories of implicature and for further study of the semantic/ pragmatic interface in sign languages

Comparative-modified numerals (CMNs) and superlative-modified numerals (SMNs) are reported to exhibit a polarity sensitivity contrast: unlike CMNs, the use of SMNs is said to be sensitive to embedding under negation. This contrast is however neither well studied nor well understood, such that the existing views in the literature disagree vastly on both the basic facts and related expectations. In this paper we investigate this contrast in three offline experiments. We show that there is strong empirical support for this reported contrast under negation, but none of the existing analyses of the contrast can capture it in full, though we do seem to require insights from each.

This review examines two new socio-ecological imperatives that have the potential to reshape planning practice and policy: urban climate governance and governance for resilience. The roots of the new imperatives lie in international city collaborative networks funded by philanthropy organisations that operate at city scale. City networks operating at the metropolitan scale raise issues for Australian cities with distributed governance. This practice review considers the early manifestation of both imperatives in what might be termed ‘policy experiments’ in Australia’s two largest cities: the new climate governance framework emerging through the City of Sydney’s collaboration with the C40 network and the resilience regime being shaped by the City of Melbourne’s partnership with Rockefeller Foundation’s Resilient 100 program. Whilst our early analysis has accentuated the positive to some degree, pointing to different, if preliminary, forms of success in both Sydney and Melbourne, the limits and frus...

More and more cities are developing strategies and implementing actions to increase their resilience to a diversity of environmental, social and economic challenges. International networks such as 100 Resilient Cities, established by the Rockefeller Foundation, are supporting cities to find and implement solutions to ‘shocks and stresses.’ This new approach to urban governance, often initiated by philanthropic organizations, is debated. On the one hand, these initiatives are celebrated as catalysts for transformational change through ‘collaboration’ and ‘co-design’ in contexts such as mobility, energy, green space or housing. On the other hand, urban resilience initiatives have been criticized for prioritizing private sector agendas and top-down approaches and hollowing out public sector tasks and democratic participation. However, little is known how urban resilience strategies are actually implemented in practice. Embedded action research on the implementation of the Resilient Melbourne strategy provides the opportunity to have a closer look at this highly contested topic. This paper provides first insights into the research project Urban Resilience in Action, using the Resilient Melbourne strategy to assess the implementation of selected actions. It shows that a reconceptualization and new analytical dimensions are needed to understand urban resilience as an urban innovation strategy.

In July 2012 the American College of Obstetricians and Gynecologists (ACOG) published Committee Opinion No. 530, stating that postpartum sterilization should be considered an urgent surgical procedure. The purpose of this study was to determine whether active dissemination of the ACOG Committee Opinion and education of staff (our intervention) would result in higher rates of postpartum sterilizations.Two separate studies were conducted: (1) a retrospective chart review that examined postpartum sterilization rates prior to our intervention and (2) a prospective study that examined postpartum sterilization rates after the intervention.In the 3 months prior to the ACOG publication, 14 of 23 (61%) intended postpartum sterilization procedures were performed. During the 4 months after publication, 29 of 52 (55%) were completed (x² p=0.619). In the 5 months after education efforts, 69 of 79 (87%) were completed, showing a statistically significant improvement frot both prior time periods (x² p0.001).Patients who desired postpartum sterilization during the prospective study were 5 times less likely to have their procedure canceled than were patients in the retrospective study. The Committee Opinion had. no significant effect on. com- pletion rates. Education of staff and the ongoing study were instrumental in facilitating desired tubal sterilizations.

Building energy code change in Australia, and many other developed nations, is subject to standardised economic tests, with a net present value calculation at the heart of the economic analysis. Although many nations have introduced minimum energy efficiency standards for residential and commercial buildings, increases in stringency have been hindered by limitations to the range of private and societal impacts typically incorporated in regulatory impact assessments. Given the policy move towards net zero energy homes, a more comprehensive set of inputs and robust assumptions are needed to support further regulatory change. Yet the literature provides substantial evidence of many private and societal costs and benefits not commonly incorporated into the economic assessments that underpin regulatory change. Drawing on a case study of Australian and UK residential regulatory change assessments, this paper highlights limitations to the range of inputs and assumptions currently incorporated within the economic arguments applied during residential energy code change processes, and presents a more comprehensive economic argument that could support further stringency improvements. Refereed/Peer-reviewed

Sometimes form-meaning mappings in language are not arbitrary, but iconic: they depict what they represent. Incorporating iconic elements of language into a compositional semantics faces a number of challenges in formal frameworks as evidenced by the lengthy literature in linguistics and philosophy on quotation/direct speech, which iconically portrays the words of another in the form that they were used. This paper compares the well-studied type of iconicity found with verbs of quotation with another form of iconicity common in sign languages: classifier predicates. I argue that these two types of verbal iconicity can, and should, incorporate their iconic elements in the same way using event modification via the notion of a context dependent demonstration. This unified formal account of quotation and classifier predicates predicts that a language might use the same strategy for conveying both, and I argue that this is the case with role shift in American Sign Language. Role shift is used to report others’ language and thoughts as well as their actions, and recently has been argued to provide evidence in favor of Kaplanian “monstrous” indexical expressions. By reimagining role shift as involving either (i) quotation for language demonstrations or (ii) “body classifier” predicates for action demonstrations, the proposed account eliminates one major argument for these monsters coming from sign languages. Throughout this paper, sign languages provide a fruitful perspective for studying quotation and other forms of iconicity in natural language due to their (i) lack of a commonly used writing system which is otherwise often mistaken as primary data instead of speech, (ii) the rich existing literature on iconicity within sign language linguistics, and (iii) the ability of role shift to overtly mark the scope of a language report. In this view, written language is merely a special case of a more general phenomenon of sign and speech demonstration, which accounts more accurately for natural language data by permitting more strict or loose verbatim interpretations of demonstrations through the context dependent pragmatics.

