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

Background: In this study, we aimed to evaluate the effects of tocilizumab in adult patients admitted to hospital with COVID-19 with both hypoxia and systemic inflammation. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. Those trial participants with hypoxia (oxygen saturation <92% on air or requiring oxygen therapy) and evidence of systemic inflammation (C-reactive protein ≥75 mg/L) were eligible for random assignment in a 1:1 ratio to usual standard of care alone versus usual standard of care plus tocilizumab at a dose of 400 mg–800 mg (depending on weight) given intravenously. A second dose could be given 12–24 h later if the patient's condition had not improved. The primary outcome was 28-day mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936). Findings: Between April 23, 2020, and Jan 24, 2021, 4116 adults of 21 550 patients enrolled into the RECOVERY trial were included in the assessment of tocilizumab, including 3385 (82%) patients receiving systemic corticosteroids. Overall, 621 (31%) of the 2022 patients allocated tocilizumab and 729 (35%) of the 2094 patients allocated to usual care died within 28 days (rate ratio 0·85; 95% CI 0·76–0·94; p=0·0028). Consistent results were seen in all prespecified subgroups of patients, including those receiving systemic corticosteroids. Patients allocated to tocilizumab were more likely to be discharged from hospital within 28 days (57% vs 50%; rate ratio 1·22; 1·12–1·33; p<0·0001). Among those not receiving invasive mechanical ventilation at baseline, patients allocated tocilizumab were less likely to reach the composite endpoint of invasive mechanical ventilation or death (35% vs 42%; risk ratio 0·84; 95% CI 0·77–0·92; p<0·0001). Interpretation: In hospitalised COVID-19 patients with hypoxia and systemic inflammation, tocilizumab improved survival and other clinical outcomes. These benefits were seen regardless of the amount of respiratory support and were additional to the benefits of systemic corticosteroids. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

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

Background: Many patients with COVID-19 have been treated with plasma containing anti-SARS-CoV-2 antibodies. We aimed to evaluate the safety and efficacy of convalescent plasma therapy in patients admitted to hospital with COVID-19. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. The trial is underway at 177 NHS hospitals from across the UK. Eligible and consenting patients were randomly assigned (1:1) to receive either usual care alone (usual care group) or usual care plus high-titre convalescent plasma (convalescent plasma group). The primary outcome was 28-day mortality, analysed on an intention-to-treat basis. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings: Between May 28, 2020, and Jan 15, 2021, 11558 (71%) of 16287 patients enrolled in RECOVERY were eligible to receive convalescent plasma and were assigned to either the convalescent plasma group or the usual care group. There was no significant difference in 28-day mortality between the two groups: 1399 (24%) of 5795 patients in the convalescent plasma group and 1408 (24%) of 5763 patients in the usual care group died within 28 days (rate ratio 1·00, 95% CI 0·93–1·07; p=0·95). The 28-day mortality rate ratio was similar in all prespecified subgroups of patients, including in those patients without detectable SARS-CoV-2 antibodies at randomisation. Allocation to convalescent plasma had no significant effect on the proportion of patients discharged from hospital within 28 days (3832 [66%] patients in the convalescent plasma group vs 3822 [66%] patients in the usual care group; rate ratio 0·99, 95% CI 0·94–1·03; p=0·57). Among those not on invasive mechanical ventilation at randomisation, there was no significant difference in the proportion of patients meeting the composite endpoint of progression to invasive mechanical ventilation or death (1568 [29%] of 5493 patients in the convalescent plasma group vs 1568 [29%] of 5448 patients in the usual care group; rate ratio 0·99, 95% CI 0·93–1·05; p=0·79). Interpretation: In patients hospitalised with COVID-19, high-titre convalescent plasma did not improve survival or other prespecified clinical outcomes. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Does visual-perceptual training augment the fielding performance of skilled cricketers?

This study examined the effectiveness of visual-perceptual training for improving fielding performance in cricket. Twelve highly-skilled cricket players completed a video-based decision-making test and an in-situ fielding test before and after a six-week training intervention. During this period, all participants completed the same on-field training program, but seven players completed three additional perceptual training sessions per week (TRAIN). The remaining five players acted as a control (CON). Despite no group differences at pre-test, TRAIN scored significantly higher than CON at post-test for decision accuracy within the video-based test. For the in-situ fielding test, TRAIN demonstrated greater improvements in fielding success following the intervention compared to CON. The results indicate that six weeks of on-field training combined with visual-perceptual training can lead to improvements in the fielding performance of skilled cricketers above those of on-field training alone. Findings are discussed from empirical and applied coaching perspectives

The effects of online advertising

The effects of online Internet advertising techniques, such as banners, pop-ups, and pop-under, on the consumers or Internet users are discussed. Online consumers are goal-oriented and judge online advertisements even more harshly that those in other media, such as television. Some researchers have found that the online users find information helpful when presented in an enjoyable context, and some consumers develop such negative attitudes toward the ads and avoid them whenever possible. Experimental Web sites with different type of advertisements were developed that were accessed over the Internet in a controlled laboratory setting by 536 undergraduate students enrolled in two US universities. The researchers discovered that interruption from a task cause people to suffer in their recall performance and react negatively to the need to try and process the information provided in the interruption as well as the Web site

Perceptual training using explicit and implicit instructional techniques: does it benefit skilled performers?

This study investigated the efficacy of explicit and implicit perceptual training approaches designed to improve the pattern perception capabilities of skilled basketball players, relative to control and placebo groups. The explicit and implicit groups completed 4 weeks of training using temporally occluded video footage while the placebo group used general visual stimuli. Results from a video-based test showed no significant differences between the four groups after the training intervention, despite large absolute gains by the two experimental groups. After a 14-day retention interval, improvements by the control group suggested that test familiarity may have influenced the retention test results. The transfer data showed that the laboratory-based training failed to elicit a significant change in on-court performance. The results, while not statistically significant, highlight a number of key considerations when attempting to develop perceptual-cognitive abilities in experienced athletes and provide direction for researchers and practitioners when designing similar training approaches

Manipulating constraints to train decision making in Rugby Union

This paper focuses on the paradoxical relationship between game unpredictability and the certainty of players' actions in team ball sports. Our research on this relationship leads us to suggest a method for training decision making, which we exemplify in the team sport of Rugby Union. The training methodology is based on application of theoretical insights from ecological psychology, complex dynamical systems and the constraints-led approach. The paper starts with a critical overview of traditional approaches to studying decision making in sport. Next we describe the sport of Rugby Union to exemplify a complex dynamical system, and explain how that conceptualisation captures the interactions of players within that performance context. We conclude our analysis by describing how to manipulate task constraints to improve decision-making performance, as players search for an appropriate blend of stability and variability in their actions. In the final part of the paper, we suggest some methods to train decision making based on four stages: i) identifying the problem; ii) setting out a strategy to solve it; iii) creating an action model; and iv) building a decision-making exercise. The main conclusion from our work for coaches and sports scientists is that decision making should be improved through training methods that provide an accurate balance between stability of actions, which gives structure to the players' performance, and variability, which allows them to cope with the uncertainty of situational constraints, such as the behaviour of specific opponents