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

Alcyonarian spiculites as possible proxy climate archives: preliminary results

Alcyonarian spiculite (KONISHI 1981) is a carbonate rock built by a few soft coral species, notably Sinularia minima VERSEVELDT 1971, Sinularia polydactyla (EHRENBERG 1834), Sinularia leptoclados (EHRENBERG 1834) (the latter two are common in the tropical Indo-Pacific) and possibly Lobophytum pauciflorum (EHRENBERG 1834) (PAULAY & BENAYAHU 1999). The corals excrete 1-3 mm long sclerites (also called spindles or spicules) of high Mg calcite from the base of the stalk which become cemented by marine cements as the coral grows upwards (Fig. 3, A, B). In the tropical Pacific Ocean pedestals up to 1.5 m high with living Sinularia colonies on top have been described in the literature and by eye witnesses (CAREY 1931, SCHUHMACHER 1997, R. KELLEY, written com. 2008). Spiculites were found in sediment cores as old as 7,500 years (KLEYPASS 1996, southern GBR). ACCORDI et al. (1989) reported Quaternary Alcyonarian spiculites from the coast of Somalia. The spicules (or sclerites) are cemented soon after deposition by several generations of aragonite and high-Mg calcite cements. X-ray analyses of sawn slabs of spiculite rock show that the spicules are arranged in layers and that density bands are present (Fig. 3, D). These bands may contain paleoclimate information enclosed in either cements or spicules or both, similar to hard corals

Quantifying Mechanisms Responsible for Extreme Coastal Water Levels and Flooding during Severe Tropical Cyclone Harold in Tonga, Southwest Pacific

The South Pacific region is characterised by steep shelves and fringing coral reef islands. The lack of wide continental shelves that can dissipate waves makes Pacific Island countries vulnerable to large waves that can enhance extreme total water levels triggered by tropical cyclones (TCs). In this study, hindcasts of the waves and storm surge induced by severe TC Harold in 2020 on Tongatapu, Tonga’s capital island, were examined using the state-of-the-art hydrodynamic and wave models ADCIRC and SWAN. The contributions of winds, atmospheric pressure, waves, and wave-radiation-stress-induced setup to extreme total water levels were analysed by running the models separately and two-way coupled. The atmospheric pressure deficit contributed uniformly to the total water levels (~25%), while the wind surge was prominent over the shallow shelf (more than 75%). Wave setup became significant at locations with narrow fringing reefs on the western side (more than 75%). Tides were dominant on the leeward coasts of the island (50–75%). Storm surge obtained from the coupled run without tide was comparable with the observation. The wave contribution to extreme total water levels and inundation was analysed using XBEACH in non-hydrostatic mode. The model (XBEACH) was able to reproduce coastal inundation when compared to the observed satellite imagery after the event on a particular coastal segment severely impacted by coastal flooding induced by TC Harold. The coupled ADCIRC+SWAN underestimated total water levels nearshore on the reef flat and consequently inundation extent as infragravity waves and swash motion are not resolved by these models. The suite of models (ADCIRC+SWAN+XBEACH) used in this study can be used to support the Tonga Meteorological Service Tropical Cyclone Early Warning System

Climate Change in the Pacific 2022: Historical and Recent Variability, Extremes and Change

<p>This report presents key scientific findings from the second phase of the Climate and Oceans Support Program in the Pacific (COSPPac, July 2018–June 2023), Seasonal Prediction and the Pacific Sea Level and Geodetic Monitoring (PSLGM) projects. The report contributes to COSPPac's aim for Pacific Island national meteorological services to understand and use climate, ocean and sea level data and information to develop and disseminate useful products and services to Pacific Island governments and communities, building resilience against the impact of climate change, climate variability and disasters. </p><p>The report also provides an update of scientific understanding of large-scale climate processes, variability and extremes in the western tropical Pacific first presented in the Pacific Climate Change Science Program (PCCSP) Climate Change in the Pacific: Scientific Assessment and New Research, Volume 2, Country Reports (2011) and the Pacific–Australia Climate Change Science and Adaptation Planning (PACCSAP) Program Climate Variability, Extremes and Change in the Western Tropical Pacific: New Science and Updated Country Reports (2014).</p><p>The work is designed to complement the recently released 'NextGen' Projections for the Western Tropical Pacific country reports and provide finer-scale partner country historical climate change information not presented in the Intergovernmental Panel on Climate Change (IPCC)'s Sixth Assessment Report (AR6), Climate Change 2021: The Physical Science Basis, and World Meteorological Organization (WMO) Regional Association Five (RA-V) Pacific Regional Climate Centre (RCC) Network's Pacific Climate Change Monitor (PCCM) Report (2022).</p&gt

