Monitoreo del movimiento de la corteza terrestre asociado a sismos mediante observaciones GPS en el Golfo de California

The distribution of the velocities of the Pacific and North American plates and their possible alteration by earthquakes has been studied using the GPS continuous measurements in the lapse from 2010 to 2016. The GPS data were processed with GAMIT/GLOBK to estimate the position and velocity of the continuous stations. Subsequent analysis has shown that the average relative movement between the Pacific and North American plates is consistent with previous studies, estimating 7.33 mm/year for the north component, and -9.50 mm/year for the east component with an absolute value of 500 mm/yr. A possible relationship between sudden changes in velocity associated with coseismic events and a trend indicates that the probability of having an earthquake of magnitude Mw ≥ 5.0 increases with an increase of the relative velocity between plates is presented.La distribución de velocidades entre las placas del Pacífico y de Norteamé-rica, así como su posible relación con los sismos ocurridos en la zona del Golfo de California en México ha sido estudiada mediante mediciones continuas GPS en el periodo 2010-2016. Los datos GPS fueron procesados con Gamit/Globk para estimar la posición y velocidad de las estaciones continuas. El análisis posterior ha mostrado que el movimiento relativo promedio entre las placas de Pacífico y de Norteamérica es consistente con estudios anteriores, estimando en 40 mm/año en la dirección norte y 30 mm/año en la dirección oeste, con un valor absoluto de 50 mm/año. Se presenta una posible relación entre los cambios repentinos en la velocidad asociados con los eventos cosísmicos y una tendencia que indica que la probabilidad de que se presente un sismo de magnitud Mw ≥ 5.0 crece con el aumento de la velocidad relativa entre las placas

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)