Azithromycin versus standard care in patients with mild-to-moderate COVID-19 (ATOMIC2): an open-label, randomised trial

BACKGROUND: The antibacterial, anti-inflammatory, and antiviral properties of azithromycin suggest therapeutic potential against COVID-19. Randomised data in mild-to-moderate disease are not available. We assessed whether azithromycin is effective in reducing hospital admission in patients with mild-to-moderate COVID-19. METHODS: This prospective, open-label, randomised superiority trial was done at 19 hospitals in the UK. We enrolled adults aged at least 18 years presenting to hospitals with clinically diagnosed, highly probable or confirmed COVID-19 infection, with fewer than 14 days of symptoms, who were considered suitable for initial ambulatory management. Patients were randomly assigned (1:1) to azithromycin (500 mg once daily orally for 14 days) plus standard care or to standard care alone. The primary outcome was death or hospital admission from any cause over the 28 days from randomisation. The primary and safety outcomes were assessed according to the intention-to-treat principle. This trial is registered at ClinicalTrials.gov (NCT04381962) and recruitment is closed. FINDINGS: 298 participants were enrolled from June 3, 2020, to Jan 29, 2021. Three participants withdrew consent and requested removal of all data, and three further participants withdrew consent after randomisation, thus, the primary outcome was assessed in 292 participants (145 in the azithromycin group and 147 in the standard care group). The mean age of the participants was 45·9 years (SD 14·9). 15 (10%) participants in the azithromycin group and 17 (12%) in the standard care group were admitted to hospital or died during the study (adjusted OR 0·91 [95% CI 0·43-1·92], p=0·80). No serious adverse events were reported. INTERPRETATION: In patients with mild-to-moderate COVID-19 managed without hospital admission, adding azithromycin to standard care treatment did not reduce the risk of subsequent hospital admission or death. Our findings do not support the use of azithromycin in patients with mild-to-moderate COVID-19. FUNDING: National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford and Pfizer

Hopes and Fears: Community cohesion and the ‘White working class’ in one of the ‘failed spaces’ of multiculturalism

Since 2001, community cohesion has been an English policy concern, with accompanying media discourse portraying a supposed failure by Muslims to integrate. Latterly, academia has foregrounded White majority attitudes towards ethnic diversity, particularly those of the ‘White working class’. Whilst questioning this categorisation, we present data on attitudes towards diversity from low income, mainly White areas within Dewsbury, West Yorkshire, a town portrayed in media discourse as one of the ‘failed spaces’ of multiculturalism. Drawing on mixed methods research, we present and discuss data that provide a complex message, seemingly confirming pessimistic analyses around ethnic diversity and predominantly White neighbourhoods but also highlighting an appetite within the same communities for greater and more productive inter-ethnic contact. Furthermore, anxieties about diversity and integration have largely failed to coalesce into broad support for organised anti-minority politics manifest in groups such as the English Defence League

Whiteness, Blackness and Settlement: Leisure and the Integration of New Migrants

At times of economic uncertainty the position of new migrants is subject to ever closer scrutiny. While the main focus of attention tends to be on the world of employment the research on which this paper is based started from the proposition that leisure and sport spaces can support processes of social inclusion yet may also serve to exclude certain groups. As such, these spaces may be seen as contested and racialised places that shape behaviour. The paper draws on interviews with White migrants from Poland and Black migrants from Africa to examine the normalising of whiteness. We use this paper not just to explore how leisure and sport spaces are encoded by new migrants, but how struggles over those spaces and the use of social and cultural capital are racialised

Social cohesion and the notion of 'suspect communities': A study of the experiences and impacts of being 'suspect' for Irish communities and Muslim communities in Britain

