Please select the eligibility criteria that correspond to the clinical trial below.
Title: Effects of Hydrocortisone and D-Cycloserine on Fear Extinction in Veterans With Posttraumatic Stress Disorder
Brief Summary: This is a research study examining the use of two medications, Hydrocortisone and D-Cycloserine, compared to an inactive substance (placebo), on their ability to reduce fear responses and memory of fear in Veterans with symptoms of Posttraumatic Stress Disorder (PTSD). These responses will be tested using a fear learning and memory task administered by computer.


Options:
A: Inclusion Criteria:

* Adult patients admitted to an intensive care unit requiring mechanical ventilation and anticipated to require mechanical ventilation \>48h
* Patient has a sedation target (e.g. using the Richmond Agitation Sedation Scale or Sedation Agitation Scale) that is anticipated to be stable \>48h
* Minimum sedative infusion doses (any one of):

  * Propofol \>/=1.5 mg/kg/h \>24h
  * Midazolam \>/=3.0 mg/h \>24h

Exclusion Criteria:

* Sedation for paralysis
* Use of neuromuscular blocking agents (patients may be eligible once these are discontinued)
* Asthma or known reactive airways disease
* 1st, 2nd or 3rd-degree heart block (with no permanent pacemaker) at the time of screening
* Known history of congestive heart failure with ejection fraction \<20%
* HR\<60 bpm at baseline
* Hypotension requiring vasopressor support above the following levels

  * Norepinephrine dose \>0.15mcg/kg/min or equivalent (\>0.15mcg/kg/min epinephrine; \>22.5 mcg/kg/min dopamine; \>0.06 U/min vasopressin)
  * Phenylephrine \>2.0 mcg/kg/min
  * Receiving 3 or more vasopressors, regardless of dose
* Pregnancy or lactation
* Allergy to propranolol
* Patients for whom an enteral route of drug administration is not available
* Patients who are on digoxin, diltiazem, or verapamil
* Patients on chronic betablockers are eligible for enrolment. Patients allocated to the intervention arm will have their betablocker replaced with propranolol. Once propranolol is discontinued, the treating team may resume their usual betablocker. Control patients may continue their usual betablocker (unless it is propranolol) at the treating team's discretion.
B: Inclusion Criteria:

* Age 18-64
* ISS \>15
* Infusion can be started within 24 hrs of arrival to FMLH (time of injury irrelevant)
* Admitted to Inpatient hospital trauma service (not Ortho/Plastics/Neurosurgery etc)

Exclusion Criteria:

* Age \<18 or \>64
* History of adverse reaction to ketamine therapy
* Chronic opioid therapy defined as \> 3 weeks of \>30mg oral morphine equivalents per day
* Current substance abuse with opioids including prescription and/or heroin
* Intubation on arrival or need for urgent intubation on arrival
* GCS \<13, significant traumatic brain injury, or suspicion of elevated intracranial pressure resulting in the patient's inability to communicate
* History of psychosis
* Active delirium
* Glaucoma
* Ischemic heart disease defined as active acute coronary syndrome
* Severe, poorly controlled hypertension (SBP \>200) on more than two readings
* Aortic Injury requiring HR and BP control
* Concurrent use of monoamine oxidase inhibitors (MAOIs)
* Pregnancy
* Prisoners
* Inability to start investigational drug infusion within 24 hours of arrival
C: Inclusion Criteria:

* Veterans and civilians with an age range of 18 to 65 years
* Participants must be physically healthy volunteers

Exclusion Criteria:

* Individuals who fall outside the age range
* Individuals with medical conditions that would interfere with participation
* Other criteria
D: Inclusion Criteria:

1. Males and females aged 18-90 years with multiple-trauma or head trauma admitted to the ICU.
2. Enteral nutrition can be initiated within 36 hours of admission/ injury.
3. Mechanical ventilation.

Exclusion criteria:

1. Severe underlying systemic disease and /or treatment with immunosuppressive agents.
2. Contra-indication for Enteral Nutrition (mechanical or functional bowel. obstruction, high-output fistula, severe necrotizing pancreatitis).
3. 2nd /3rd degree burns covering \> 66% BSA.
4. Pregnancy.
5. Participants under the age of 18.

Answer: C