Redescrição de duas espécies neotropicais de Empididae (Diptera) descritas por curran e revalidação do gênero Porphyrochroa

The two species described in the genus Axelempis Curran, 1931, junior synonym of Macrostomus Wiedemann, 1817, Axelempis fulvithorax Curran, 1931 and A. fasciventris Curran, 1931 are redescribed from the types. The first one remains in the genus Macrostomus and the second one is transferred to Porphyrochroa Melander, 1928, here revalidated

Laughing at lunacy: othering and comic ambiguity in popular humour about mental distress

Jokes and humour about mental distress are said by anti-stigma campaigners to be no laughing matter. The article takes issue with this viewpoint arguing that this is clearly not the case since popular culture past and present has laughed at the antics of those perceived as ‘mad’. Drawing on past and present examples of the othering of insanity in jokes and humour the article incorporates a historical perspective on continuity and change in humour about madness/mental distress, which enables us to recognise that psychiatry is a funny-peculiar enterprise and its therapeutic practices in past times are deserving of funny ha-ha mockery and mirth in the present. By doing so, the article also argues that humour and mental distress illuminate how psychiatric definitions and popular representations conflict and that some psychiatric service users employ comic ambiguity to reflexively puncture their public image as ‘nuts’

Environmental monitoring : phase 5 final report (April 2019 - March 2020)

This report presents the results and interpretation for Phase 5 of an integrated environmental monitoring programme that is being undertaken around two proposed shale gas sites in England – Preston New Road, Lancashire and Kirby Misperton, North Yorkshire. The report should be read in conjunction with previous reports freely available through the project website1 . These provide additional background to the project, presentation of earlier results and the rationale for establishment of the different elements of the monitoring programme

Environmental monitoring : phase 4 final report (April 2018 - March 2019)

This report describes the results of activities carried out as part of the Environmental Monitoring Project (EMP) led by the British Geological Survey (BGS) in areas around two shale gas sites in England – Kirby Misperton (Vale of Pickering, North Yorkshire) and Preston New Road (Fylde, Lancashire). It focuses on the monitoring undertaken during the period April 2018–March 2019 but also considers this in the context of earlier monitoring results that have been covered in reports for earlier phases of the project (Phases I–IV) 2 . The EMP project is a multi-partner project involving BGS together with Public Health England (PHE), University of Birmingham, University of Bristol, University of Manchester, Royal Holloway University of London (RHUL) and University of York. The work has been enabled by funding from a combination of the BGS National Capability programme, a grant awarded by the UK Government’s Department for Business Energy & Industrial Strategy (BEIS) and additional benefit-in-kind contributions from all partners. The project comprises the comprehensive monitoring of different environment compartments and properties at and around the two shale-gas sites. The component parts of the EMP are all of significance when considering environmental and human health risks associated with shale gas development. Included are seismicity, ground motion, water (groundwater and surface water), soil gas, greenhouse gases, air quality, and radon. The monitoring started before hydraulic fracturing had taken place at the two locations, and so the results obtained before the initiation of operations at the shale-gas sites represent baseline conditions. It is important to characterise adequately the baseline conditions so that any future changes caused by shale gas operations, including hydraulic fracturing, can be identified. This is also the case for any other new activities that may impact those compartments of the environment being monitored as part of the project. In the period October 2018–December 2018, an initial phase of hydraulic fracturing took place at the Preston New Road (PNR) shale-gas site (shale gas well PNR1-z) in Lancashire. This was followed by a period of flow testing of the well to assess its performance (to end of January 2019). The project team continued monitoring during these various activities and several environmental effects were observed. These are summarised below and described in more detail within the report. The initiation of operations at the shale-gas site signified the end of baseline monitoring. At the Kirby Misperton site (KMA), approval has not yet been granted for hydraulic fracturing of the shale gas well (KM8), and so no associated operations have taken place during the period covered by this report. The effects on air quality arising from the mobilisation of equipment in anticipation of hydraulic fracturing operations starting was reported in the Phase III report, and in a recently published paper3 . Following demobilisation of the equipment and its removal from the site, conditions returned to baseline and the on-going monitoring (reported in this report) is effectively a continuation of baseline monitoring

Optimizing design of research to evaluate antibiotic stewardship interventions: consensus recommendations of a multinational working group.

BACKGROUND: Antimicrobial stewardship interventions and programmes aim to ensure effective treatment while minimizing antimicrobial-associated harms including resistance. Practice in this vital area is undermined by the poor quality of research addressing both what specific antimicrobial use interventions are effective and how antimicrobial use improvement strategies can be implemented into practice. In 2016 we established a working party to identify the key design features that limit translation of existing research into practice and then to make recommendations for how future studies in this field should be optimally designed. The first part of this work has been published as a systematic review. Here we present the working group's final recommendations. METHODS: An international working group for design of antimicrobial stewardship intervention evaluations was convened in response to the fourth call for leading expert network proposals by the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR). The group comprised clinical and academic specialists in antimicrobial stewardship and clinical trial design from six European countries. Group members completed a structured questionnaire to establish the scope of work and key issues to develop ahead of a first face-to-face meeting that (a) identified the need for a comprehensive systematic review of study designs in the literature and (b) prioritized key areas where research design considerations restrict translation of findings into practice. The working group's initial outputs were reviewed by independent advisors and additional expertise was sought in specific clinical areas. At a second face-to-face meeting the working group developed a theoretical framework and specific recommendations to support optimal study design. These were finalized by the working group co-ordinators and agreed by all working group members. RESULTS: We propose a theoretical framework in which consideration of the intervention rationale the intervention setting, intervention features and the intervention aims inform selection and prioritization of outcome measures, whether the research sets out to determine superiority or non-inferiority of the intervention measured by its primary outcome(s), the most appropriate study design (e.g. experimental or quasi- experimental) and the detailed design features. We make 18 specific recommendation in three domains: outcomes, objectives and study design. CONCLUSIONS: Researchers, funders and practitioners will be able to draw on our recommendations to most efficiently evaluate antimicrobial stewardship interventions

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