In this article, we consider how the practice of conceiving of groups within civil society as 'communities' meshes with conceptualisations of certain populations as 'suspect' and consider some of the impacts and consequences of this for particular populations and for social cohesion. We examine how Irish and Muslim people in Britain have become aware of and have experienced themselves to be members of 'suspect communities' in relation to political violence and counterterrorism policies from 1974 to 2007 and investigate the impacts of these experiences on their everyday lives. The study focuses on two eras of political violence. The first coincides with the Irish Republican Army's (IRA) bombing campaigns in England between 1973 and 1996, when the perpetrators were perceived as 'Irish terrorists'; and the second since 2001, when, in Britain and elsewhere, the main threat of political violence has been portrayed as stemming from people who are assumed to be motivated by extreme interpretations of Islam and are often labelled as 'Islamic terrorists'. We outline why the concept of 'suspect communities' continues to be analytically useful for examining: the impact of 'bounded communities' on community cohesion policies; the development of traumatogenic environments and their ramifications; and for examining how lessons might be learnt from one era of political violence to another, especially as regards the negative impacts of practices of suspectification on Irish communities and Muslim communities. The research methods included discussion groups involving Irish and Muslim people. These demonstrated that with the removal of discourses of suspicion the common ground of Britain's urban multiculture was a sufficient basis for sympathetic exchanges. © 2012 Taylor and Francis Group, LLC

Super diversity and city branding: Rotterdam in perspective

As many other cities around the world, Rotterdam has been investing in improving its image to stimulate urban development and to attract visitors, residents and investors. In particular, during the last 15 years the municipality of Rotterdam has intensified its attempts to develop a ‘brand’ that fits the ‘new Rotterdam’, which was gradually rebuilt after destructive bombardments during the Second World War (Riezebos 2014). In 2014 Rotterdam was ranked 8th by ‘Rough Guide’ in the list of ‘Top 10 Cities to See’, whereas the ‘New York Times’ listed Rotterdam in the top 10 of 52 Places to Go. These rankings demonstrate Rotterdam’s success in repositioning itself, using the physical interior of the city as a key element in its branding strategy.</p

‘As a woman…’; ‘As a Muslim…’: Subjects, positions and counter-terrorism powers in the United Kingdom

This article presents findings from original focus group research on the importance of identity claims within public understandings of counter-terrorism across the UK. Following a review of existing literature on the terrorism/counter-terrorism/identity nexus, the article introduces four prominent subject positions inhabited within public articulations of counter-terrorism powers: the ‘Muslim’, the ‘target’, the ‘woman’ and the ‘unaffected’. Positions such as these, we argue, both enable and inhibit particular normative, political and anecdotal claims about counter-terrorism frameworks and their impact upon the body politic. This, we suggest, is demonstrative of the co-constitutive role between counter-terrorism and identity claims. Thus, on the one hand, counter-terrorism initiatives work to position individuals socially, politically, and culturally: (re)producing various religious, ethnic and other identities. Yet, at the same time, specific subject positions are integral to the articulation of people’s attitudes toward developments in counter-terrorism. The article concludes by thinking through some of the implications of this, including for resistance toward securitising moves and for citizenship more generally

What lies beneath: exploring links between asylum policy and hate crime in the UK

This paper explores the link between increasing incidents of hate crime and the asylum policy of successive British governments with its central emphasis on deterrence. The constant problematisation of asylum seekers in the media and political discourse ensures that 'anti-immigrant' prejudice becomes mainstr earned as a common-sense response. The victims are not only the asylum seekers hoping for a better life but democratic society itself with its inherent values of pluralism and tolerance debased and destabilised

Placental syncytiotrophoblast constitutes a major barrier to vertical transmission of Listeria monocytogenes.

Listeria monocytogenes is an important cause of maternal-fetal infections and serves as a model organism to study these important but poorly understood events. L. monocytogenes can infect non-phagocytic cells by two means: direct invasion and cell-to-cell spread. The relative contribution of each method to placental infection is controversial, as is the anatomical site of invasion. Here, we report for the first time the use of first trimester placental organ cultures to quantitatively analyze L. monocytogenes infection of the human placenta. Contrary to previous reports, we found that the syncytiotrophoblast, which constitutes most of the placental surface and is bathed in maternal blood, was highly resistant to L. monocytogenes infection by either internalin-mediated invasion or cell-to-cell spread. Instead, extravillous cytotrophoblasts-which anchor the placenta in the decidua (uterine lining) and abundantly express E-cadherin-served as the primary portal of entry for L. monocytogenes from both extracellular and intracellular compartments. Subsequent bacterial dissemination to the villous stroma, where fetal capillaries are found, was hampered by further cellular and histological barriers. Our study suggests the placenta has evolved multiple mechanisms to resist pathogen infection, especially from maternal blood. These findings provide a novel explanation why almost all placental pathogens have intracellular life cycles: they may need maternal cells to reach the decidua and infect the placenta