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

Progress on the Los Alamos heavy-ion injector

Heavy-ion fusion using an induction linac requires injection of multiple high-current beams from a pulsed electrostatic accelerator at as high a voltage as practical. Los Alamos National Laboratory is developing a 16-beam, 2-MeV, pulsed electrostatic accelerator for Al/sup +/ ions. The ion source will use a pulsed metal vapor arc plasma. A biased grid will control plasma flux into the ion extraction region. This source has achieved a normalized emittance of epsilon/sub n/ < 3.10/sup -7/..pi..-m-rad with Al/sup +/ ions. An 800 kV Marx prototype with a laser fired diverter is being assembled. The ceramic accelerating column sections have been brazed and leak tested. Voltage hold off on a brazed sample was more than doubled by selective removal of the Ticusil braze fillet extending along the ceramic. A scaled test module held 250 kV for 50 ..mu..s, giving confidence that the full module can hold 175 kV per section. The pressure vessel should be received in June 1986. High-voltage testing of a 1 MV column will begin by early 1987

Comparing active vision models

Contains fulltext : 76637.pdf (publisher's version ) (Closed access)Active vision models can simplify visual tasks, provided that they can select sensible actions given incoming sensory inputs. Many active vision models have been proposed, but a comparative evaluation of these models is lacking. We present a comparison of active vision models from two different approaches. The ''probabilistic approach'' is an approach in which state estimation is the central goal. The ''behavioural approach'' is an approach that does not divide the vision process in a state estimation and an acting phase. We identify different types of models of the probabilistic approach, and introduce a model inspired on the behavioural approach. We describe these types of models in a common framework and evaluate their performances on a task of viewpoint selection for the classification of three-dimensional objects. The experimental results reveal how the performances of the active vision models relate to each other. For example, the behavioural model performs as good as the best model from the probabilistic approach. Overall, the experimental results reveal relations between the usefulness of active vision, the number of objects involved in the classification task, and the richness of the visual observations of the models. We conclude that research on active vision should aim at reaching a deeper understanding of these relations by applying active vision models to more complex and real-world tasks

Evolution of embodied intelligence

Abstract. We provide an overview of the evolutionary approach to the emergence of artificial intelligence in embodied behavioral agents. This approach, also known as Evolutionary Robotics, builds and capitalizes upon the interactions between the embodied agent and its environment. Although we cover research carried out in several laboratories around the world, the choice of topics and approaches is based on work carried out at EPFL. We describe a large number of experiments including evolution of single robots in environments of increasing complexity, competitive and cooperative evolution, evolution of vision-based systems, evolution of learning, and evolution of electronics and morphologies for autonomous robots.