Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Thigh-length compression stockings and DVT after stroke

Controversy exists as to whether neoadjuvant chemotherapy improves survival in patients with invasive bladder cancer, despite randomised controlled trials of more than 3000 patients. We undertook a systematic review and meta-analysis to assess the effect of such treatment on survival in patients with this disease

Performance of GE1/1 Chambers for the CMS Muon Endcap Upgrade

The high-luminosity phase of the Large Hadron Collider (HL-LHC) will result in particle backgrounds ten times higher than its current value. In order to fully exploit the highly-demanding operating conditions during HL-LHC, the Compact Muon Solenoid (CMS) Collaboration has proposed the use of Gas Electron Multiplier (GEM) detector technology. The technology will be integrated into the innermost region of the forward muon spectrometer of the CMS as the additional muon station in the form of GE1/1. The primary purpose of this auxiliary station is to help in muon reconstruction and to control level-1 muon trigger rates in the pseudo-rapidity region of $1.6 <|\eta|<2.2$. The new station will be embellished with specific trapezoidal shaped GEM detectors known as GE1/1 chambers. The design of these chambers is finalized, and the installation is foreseen during the Long Shutdown phase two (LS-2) starting at the beginning of 2019. Several full-size prototypes were built and operated successfully in various beam tests at CERN. We describe the performance measurements such as gain, efficiency, and timing resolution of such chambers after years of R&D and summarize their behavior in different gas compositions as a function of the voltage fed to the HV divider chain that feeds the different electrodes

Layout and Assembly Technique of the GEM Chambers for the Upgrade of the CMS First Muon Endcap Station

Triple-GEM detector technology was recently selected by CMS for a part of the upgrade of its forward muon detector system as GEM detectors provide a stable operation in the high radiation environment expected during the future High-Luminosity phase of the Large Hadron Collider (HL-LHC). In a first step, GEM chambers (detectors) will be installed in the innermost muon endcap station in the $1.6<\left|\eta\right|<2.2$ pseudo-rapidity region, mainly to control level-1 muon trigger rates after the second LHC Long Shutdown. These new chambers will add redundancy to the muon system in the $\eta$-region where the background rates are high, and the bending of the muon trajectories due to the CMS magnetic field is small. A novel construction technique for such chambers has been developed in such a way where foils are mounted onto a single stack and then uniformly stretched mechanically, avoiding the use of spacers and glue inside the active gas volume. We describe the layout, the stretching mechanism and the overall assembly technique of such GEM chambers.Triple-GEM detector technology was recently selected by CMS for a part of the upgrade of its forward muon detector system as GEM detectors provide a stable operation in the high radiation environment expected during the future High-Luminosity phase of the Large Hadron Collider (HL-LHC). In a first step, GEM chambers (detectors) will be installed in the innermost muon endcap station in the $1.6 \lt \eta \lt 2.2$ pseudo-rapidity region, mainly to control level-1 muon trigger rates after the second LHC Long Shutdown. These new chambers will add redundancy to the muon system in the $\eta$-region where the background rates are high, and the bending of the muon trajectories due to the CMS magnetic field is small. A novel construction technique for such chambers has been developed in such a way where foils are mounted onto a single stack and then uniformly stretched mechanically, avoiding the use of spacers and glue inside the active gas volume. We describe the layout, the stretching mechanism and the overall assembly technique of such GEM chambers