Experimental trials of species-specific bat flight responses to an ultrasonic deterrent

Unintended consequences of increasing wind energy production include bat mortalities from wind turbine blade strikes. Ultrasonic deterrents (UDs) have been developed to reduce bat mortalities at wind turbines. Our goal was to experimentally assess the species-specific effectiveness of three emission treatments from the UD developed by NRG Systems. We conducted trials in a flight cage measuring approximately 60 m × 10 m × 4.4 m (length × width × height) from July 2020 to May 2021 in San Marcos, Texas, USA. A single UD was placed at either end of the flight cage, and we randomly selected one for each night of field trials. Trials focused on a red bat species group (Lasiurus borealis and Lasiurus blossevillii; n = 46) and four species: cave myotis (Myotis velifer; n = 57), Brazilian free-tailed bats (Tadarida brasiliensis; n = 73), evening bats (Nycteceius humeralis; n = 53), and tricolored bats (Perimyotis subflavus; n = 17). The trials occurred during three treatment emissions: low (emissions from subarrays at 20, 26, and 32 kHz), high (emissions from subarrays at 38, 44, and 50 kHz), and combined (all six emission frequencies). We placed one wild-captured bat into the flight cage for each trial, which consisted of an acclimation period, a control period with the UD powered off, and the three emission treatments (order randomly selected), each interspersed with a control period. We tracked bat flight using four thermal cameras placed outside the flight cage. We quantified the effectiveness of each treatment by comparing the distances each bat flew from the UD during each treatment vs. the control period using quantile regression. Additionally, we conducted an exploratory analysis of differences between sex and season and sex within season using analysis of variance. Broadly, UDs were effective at altering the bats’ flight paths as they flew farther from the UD during treatments than during controls; however, results varied by species, sex, season, and sex within season. For the red bat group, bats flew farther from the UD during all treatments than during the control period at all percentiles (p < 0.001), and treatments were comparable in effectiveness. For cave myotis, all percentile distances were farther from the UD during each of the treatments than during the control, except the 90th percentile distance during high, and low was most effective. For evening bats and Brazilian free-tailed bats, results were inconsistent, but high and low were most effective, respectively. For tricolored bats, combined and low were significant at the 10th–75th percentiles, high was significant at all percentiles, and combined was most effective. Results suggest UDs may be an effective means of reducing bat mortalities due to wind turbine blade strikes. We recommend that continued research on UDs focus on low emission treatments, which have decreased sound attenuation and demonstrated effectiveness across the bat species evaluated in this study

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

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

Background Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatory actions. 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-19 Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospital with COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients were randomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once per day by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatment groups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment and were twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants and local study staff were not masked to the allocated treatment, but all others involved in the trial were masked to the outcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treat population. 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%) were eligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was 65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomly allocated 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 (median 10 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, no significant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilation or 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 other prespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restricted to patients in whom there is a clear antimicrobial indication. Funding UK Research and Innovation (Medical Research Council) and National Institute of Health Research