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PurposePatients receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) frequently develop arterial hyperoxaemia, which may be harmful. However, lower oxygen saturation targets may also lead to harmful episodes of hypoxaemia.MethodsIn this registry-embedded, multicentre trial, we randomly assigned adult patients receiving VA-ECMO in an intensive care unit (ICU) to either a conservative (target SaO2 92–96%) or to a liberal oxygen strategy (target SaO2 97–100%) through controlled oxygen administration via the ventilator and ECMO gas blender. The primary outcome was the number of ICU-free days to day 28. Secondary outcomes included ICU-free days to day 60, mortality, ECMO and ventilation duration, ICU and hospital lengths of stay, and functional outcomes at 6 months.ResultsFrom September 2019 through June 2023, 934 patients who received VA-ECMO were reported to the EXCEL registry, of whom 300 (192 cardiogenic shock, 108 refractory cardiac arrest) were recruited. We randomised 149 to a conservative and 151 to a liberal oxygen strategy. The median number of ICU-free days to day 28 was similar in both groups (conservative: 0 days [interquartile range (IQR) 0–13.7] versus liberal: 0 days [IQR 0–13.3], median treatment effect: 0 days [95% confidence interval (CI) – 3.1 to 3.1]). Mortality at day 28 (59/149 [39.6%] vs 59/151 [39.1%]) and at day 60 (64/149 [43%] vs 62/151 [41.1%] were similar in conservative and liberal groups, as were all other secondary outcomes and adverse events. The conservative group experienced 44 (29.5%) major protocol deviations compared to 2 (1.3%) in the liberal oxygen group (P < 0.001).ConclusionsIn adults receiving VA-ECMO in ICU, a conservative compared to a liberal oxygen strategy, did not affect the number of ICU-free days to day 28.

Background The optimal transfusion threshold for patients undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO) remains uncertain. Methods We used data from OBLEX (ClinicalTrials.gov: NCT03714048), an international, prospective, observational study conducted across 12 centres in Australia, Europe, and North America between 2019 and 2022. The study collected information on patient demographics, bleeding risk factors, transfusion practices during the first seven days of ECMO, and in-hospital mortality. Using these data, we emulated a target trial comparing the effects of liberal transfusion practice (transfusion initiated at Hb ≥ 90 g/L) and restrictive transfusion practice (transfusion initiated at Hb ≤ 70 g/L) on hospital mortality within seven days of ECMO initiation. Sequential trials approach was used to estimate the causal contrast. Results A total of 534 patients were included, with 46% dying during hospitalisation. After accounting for potential confounders, the liberal transfusion practice demonstrated a modest survival benefit within the first two days of ECMO, with differences in survival probabilities of 12% (95% CI 3% to 21%) at day 2 and 13% (95% CI 2% to 25%) at day 3, corresponding to the number needed to treat (NNT) of 8 and 7 respectively. No differences in survival benefit were found after day 3. These results were consistent across sensitivity and exploratory analyses. Conclusion This target trial emulation study suggests that a liberal transfusion threshold may provide a modest survival benefit during the early course of VA-ECMO, but no benefit afterwards. Prospective studies are needed to confirm these findings, assess clinical adoption, and investigate underlying mechanism.

The purpose of this study was to determine if significant differences existed among four local universities' teacher education programs. While it has been demonstrated that many teacher education reform movements have occurred, the research suggest the results of national, state, and local reform movements have been varied. The sample for this study included 147 pre-service, student teachers and 14 of their methods instructors from four local universities. Each institution, was within forty miles of the others, but drew from different segments of the population. Ventures For Excellence, a Nebraskan teacher selection company, provided the survey instrument that was utilized to assess the four different teacher education programs. Ventures For Excellence provided the survey, provided the criteria for evaluating the survey, and scored the survey themselves based on their own criteria. To analyze the results of the data, two ANOVA tests and one unpaired T-test were utilized. Responses from the questionnaire produced the subsequent results: (1) Eight questions were worded to elicit responses that measured the pre-service, elementary student teachers at four local universities. When the questions were analyzed as a group, there was a statistically significant difference in the mean scores between University #1 and the other three universities. (2) The same eight questions were also answered by the pre-service, elementary student teachers' methods instructors. When their responses were analyzed as a group, there was no statistically significant difference among the universities. However, when the methods instructors' responses were compared to the pre-service, student teacher responses, there was a statistical significant difference, with the methods instructors scoring higher than the pre-service, elementary student teachers. (3) According to the Ventures For Excellence's criteria, neither of the groups, the pre-service, elementary student teachers nor the methods instructors, from the four universities obtained the adequate 4.0 mean score, although many did achieve scores of (+) on individual items. (4) After examining the four universities' mission statements, curricula and syllabi, there appeared to be a discernable relationship between each universities' “focus” and the pre-service, student teachers' responses. This study indicated that the significant difference between University #1 and the other three universities should warrant further study. Further focus should be placed on the communication between local universities.

Abundance and density are vital metrics for assessing a species’ conservation status and for developing effective management strategies. Remote‐sensing cameras are being used increasingly as part of citizen science projects to monitor wildlife, but current methodologies to monitor densities pose challenges when animals are not individually recognizable. We investigated the use of camera traps and the Random Encounter Model (REM) for estimating the density of West European hedgehogs (Erinaceus europaeus) within a citizen science framework. We evaluated the use of a simplified version of the REM in terms of the parameters’ estimation (averaged vs. survey‐specific) and assessed its potential application as part of a large‐scale, long‐term citizen science project. We compared averaged REM estimates to those obtained via spatial capture–recapture (SCR) using data from nocturnal spotlight surveys. There was a high degree of concordance in REM‐derived density estimates from averaged parameters versus those derived from survey‐specific parameters. Averaged REM density estimates were also comparable to those produced by SCR at eight out of nine sites; hedgehog density was 7.5 times higher in urban (32.3 km−2) versus rural (4.3 km2) sites. Power analyses indicated that the averaged REM approach would be able to detect a 25% change in hedgehog density in both habitats with >90% power. Furthermore, despite the high start‐up costs associated with the REM method, it would be cost‐effective in the long term. The averaged REM approach is a promising solution to the challenge of large‐scale and long‐term species monitoring. We suggest including the REM as part of a citizen science monitoring project, where participants collect data and researchers verify and implement the required analysis. We investigate the use of camera traps and the Random Encounter Model (REM) for estimating the density of West European hedgehogs (Erinaceus europaeus) within a citizen science framework. We evaluate the use of a simplified version of the REM in terms of the parameters’ estimation and asses its potential application as part of a large‐scale, long‐term citizen science project. REM density estimates were comparable to those produced by SCR at eight out of nine sites; hedgehog density was 7.5 times higher in urban (32.3 km−2) versus rural (4.3 km2) sites. Power analysis indicate that REM would be able to detect a 25% change in hedgehog density in both habitats with >90% power, and could be implemented as part of citizen science projects.