The Prevention of Delirium and Complications Associated with Surgical Treatments (PODCAST) study: protocol for an international multicentre randomised controlled trial

Introduction: Postoperative delirium is one of the most common complications of major surgery, affecting 10–70% of surgical patients 60 years and older. Delirium is an acute change in cognition that manifests as poor attention and illogical thinking and is associated with longer intensive care unit (ICU) and hospital stay, long-lasting cognitive deterioration and increased mortality. Ketamine has been used as an anaesthetic drug for over 50 years and has an established safety record. Recent research suggests that, in addition to preventing acute postoperative pain, a subanaesthetic dose of intraoperative ketamine could decrease the incidence of postoperative delirium as well as other neurological and psychiatric outcomes. However, these proposed benefits of ketamine have not been tested in a large clinical trial. Methods: The Prevention of Delirium and Complications Associated with Surgical Treatments (PODCAST) study is an international, multicentre, randomised controlled trial. 600 cardiac and major non-cardiac surgery patients will be randomised to receive ketamine (0.5 or 1 mg/kg) or placebo following anaesthetic induction and prior to surgical incision. For the primary outcome, blinded observers will assess delirium on the day of surgery (postoperative day 0) and twice daily from postoperative days 1–3 using the Confusion Assessment Method or the Confusion Assessment Method for the ICU. For the secondary outcomes, blinded observers will estimate pain using the Behavioral Pain Scale or the Behavioral Pain Scale for Non-Intubated Patients and patient self-report. Ethics and dissemination The PODCAST trial has been approved by the ethics boards of five participating institutions; approval is ongoing at other sites. Recruitment began in February 2014 and will continue until the end of 2016. Dissemination plans include presentations at scientific conferences, scientific publications, stakeholder engagement and popular media. Registration details The study is registered at clinicaltrials.gov, NCT01690988 (last updated March 2014). The PODCAST trial is being conducted under the auspices of the Neurological Outcomes Network for Surgery (NEURONS). Trial registration number NCT01690988 (last updated December 2013)

LARP Long Nb3Sn Racetrack Coil Program

Development of high-performance Nb{sub 3}Sn quadrupoles is one of the major goals of the LHC Accelerator Research Program (LARP). As part of this program, long racetrack magnets are being made in order to check that the change in coil length that takes place during reaction is correctly accounted for in the quadrupole design and to check for length effects in implementing the 'shell' method of coil support. To check the racetrack magnet manufacturing plan, a short racetrack magnet is being made. This magnet will be the first to use restack-rod process Nb{sub 3}Sn, making it a 'long sample' test vehicle for this new material. The paper reports the reaction and characterization of the Nb{sub 3}Sn, and construction features and test results from the short racetrack magnet. The paper also reports on the status of the construction of the first long racetrack magnet

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

Construction and Test of 3.5 m Nb3Sn Racetrack Coils for LARP.

Development of high-performance Nb{sub 3}Sn quadrupoles is one of the major goals of the LHC Accelerator Research Program (LARP). As part of this program, long racetrack magnets were made in order to check the fabrication steps for long Nb{sub 3}Sn coils, that the changes in coil length that take place during reaction and cooldown are correctly accounted for in the quadrupole design, and the use of a long aluminum shell for the support structure. This paper reports the construction of the first long Nb{sub 3}Sn magnet with racetrack coils 3.6 m long. The magnet reached a nominal 'plateau' at 9596 A after five quenches. This is about 90% of the estimated conductor limit. The peak field in the coils at this current was 11 T

First muon-neutrino disappearance study with an off-axis beam

We report a measurement of muon-neutrino disappearance in the T2K experiment. The 295-km muon-neutrino beam from Tokai to Kamioka is the first implementation of the off-axis technique in a long-baseline neutrino oscillation experiment

The role of antenatal and postnatal maternal bonding in infant development: A systematic review and meta‐analysis

The purpose of this study was to systematically review the empirical literature on maternal bonding and associations with infant physical, psychological, and social development. Nineteen articles met inclusion criteria and were included in a qualitative synthesis (79 effect sizes); 15 articles were suitable for aggregation in a series of 14 meta-analyses (51 effect sizes). All mean effects were in the expected direction, with higher maternal bonding contributing to infant developmental outcomes, including higher attachment quality (r = .35) and parent-reported lower colic rating (r = .22), easier temperament (r = .19), and positive infant mood (r = .27). Consistent with theoretical explanatory models, the review provides support for the hypothesis that maternal bonding plays a role in fostering more optimal infant development. The review also identifies a paucity of empirical work on this topic and provides directions for future research