Climate Change in the Pacific 2022: Historical and Recent Variability, Extremes and Change

<p>This report presents key scientific findings from the second phase of the Climate and Oceans Support Program in the Pacific (COSPPac, July 2018–June 2023), Seasonal Prediction and the Pacific Sea Level and Geodetic Monitoring (PSLGM) projects. The report contributes to COSPPac's aim for Pacific Island national meteorological services to understand and use climate, ocean and sea level data and information to develop and disseminate useful products and services to Pacific Island governments and communities, building resilience against the impact of climate change, climate variability and disasters. </p><p>The report also provides an update of scientific understanding of large-scale climate processes, variability and extremes in the western tropical Pacific first presented in the Pacific Climate Change Science Program (PCCSP) Climate Change in the Pacific: Scientific Assessment and New Research, Volume 2, Country Reports (2011) and the Pacific–Australia Climate Change Science and Adaptation Planning (PACCSAP) Program Climate Variability, Extremes and Change in the Western Tropical Pacific: New Science and Updated Country Reports (2014).</p><p>The work is designed to complement the recently released 'NextGen' Projections for the Western Tropical Pacific country reports and provide finer-scale partner country historical climate change information not presented in the Intergovernmental Panel on Climate Change (IPCC)'s Sixth Assessment Report (AR6), Climate Change 2021: The Physical Science Basis, and World Meteorological Organization (WMO) Regional Association Five (RA-V) Pacific Regional Climate Centre (RCC) Network's Pacific Climate Change Monitor (PCCM) Report (2022).</p&gt

Developing High Resolution Baseline Coast Resource Maps Using World View 2 Imagery for a Coastal Village in Fiji

In Fiji, like most Pacific Island countries, there have been numerous reports of degradation of coastal resources, including adverse changes in abundance and stock distribution of numerous aquatic species associated with the coastal habitat. To develop effective management plans, assessment of existing coastal resources is pertinent. High spatial resolution satellite imagery, combined with geographic information systems allow for efficient and synoptic mapping of coastal resources to provide a baseline for developing effective and improved management plans. The purpose of this study was to develop a baseline habitat map of the intertidal benthic cover in Komave Village, Coral Coast, Sigatoka, Fiji. Resource mapping was based on high resolution (2 m) WorldView-2 imagery. Ground-truthing was attained by means of on-site data logging of the intertidal resources, image capturing and GPS recording. Based on these records, the benthic cover was classified into seven classes: ‘coral,’ ‘algae,’ ‘brown algae,’ ‘volcanic rocks,’ ‘sand and gravel,’ ‘sea grass,’ and ‘bare.’ Ground referencing points were randomly assigned for either supervised classification training or accuracy assessment. A community participatory research approach was used to conduct interviews to assimilate information on fishing sites and coastal land use activities. This exercise explored the social-ecological approach in natural resource management and how it can become an important tool in coastal conservation practices. The coastal resource map generated through this study serves as a baseline for monitoring the status and spatial distribution of the coastal resources in Komave. Annual mapping of the resources and enrichment of maps along with iterative village consultation will enable managers to develop and gauge the effectiveness of coastal management plans. This high resolution map is particularly relevant to Fiji as it is the first of its kind for the country. This work also serves to reduce the global information gap of coastal resource status for Fiji