Comportamiento termal de mezclas forrajeras (ray grass, pasto azul, trébol) en la hacienda el Rosario- Cumbijin.

This research project aims to evaluate the optimal thermal time in the fodder mixture for dairy cattle of the Hda. El Rosario, initiating the need to obtain a good pasture for a better production in the livestock, taking into account the analysis of the pasture and analyzing some characteristics of it such as: the growth, composition, leaves' morphology, pasture's quality and type, the rotation of each pasture, which will improve the future of the design and management of the pastures to obtain a greater benefit and, consequently, lead to the owner to have a better profitability in his exploitation (cost - benefit). The research was conducted in Hda. The Rosario that is in Salcedo canton in Cumbijín community that is at an initial altitude of approximately 2900 meters above sea level and with a maximum height of 3400 meters above sea level, there is found a good part of pastures for dairy production with breeds such as Jersey, Holstein, Brown Swiss, F1 (Holstein with Jersey). The use of grass with a load between 1-2 AU / ha, is rotational in pastures with approximately 45% of Ryegrass (Lolium perennial) - 25% of Bluegrass (Dactylis glomerata) - 30% of Clover (Trifolium repens) comes by Sample system of it, to which they have daily access. Agrotechnics in the areas are managed with organic fertilization (chicken manure).El presente proyecto de investigación tiene como objetivo evaluar el tiempo termal óptimo en mezcla forrajera para bovinos lecheros de la Hda. El Rosario, iniciando de la necesidad de obtener un buen pasto para una mejor producción en la ganadería propiamente dicha, basándose en el análisis del pasto teniendo en cuenta y analizando algunas características del mismo como: el crecimiento, composición, morfología de las hojas, calidad de pastura, tipo de pastura, rotación de cada potrero, que a futuro será utilizada para mejorar los pastizales el diseño y el manejo de los mismos para obtener mayor beneficio y con eso llevar a que el propietario tenga una mejor rentabilidad en su explotación (costo- beneficio). La investigación se realizó en la Hda. El Rosario que se encuentra ubicada en el Cantón Salcedo en la comunidad de Cumbijin que se encuentra a una altitud aproximada inicial 2900 msnm y con una altura máxima de 3400 msnm, dedicada en una buena parte a pastizales para ganadería de leche con razas como Jersey, Holstein, Brown Swiss, F1(Holstein con Jersey). El uso del pasto con carga entre 1-2 UA/ha, es en forma rotacional en pasturas con aproximadamente 45 % de Ryegrass (Lolium perenne)- 25 % de Pasto azul (Dactylis glomerata)- 30% de Trébol (Trifolium repens) comprobada por muestreo sistemático de la misma, a la cual tienen acceso diariamente. La agrotecnia de las áreas se maneja con fertilización orgánica (abono de gallina)

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)