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

Advances in games technology: Software, models, and intelligence

Games technology has undergone tremendous development. In this article, the authors report the rapid advancement that has been observed in the way games software is being developed, as well as in the development of games content using game engines. One area that has gained special attention is modeling the game environment such as terrain and buildings. This article presents the continuous level of detail terrain modeling techniques that can help generate and render realistic terrain in real time. Deployment of characters in the environment is increasingly common. This requires strategies to map scalable behavior characteristics for characters as well. The authors present two important aspects of crowd simulation: the realism of the crowd behavior and the computational overhead involved. A good simulation of crowd behavior requires delicate balance between these aspects. The focus in this article is on human behavior representation for crowd simulation. To enhance the player experience, the authors present the concept of player adaptive entertainment computing, which provides a personalized experience for each individual when interacting with the game. The current state of game development involves using very small percentage (typically 4% to 12%) of CPU time for game artificial intelligence (AI). Future game AI requires developing computational strategies that have little involvement of CPU for online play, while using CPU's idle capacity when the game is not being played, thereby emphasizing the construction of complex game AI models offline. A framework of such nonconventional game AI models is introduced