Flora vascular en el espacio público de Santiago, Chile

After an extensive two-year long research effort, the results document the diversity of vascular plants that grow in the public spaces of Santiago, Chile. We analyze the taxonomic composition, life-forms and phytogeographic origin of the vascular flora of Santiago and, finally, we compare the results with those of urban areas in the Northern Hemisphere. We identified 508 species, 100 families, and 338 genera. The families that showed the greatest richness were Asteraceae and Poaceae. We found that at least 85.1% of the species are exotic. The life-forms are similarly represented, although chamaephytes and geophytes are poorly represented. We conclude that the composition of the urban flora of Santiago differs from that of most Northern Hemisphere cities, due to the increased presence of exotic species, which is likely a consequence of the historical and cultural patterns of ornamentation. Therefore it is likely that this urban area would be an adverse environment for the establishment and development of native species.Los resultados documentan la diversidad de plantas vasculares que se desarrollan en el espacio público de Santiago en una investigación que se prolongó por dos años. Nosotros analizamos la composición taxonómica, la forma de vida y el origen fitogeográfico de la flora vascular y, finalmente, comparamos los resultados con aquellos de áreas urbanas del Hemisferio Norte. Se reconocen 508 especies, 100 familias y 338 géneros. Las familias que tienen mayor riqueza fueron Asteraceae y Poaceae. El 85,1% de las especies son exóticas. Las formas de vida están similarmente representadas, aunque las caméfitas y las geófitas están muy poco representadas. Concluimos que la composición de la flora urbana de Santiago se distingue de la mayoría de las ciudades del Hemisferio Norte por el mayor número de especies exóticas, que es probablemente una consecuencia de los patrones históricos y culturales de ornamentación, al tiempo que los espacios urbanos parecen representar un ambiente adverso para el establecimiento y desarrollo de especies nativas

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)