Dataset on the RETRO-BMC cruise onboard the R/V Hespérides, April 2017, Brazil-Malvinas Confluence

This dataset, gathered during the RETRO-BMC cruise, reports multiple-scale measurements at the Confluence of the Brazil and Malvinas Currents. The cruise was carried out between 8 and 28 April 2017 onboard R/V Hespérides, departing from Ushuaia and arriving to Santos. Along its track, the vessel recorded near-surface temperature and salinity, as well as the horizontal flow from 20 m down to about 800 m. A total of 33 hydrographic stations were completed in a region off the Patagonian Shelf, within 41.2°S-35.9°S and out to 53.0°W. At each station, a multiparametric probe and velocity sensors were deployed inside the frame of a rosette used to collect water samples at selected depths; these samples were later used for several water analyses, including inorganic nutrient concentrations. Microstructure measurements were carried out in 11 of these hydrographic stations. In addition, two high-resolution three-dimensional surveys were conducted with an instrumented undulating vehicle between 40.6°S-39.0°S and 55.6°W-53.8°W. Lastly, eight high-frequency vertical profilers were deployed in the region and five position-transmitting drifters were launched. These data allow the description of the Confluence from the regional scale to the microscale, and provide a view of the variability of the frontal region on time scales from days to weeks

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)