Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Ant farmers practice proactive personal hygiene to protect their fungus crop

Agricultural systems often involve monocultures that are vulnerable to competitors and pathogens. Successful agriculture, therefore, relies on preventing the contamination of the crop by detrimental organisms or on removing such organisms. The fungus-growing ants exhibit one of the most ancient forms of agriculture, farming a clonal fungal crop that is highly susceptible to competitive and pathogenic microorganisms [1,2]. Like human farmers, the ants have a suite of reactive and prophylactic defence mechanisms, including the application of pesticides and weeding [3,4,5]. Here, we show that fungus-growing ants also engage in proactive self-cleaning behaviour to remove undetected microbes and prevent them from contaminating the vulnerable fungal crop. Although many social animals show reactive hygiene, the behaviour detailed here is proactive and a response to the detection of vulnerable individuals rather than the threat itsel

Do saving promotion interventions increase household savings, consumption, and investments in Sub-Saharan Africa? A systematic review and meta-analysis

Saving promotion interventions have gained momentum in international development in recent years. Our analysis investigates whether saving promotion can effectively increase savings, consumption, and future-oriented investments in Sub-Saharan Africa. In an extensive search of 28 academic and policy-focused databases in the fields of economics, psychology, and social sciences, 9330 titles and abstracts of published and unpublished studies were screened and 27 randomized controlled trials on saving promotion interventions fulfilled the inclusion criteria. Of these, 24 studies reporting on an aggregated sample of 87,025 individuals provided sufficient information to be included in the meta-analysis. Robust-variance estimations of pooled effect sizes show small but significant impacts on poverty reduction, including increases in household expenditures and incomes, higher returns from family businesses, and improved food security. They also show positive and significant impacts on more intermediate outcomes including total savings, pro-saving attitudes, financial literacy, and investments in small-scale family businesses. Our results do not show significant effects on assets, housing quality, education, or health. Results from meta-regressions suggest that supply-based programs are superior to demand-enhancing program types such as financial education. They further reveal reduced program effectiveness for women. Overall, findings from this analysis suggest that saving promotion schemes are highly relevant in reducing poverty in Sub-Saharan Africa, and that future efforts should focus on expansion of banking services to the poor as well as gender-sensitive programming