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

Migrant Mobilization Between Political Institutions and Citizenship Regimes. A Comparison of France and Switzerland

Thisarticlefocusesonthepoliticalclaimsmadebyimmigrantsandethnicminori- ties in France and Switzerland. We look at cross-national variations in the overall presence of immigrants and ethnic minorities in the national public space, and the forms and content of their claims. Following a political opportunity approach, we argue that claim-making is affected both by institutional opportunities and by national models of citizenship. The civic- assimilationist conception of citizenship in France gives migrants greater legitimacy to intervene in the national public space. Furthermore, the inclusive definition of ‘membership in the national community' favors claims pertaining to minority integration politics. However, the pressure toward assimilation to the republican norms and values tends to provoke claims for the recognition of ethnic and cultural difference. Finally, closed institutional opportunities push migrants' mobilization to become more radical, but at the same time the more inclusive model of citizenship favors a moderate action repertoire of migrants. Conversely, the ethnic-assimilationist view in Switzerland leads migrants to stress homeland-related claims. When they do address the policy field of ethnic relations, immigration and citizen- ship, they focus on issues pertaining to the entry and stay in the host society. Finally, the forms of action are more moderate due to the more open institutional context, but at the same time the action repertoire of migrants is moderated by the more exclusive model of citizenship. Our article is an attempt to specify the concept of ‘political opportunity structure', and to combine institutional and cultural factors in explaining claim-making by immi- grants and ethnic minorities. We confront our arguments with data from a comparative project on the mobilization on ethnic relations, citizenship and immigration

Elite sport in Scandinavian welfare states: legitimacy under pressure?

I Brage finner du siste tekst-versjon av artikkelen, og den kan inneholde ubetydelige forskjeller fra forlagets pdf-versjon. Forlagets pdf-versjon finner du på www.tandfonline.com: http://dx.doi.org/10.1080/19406940.2014.987309 / In Brage you'll find the final text version of the article, and it may contain insignificant differences from the journal's pdf version. The definitive version is available at www.tandfonline.com: http://dx.doi.org/10.1080/19406940.2014.987309Taking part in the global ‘sports arming race’ is demanding to all small nations, in terms of the efforts needed to succeed at the international stage. The Scandinavian countries are wealthy and could afford (in pure economic terms) wide-ranging elite sport investments. The question put to the foreground in this paper is the legitimacy of such efforts. More specifically, the aims are to investigate and discuss (1) the societal legitimacy essential to Scandinavian elite sport’s credibility and support in general, and (2) how organizational legitimacy may be threatened by current developments aimed to strengthen international competitiveness. Based on an outline of the social democratic welfare model and the voluntary sport movements characterizing these societies, the paper emphasizes some rooted values and tensions underpinning sport in Scandinavia. Then, recent developments in the three countries’ elite sport efforts are described and discussed. Over the last decades, Scandinavian elite sports have been professionalized, extended and run in line with general international tendencies. Some of these developments challenge values fundamental to the voluntary sport model. A paradox arises: aspects that at the surface seem counterproductive to modern elite sport development; voluntarism, decentralization and local ownership to sport contribute at a deeper level substantially to elite sports’ legitimacy in this region. The paper is concluded by discussing conditions central to maintain elite sports’ social legitimacy in Scandinavia, particularly in what ways sustainable elite sport development relies on the links to the broad voluntary movement.Seksjon for kultur og samfunn / Department of Cultural and Social Studie

A popular Indonesian preacher: The significance of AA Gymnastiar

Aa Gymnastiar (Gym) is a popular Indonesian Muslim preacher who seems to be now at the pinnacle of his fame. He regularly gives advice to the head of state and to ministers and yet at the same time his approach to Islam appeals to all sections of the national Muslim community. His is a familiar face in newspaper columns and above all on television screens; Aa Gym has a masterful command of the media. This article describes and accounts for his popularity and discusses it in terms of continuity and change in the rise and decline of Muslim celebrities in Indonesia. It points out the difference between Gym and some obvious forerunners such as the scholar Hamka, and stresses that the nature of Gym's appeal is new in as much as he does not come from within the circle of traditional families of Muslim ulama. He seems to draw his information as much from secular sources of self-help manuals as from books of Sufi wisdom. Although very popular and influential among the general circle of believers, he is regarded with some suspicion by those who criticize his sufistic leanings and lack of an orthodox Muslim education. The article concludes by arguing that Gym and his approach to the implementation of Muslim precepts is more representative of the nature of Islam in Indonesia today than the activities of terrorists