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)

Trace metal distribution in the bed, bank and suspended sediment of the Ravensbourne River and its implication for sediment monitoring in an urban river

Purpose This study aims to identify a suitable sediment compartment for sediment quality monitoring by: (a) studying the concentration of trace metals (Cd, Cu, Ni, Pb and Zn) in the bed, bank and suspended sediment compartments of the Ravensbourne River to establish any differences in trace metal concentrations with compartment; (b) determining the influence of sediment particle size fractions ( 0.05) in the concentrations of metals between the suspended sediment and the < 63 μm bed sediment fraction, but there was a significant difference (p < 0.05) between the suspended sediment and the < 63 μm bank sediment fraction. There were also significant differences between the concentrations of metals in the < 63 μm and the 63 μm–2 mm fractions. Generally, the Ravensbourne River did not comply with the draft UK sediment quality guidelines for the metals analysed. Conclusions This study shows the importance of identifying a suitable sediment compartment to sample for compliance with sediment quality standards. The bed and suspended sediments are the most widely used sediment compartments for sediment monitoring, but collecting sufficient mass of the < 63 μm sediment fraction for monitoring presents a challenge for urban gravel bed rivers like the Ravensbourne River. It seems appropriate to establish individual monitoring regimes for different rivers

Whitecapping and wave field evolution in a coastal bay

Evolution of the wave field in a coastal bay is investigated, by comparison between field observations and numerical simulations using a spectral wave model (Simulating WAves Nearshore (SWAN)). The simulations were conducted for the passage of an extratropical storm, during which surface elevation spectra were bimodal owing to local wind-sea generation and swell propagation into the bay. SWAN was run in stationary and nonstationary mode for two whitecapping source term formulations. The first was developed by Komen et al. (1984) and is dependent on spectrally averaged wave steepness, and thus includes swell in the calculation of whitecapping dissipation and typically overestimates wind sea in the presence of swell. The second, proposed by van der Westhuysen et al. (2007), estimates whitecapping of wind sea locally in the wave spectrum and is not coupled to swell energy. This formulation reproduced the magnitude and shape of the observed wind-sea spectral peak much better than the previous formulation. Whitecapping dissipation rates have been estimated from observations, using the equilibrium range theory developed by Phillips (1985), and are well correlated with both wind speed and acoustic backscatter observations. These rates agree with SWAN estimates using the spectrally local expression, and provide additional physical validation for the whitecapping source term.Hydraulic EngineeringCivil Engineering and Geoscience

Vectorization by nanoparticles decreases the overall toxicity of airborne pollutants

Atmospheric pollution is mainly composed of volatile pollutants and particulate matter that strongly interact. However, their specific roles in the induction of cellular toxicity, in particular the impact of the vectorization of atmospheric pollutants by ultrafine particles, remains to be fully elucidated. For this purpose, non-toxic poly-lactic co-glycolic acid (PLGA) nanoparticles were synthesized and three pollutants (benzo(a)pyrene, naphthalene and di-ethyl-hexyl-phthalate) were adsorbed on the surface of the nanoparticles in order to evaluate the toxicity (cytotoxicity, genotoxicity and ROS induction) of these complexes to a human airway epithelial cell line. The adsorption of the pollutants onto the nanoparticles was confirmed by HPLC analysis. Interestingly, the cytotoxicity assays (MTT, LDH and CellTox Green) clearly demonstrated that the vectorization by nanoparticles decreases the toxicity of the adsorbed pollutants. Genotoxicity was assessed by the micronucleus test and the comet assay and showed no increase in primary DNA damage or in chromosomal aberrations of nanoparticle vectorized pollutants. Neither cytotoxicity nor genotoxicity was correlated with ROS induction. To conclude, our results indicate that the vectorization of pollutants by nanoparticles does not potentiate the toxicity of the pollutants studied and that, on the contrary, adsorption onto nanoparticles could protect cells against pollutants' toxicity

Water quality, pollutant loads, and multivariate analysis of the effects of sewage discharges into urban streams of Southeast Brazil

Water demand, pollution, and climate change threaten water security in industrialized and urbanized regions worldwide, especially in developing countries. Investments in massive infrastructure have often not met the water needs of the population, requiring water resource managers to adopt new approaches, such as decentralized and regionalized management at the micro-basin scale. However, little is known about the impact of anthropogenic activities on the water quality and vulnerability of streams that cross urban areas and feed into the main rivers and reservoirs supplying cities and industrial regions. The main goals of this research were to evaluate the water quality, pollutant loads, and effect of untreated sewage discharges in streams of the Piracicaba river basin, in the municipality of Americana, Southeast Brazil. The water quality parameters evaluated were as follows: pH, dissolved oxygen, electrical conductivity, biochemical oxygen demand, inorganic phosphorus, total phosphorus, total nitrogen, real colour, turbidity, total dissolved solids, metals (Ba, Cr, Cu, Ni, Pb, Cd, and Zn), total coliforms, and Escherichia coli. Descriptive statistics and multivariate analyses were performed. The results revealed chemical and biological degradation of the water resources, and vulnerability of the urban streams due to the release of untreated sewage into these waterways. The findings indicate the need for an immediate implementation of policies to monitor and control discharges of industrial effluents into the sewage collection systems, as well as discharges of sewage into rainwater drainage systems, together with the maintenance of green spaces.Institute of Science and Technology São Paulo State University (UNESP), Av. Tres de Março 511, 18.080-180Centro Universitário Salesiano de São Paulo (UNISAL), Rua Dom Bosco, 100Institute of Science and Technology São Paulo State University (UNESP), Av. Tres de Março 511, 18.080-18