Operational Review of the First Wireline In Situ Stress Test in Scientific Ocean Drilling

Scientific ocean drilling’s first in situ stress measurement was made at Site C0009A during Integrated Ocean Drilling Program (IODP) Expedition 319 as part of Nankai Trough Seismogenic Zone Experiment (NanTroSEIZE) Stage 2. The Modular Formation Dynamics Tester (MDT, Schlumberger)wireline logging tool was deployed in riser Hole C0009A to measure in situ formation pore pressure, formation permeability (often reported as mobility=permeability/viscosity), and the least principal stress (S3) at several isolated depths (Saffer et al., 2009; Expedition 319 Scientists, 2010). The importance of in situ stress measurements is not only for scientific interests in active tectonic drilling, but also for geomechanical and well bore stability analyses. Certain in situ tools were not previously available for scientific ocean drilling due to the borehole diameter and open hole limits of riserless drilling. The riser-capable drillship, D/V Chikyu,now in service for IODP expeditions, allows all of the techniques available to estimate the magnitudes and orientations of 3-D stresses to be used. These techniques include downhole density logging for vertical stress, breakout and caliper log analyses for maximum horizontal stress, core-based anelastic strain recovery (ASR, used in the NanTroSEIZE expeditions in 2007–2008), and leak-off test (Lin et al., 2008) and minifrac/hydraulic fracturing (NanTroSEIZE Expedition319 in 2009). In this report, the whole operational planning process related to in situ measurements is reviewed, and lessons learned from Expedition 319 are summarized for efficient planning and testing in the future

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)