To describe the prevalence of aspiration in children with unilateral vocal fold paralysis who underwent objective assessment of swallow function.Retrospective chart review.A study of patients presenting to our institution with unilateral vocal fold paralysis in 2015 was conducted. All patients were diagnosed using flexible laryngoscopy. Patients were included if they underwent at least one modified barium swallow (MBS) study for evaluation of their swallowing function due to recurrent respiratory issues and/or feeding difficulty.Twenty-eight patients diagnosed with unilateral vocal fold paralysis underwent an MBS study at our institution in 2015. Median age at the time of MBS study was 1.7 years (interquartile range: 0.4-4.3). Twenty-six patients (92.9%) had dysphagia. Sixteen patients were found to aspirate on MBS study. All patients who aspirated did so without overt signs (silent aspiration). Eighteen patients had congenital heart disease (64.3%) and nine had a history of prematurity (32.1%). Eight patients (28.6%) presented with developmental delays.Patients who present with unilateral vocal fold paralysis and recurrent respiratory and/or feeding issues may be affected by prominent issues such as swallowing dysfunction and silent aspiration. Clinicians should be aware of this risk and evaluate patients for any signs of feeding or swallowing difficulties.4 Laryngoscope, 129:569-573, 2019.

We ask whether iconic co-speech gestures are judged as more natural by naive participants when their content is entailed by a preceding context, or repeated in the same utterance, or when they contribute new information (i.e., are nontrivial). Our results show, first, that the acceptability of co-speech gestures is not affected by whether they are entailed by a preceding context (they are not “hard presupposition triggers”). In contrast, our second finding is that gestures are affected by content in the same utterance, such that they are judged more acceptable when they reinforce information already present in the proposition. In addition, gestures varied widely in how acceptable they were judged even in the same information contexts, which we take to be an indication that we are just scratching the surface of a more general question about the felicity of co-speech gestures, of which the current study provides a first experimental foundation.

Importance Thickening of fluids is a common strategy for feeding patients with oropharyngeal dysphagia but has known risks and should be stopped once it is safe to do so. Weaning children from thickened fluids safely can be challenging, and novel methods are required. Objective To describe the use of a systematic weaning process (SWP) for children who received thickened liquids owing to oropharyngeal dysphagia and identified risk of aspiration. Design, Setting, and Participants Retrospective case series (2010 to 2015) at a tertiary care center of 50 children with documented aspiration by clinical swallowing assessment, airway evaluation, and videofluoroscopic swallow study with at least 4 months of follow-up. All patients were initially receiving thickened fluids. A 10% reduction in thickness was made every 2 weeks based on clinical symptoms. Caregivers progressed to the next incremental level if there were no signs or symptoms of aspiration. Main Outcomes and Measures Number of patients weaned to a thin-fluid diet. Results Of 50 children (32 [64%] male; median [interquartile range] age, 0.7 [1.0] y at presentation and 1.8 [1.3] y at start of wean) using the SWP, 44 (88%) were able to reduce the amount of thickener used. A successful wean from thickened fluids to thin fluids was completed in 39 (78%). The mean (SD) duration of a successful wean was 0.9 (0.6) years. Five patients tolerated a reduction in thickener but not a full wean to thin fluids. For 6 patients, weaning failed and they continued to receive thickened fluids. Of those whose weaning failed, 2 patients developed pneumonia. Of the 39 successfully weaned patients, 14 (36%) experienced a temporary stall but eventually tolerated thin fluids. Only 2 (5%) developed pneumonia while all other successfully weaned patients (n = 37 [95%]) did not experience any substantial respiratory issues. Overall, 46 (92%) of children required 2 or fewer videofluoroscopic swallow study evaluations. Conclusions and Relevance Patients with oropharyngeal dysphagia and aspiration should be gradually weaned off of thickened fluids. The SWP uses small incremental steps to gradually reduce the amount of thickener. Using this method, most children tolerated a reduction in thickeners and a thin-fluid diet. The SWP presents a safe and effective way of gradually returning children to a more normal diet.

Whilst net zero energy homes are espoused in many policy circles, and many bespoke examples have been constructed to demonstrate their technical feasibility, there is a scarcity of evidence demonstrating such a standard would be economically rational, particularly for large scale housing development where orientation and aspect may not always be optimal. Drawing on energy monitoring evidence and construction economics associated with a nearly zero energy housing estate in Adelaide, Australia, this paper explores the economic feasibility of the net zero energy home policy in warm temperate climates. The results demonstrate that using economic tools and assumptions typically applied for building energy regulatory policy changes, net societal economic benefits significantly outweigh costs. The clear economic outcomes, combined with expected health and productivity benefits from improved levels of thermal comfort, should provide security to policy makers to progress home energy standards towards net zero energy performance. Refereed/Peer-reviewed