Optimization of Reaction Conditions for Hydroxypropylation of Saba Banana Starch

The aim of this study was to investigate the effects of three reaction variables on the hydroxypropylation of Saba banana (Musa acuminata x Musa balbisiana) starch. The variables were reaction pH (10, 11 and 12), amount of propylene oxide (5, 10 and 15% v/w) and reaction temperature (35, 40 and 45 oC). Response Surface Methodology (RSM) using Central Composite Design was employed to explore the effects of these three variables on the Molar Substitution (MS), pasting properties, freeze-thaw stability and thermal properties of the modified starch. Increasing the amount of propylene oxide, pH and temperature promoted higher level of substitution. All three factors were found significantly (p < 0.05) influenced the MS. These factors also affected the pasting temperature, peak viscosity, breakdown, setback and freeze-thaw stability of the starch pastes. The experimental factors only affected the onset temperature, peak temperature and gelatinization enthalpy of modified starches. In general, propylene oxide exerted the most pronounced effect on hydroxypropylation of Saba banana starch as compared to the reaction pH and temperature. The optimal reaction conditions for hydroxypropylation of Saba banana starch was successfully optimized and validated

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 &lt; 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)