On-line speciation and quantification of four arsenical species in rice samples collected in Argentina using a HPLC–HG–AFS coupling

An investigation was carried out to explore further the analytical capabilities of the coupling high performance liquid chromatography (HPLC)–hydride generation (HG)–atomic fluorescence spectrometry (AFS) for the reliable determination of the four toxicologically relevant arsenical species namely, As(III), As(V), monomethylarsonic acid (MMA) and dimethylarsinic acid (DMA) in rice. Fifty nine samples of rice of five different cultivars were collected in province of Entre Rios (Argentina). Samples were dried at 103 ± 2 °C and mild conditions were adopted for species extraction (0.28 mol L−1 HNO3 at 95± 3 °C for 90 min). Method validation included, evaluation of linearity; limits of detection, 0.020 μg g−1 for As(III) and 0.025 μg g−1 for the other three species; precision (intermediate precision), 4% for As(III) and DMA, and 6% for the other two species; trueness (bias), 9% for As(III) and As(V) and 11% for the other two species, and uncertainty (obtained from validation data) varying from 9.5% for As(III) to 19% for As(V). Total arsenic concentrations ranged from 0.08 to 1.39 mg kg−1. The mean concentrations of sum of the As species extracted and determined by HPLC–HG–AFS was approximately 99.7% of certified value for total As in NIST SRM “Rice flour”. Levels of the four species in the analyzed samples were in the order DMA N As(III) N As(V) N MMA. Inorganic As (iAs) accounted for 28% of the As detected. DMA exhibited the highest levels, representing a 72% of total grain As on average.EEA Concepción del UruguayFil: Farías, Silvia Sara. Comisión Nacional de Energía Atómica; ArgentinaFil: Londonio, Juan Agustín. Comisión Nacional de Energía Atómica; Argentina. Universidad Nacional de San Martín. Instituto de Investigación e Ingeniería Ambiental; ArgentinaFil: Quintero, Cesar Eugenio. Universidad Nacional de Entre Ríos. Facultad de Ciencias Agropecuarias; ArgentinaFil: Befani, Romina. Universidad Nacional de Entre Ríos. Facultad de Ciencias Agropecuarias; ArgentinaFil: Soro, Enrique Mariano. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Concepción del Uruguay; ArgentinaFil: Smichowski, Patricia Nora. Comisión Nacional de Energía Atómica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

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)