Protocol for the Electroencephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes (ENGAGES) study: A pragmatic, randomised clinical trial

Introduction: Postoperative delirium, arbitrarily defined as occurring within 5 days of surgery, affects up to 50% of patients older than 60 after a major operation. This geriatric syndrome is associated with longer intensive care unit and hospital stay, readmission, persistent cognitive deterioration and mortality. No effective preventive methods have been identified, but preliminary evidence suggests that EEG monitoring during general anaesthesia, by facilitating reduced anaesthetic exposure and EEG suppression, might decrease incident postoperative delirium. This study hypothesises that EEG-guidance of anaesthetic administration prevents postoperative delirium and downstream sequelae, including falls and decreased quality of life. Methods and analysis This is a 1232 patient, block-randomised, double-blinded, comparative effectiveness trial. Patients older than 60, undergoing volatile agent-based general anaesthesia for major surgery, are eligible. Patients are randomised to 1 of 2 anaesthetic approaches. One group receives general anaesthesia with clinicians blinded to EEG monitoring. The other group receives EEG-guidance of anaesthetic agent administration. The outcomes of postoperative delirium (≤5 days), falls at 1 and 12 months and health-related quality of life at 1 and 12 months will be compared between groups. Postoperative delirium is assessed with the confusion assessment method, falls with ProFaNE consensus questions and quality of life with the Veteran's RAND 12-item Health Survey. The intention-to-treat principle will be followed for all analyses. Differences between groups will be presented with 95% CIs and will be considered statistically significant at a two-sided p<0.05. Ethics and dissemination Electroencephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes (ENGAGES) is approved by the ethics board at Washington University. Recruitment began in January 2015. Dissemination plans include presentations at scientific conferences, scientific publications, internet-based educational materials and mass media. Trial registration number NCT02241655; Pre-results

Genetic Diversity and Population Structure of Acacia senegal (L) Willd. in Kenya

The level of genetic diversity and population structure of Acacia senegal variety kerensis in Kenya was examined using seven polymorphic nuclear microsatellite loci and two chloroplast microsatellite loci. In both chloroplast and nuclear datasets, high levels of genetic diversity were found within all populations and genetic differentiation among populations was low, indicating extensive gene flow. Analysis of population structure provided support for the presence of two groups of populations, although all individuals had mixed ancestry. Groups reflected the influence of geography on gene flow, with one representing Rift Valley populations whilst the other represented populations from Eastern Kenya. The similarities between estimates derived from nuclear and chloroplast data suggest highly effective gene dispersal by both pollen and seed in this species, although population structure appears to have been influenced by distributional changes in the past. The few contrasts between the spatial patterns for nuclear and chloroplast data provided additional support for the idea that, having fragmented in the past, groups are now thoroughly mixed as a result of extensive gene flow. For the purposes of conservation and in situ management of genetic resources, sampling could target a few, large populations ideally distributed among the spatial groups identified. This should ensure the majority of extant variation is preserved, and facilitate the investigation of variation in important phenotypic traits and development of breeding populations

Before architecture comes place, before place come people: contemporary Indigenous places in urban Brisbane, Queensland, Australia

This chapter examines the importance of place, within a contemporary urban Indigenous community, where in-depth ethnographic research was conducted between 2006 and 2009. Place is used as a concept to explore and examine Indigenous people’s connections to the physical environment and how these have developed through personal, family, social, and cultural means to become contemporary traditions within an Australian suburban setting that of Inala in the Queensland’s capital city Brisbane. The research argues that for Indigenous architecture to be meaningful, Indigenous people’s understandings and connections to place must be better understood and valued by the broader Australian community. The Inala case study is used to demonstrate how then place constructs of meaning, attachment, identity and sovereignty are enacted in everyday settings that will have relevance across cultural groups

The ACRIDICON-CHUVA Campaign: Studying Tropical Deep Convective Clouds and Precipitation over Amazonia Using the New German Research Aircraft HALO

Between 1 September and 4 October 2014 a combined airborne and ground–based measurement campaign was conducted to study tropical deep convective clouds over the Brazilian Amazon rainforest. The new German research aircraft HALO, a modified Gulfstream G550, and extensive ground–based instrumentation were deployed in and near Manaus (State of Amazonas). The campaign was part of the German–Brazilian ACRIDICON–CHUVA venture to quantify aerosol–cloud–precipitation interactions and their thermodynamic, dynamic, and radiative effects by in–situ and remote sensing measurements over Amazonia. The ACRIDICON–CHUVA field observations were carried out in cooperation with the second Intensive Operating Period of GoAmazon2014/5. In this paper we focus on the airborne data measured on HALO, which was equipped with about 30 in–situ and remote sensing instruments for meteorological, trace gas, aerosol, cloud, precipitation, and spectral solar radiation measurements. Fourteen research flights with a total duration of 96 flight hours were performed. Five scientific topics were pursued: (a) cloud vertical evolution and life cycle (cloud profiling), (b) cloud processing of aerosol particles and trace gases (inflow and outflow), (c) satellite and radar validation (cloud products), (d) vertical transport and mixing (tracer experiment), and (e) cloud formation over forested/deforested areas. Data were collected in near–pristine atmospheric conditions and in environments polluted by biomass burning and urban emissions. The paper presents a general introduction of the ACRIDICON–CHUVA campaign (motivation and addressed research topics) and of HALO with its extensive instrument package, as well as a presentation of a few selected measurement results acquired during the flights for some selected scientific topics