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

Arguing over Text(s): Master-Texts vs. Intertexts in the Criticism of Lucretius

Summary. There is a long history in Lucretian scholarship of finding conflict in the DRN between its philosophical content and its poetic form. Recent criticism has emphasized rather how the poem’s poetic form complements its Epicurean message. This chapter argues for important differences between literary and philosophical approaches to the poem, in particular with regard to its relationship with other texts, in order to identify some important differences in common modes of reading the poem. The chapter examines a ‘master-text’ model of reading, in which the DRN is related in strong fashion to another text on which it is dependent. The precise nature and identity of this ‘master-text’ can vary, according to the purpose or use to which the DRN is put. The approach of such ‘master-text’ readings is strikingly different from the dominant intertextual mode. In the examples of intertextual reading examined, the relationship to the other text is not one of subordination, but a tool used by the DRN to serve a particular function within the poem itself. The modes of reading explored in this chapter can lead to real differences in interpretation: e.g., on the end of the DRN, or on how uncompromising or sympathetic we should view certain parts of the poem. One important consequence is the need to acknowledge the differences in our reading practices and theoretical assumptions

Reading the 'Implied Author' in the De rerum natura

Much has been written on the ‘implied reader’ in Lucretius’ DRN. From G. B. Conte’s textually constructed reader to recent work on Lucretian receptions, Lucretius’ readers or their textual condition have received substantial scholarly attention. What remains largely undiscussed – and what has left generation upon generation of the poem’s readers spellbound – is not so much other readers of the DRN, but the elusive ‘author’ himself. Jerome famously claimed that Lucretius wrote the DRN between intervals of insanity brought on by a love potion, and increasingly wild biographies of Lucretius crop up again and again in the reception traditions of the poem – from death-bed hallucinations brought on by his wicked wife to his beautiful but unresponsive male paramour. Taking some of these biographies as its point of inspiration, this chapter uses the concept of the ‘implied author’ to investigate what exactly it is about Lucretius’ text that inspired and inspires such imaginative, but arguably still textually grounded, portraits of its author

Lucretius and the Philosophical Use of Literary Persuasion

The first part of this paper looks into the question of Lucretius’ philosophical sources and whether he draws almost exclusively from Epicurus himself or also from later Epicurean texts. I argue that such debates are inconclusive and likely will remain so, even if additional Epicurean texts are discovered, and that even if we were able to ascertain Lucretius’ philosophical sources, doing so would add little to our understanding of the De Rerum Natura. The second part of the paper turns to a consideration of what Lucretius does with his philosophical sources. The arguments within the De Rerum Natura are not original. Nonetheless, the way Lucretius presents these arguments establishes him as a distinctive philosopher. Lucretius deploys non-argumentative methods of persuasion such as appealing to emotions, redeploying powerful cultural tropes, and ridicule. These methods of persuasion do not undercut or displace reasoned argumentation. Instead, they complement it. Lucretius’ use of these methods is rooted in his understanding of human psychology, that we have been culturally conditioned to have empty desires, false beliefs, and destructive emotions, ones that are often subconscious. Effective persuasion must take into account the biases, stereotypes, and other psychological factors that hinder people from accepting Epicurus’ healing gospel

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