Colonial lives of the carceral archipelago: rethinking the neoliberal security state

Mass incarceration, police brutality, and border controls are part and parcel of the everyday experiences of marginalized and racialized communities across the world. Recent scholarship in international relations, sociology, and geography has examined the prevalence of these coercive practices through the prism of “disciplinary,” “penal,” or “authoritarian” neoliberalism. In this collective discussion, we argue that although this literature has brought to the fore neoliberalism's reliance on state violence, it has yet to interrogate how these carceral measures are linked to previous forms of global racial ordering. To rectify this moment of “colonial unknowing,” the collective discussion draws on decolonial approaches, Indigenous studies, and theories of racial capitalism. It demonstrates that “new” and “neoliberal” forms of domestic control must be situated within the global longue durée of racialized and colonial accumulation by dispossession. By mapping contemporary modes of policing, incarceration, migration control, and surveillance onto earlier forms of racial–colonial subjugation, we argue that countering the violence of neoliberalism requires more than nostalgic appeals for a return to Keynesianism. What is needed is abolition—not just of the carceral archipelago, but of the very system of racial capitalism that produces and depends on these global vectors of organized violence and abandonment. L'incarcération de masse, la brutalité policière et les contrôles aux frontières constituent une partie intégrante des expériences quotidiennes des communautés marginalisées et racialisées du monde entier. Des études récentes en relations internationales, en sociologie et en géographie ont examiné la prévalence de ces pratiques coercitives par le prisme du néolibéralisme « disciplinaire », « pénal » ou « autoritaire ». Dans cet article, nous soutenons que bien que cette littérature ait mis en évidence la dépendance du néolibéralisme à la violence étatique, elle ne s'est pas encore interrogée sur le lien entre ces mesures carcérales et les formes précédentes d'ordre racial mondial. Cet article s'appuie sur le féminisme noir, les approches décoloniales, les études indigènes et les théories de capitalisme racial pour rectifier cette « ignorance coloniale » marquante. Il démontre que les formes « nouvelles » et « néolibérales » de contrôle national doivent se situer dans la longue durée globale de l'accumulation racialisée et coloniale par dépossession. Nous associons les modes contemporains de maintien de l'ordre, d'incarcération, de contrôle migratoire et de surveillance à des formes antérieures d'assujettissement racial/colonial pour soutenir que contrer la violence du néolibéralisme exige davantage que des appels nostalgiques au retour du keynésianisme. Ce qu'il faut, c'est une abolition : non seulement de l'archipel carcéral, mais aussi du système de capitalisme racial en lui-même qui produit et dépend de ces vecteurs globaux de violence organisée et d'abandon. El encarcelamiento masivo, la brutalidad policial y los controles fronterizos forman parte de las experiencias cotidianas de las comunidades marginadas y racializadas de todo el mundo. Estudios recientes en RI, Sociología y Geografía han examinado la prevalencia de estas prácticas coercitivas a través del prisma del neoliberalismo “disciplinario,” “penal” o “autoritario.” En este artículo, sostenemos que, si bien esta literatura puso en primer plano la dependencia del neoliberalismo de la violencia estatal, aún tiene que cuestionar la manera en que estas medidas carcelarias se vinculan a formas anteriores de ordenamiento racial global. Para rectificar este momento de “desconocimiento colonial,” el artículo recurre al feminismo negro, a los abordajes descoloniales, a los estudios indígenas y a las teorías del capitalismo racial. Demuestra que las formas “nuevas” y “neoliberales” de control interno se deben situar dentro de la longue durée global de la acumulación por desposesión racializada y colonial. Al trazar un mapa de los modos contemporáneos de vigilancia policial, encarcelamiento, control de la migración y vigilancia sobre las formas anteriores de subyugación racial-colonial, sostenemos que contrarrestar la violencia del neoliberalismo requiere algo más que apelaciones nostálgicas de retorno al keynesianismo. Lo que se necesita es la abolición, no solo del archipiélago carcelario, sino también del propio sistema de capitalismo racial que produce y depende de estos vectores globales de violencia y abandono organizados

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

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

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