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

Producing cement clinker assemblages in the system : CaO-SiO2-Al2O3-SO3-CaCl2-MgO

The cement industry is carbon-intensive, and the valorisation of industrial side-streams/residuals for use as alternative raw materials can enable the cement industry to reduce its carbon footprint as well as promote resource efficiency. Apart from key clinker ingredients such as CaO, Al2O3, and SiO2, industrial residues can also contain MgO, CaCl2, and SO3. Therefore, this study investigates the formation of cement clinker assemblages in the system CaO-SiO2-Al2O3-SO3-CaCl2-MgO at temperatures ranging between 1100 and 1300 °C. The production of a clinker composed mainly of alinite and ye'elimite is first attempted; it is found that these phases cannot be simultaneously produced. Ternesite is also not compatible with alinite under the conditions studied. Wadalite is compatible with both ye'elimite and ternesite, while ternesite is also compatible with chlormayenite at 1150 °C. Additionally, the low-temperature formation of alite was also observed with the presence of CaCl2 in the raw-material mix

SCALING OF OPTICAL LOGIC DEVICES AND ARRAYS

We investigate scaling with cross-sectional area of energy and speed for optical devices, and of optical design, speed and thermal dissipation for device arrays. Theory and experiments clearly point to lower energy and faster speed for smaller devices, and to simpler optical design, smaller propagation time delays and higher thermal dissipation capability for smaller array sizes

Monitoring of a reinforced concrete reservoir

SIGLEAvailable from British Library Document Supply Centre- DSC:8714.3(CCA-TR--557) / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Animal‐borne video from a sea turtle reveals novel anti‐predator behaviors

Predation is a primary selection pressure contributing to both the morphological and behavioral adaptations of organisms (Brodie 1983, Lima and Dill 1990). However, studying the anti‐predator behaviors of aquatic taxa such as sea turtles is currently limited by the difficulty of observing the natural behaviors of free‐ranging individuals at sea (Heithaus et al. 2008). Using an Animal‐borne Video and Environmental Data‐collection (AVED) biologging device, we captured a predatory interaction between a species of sea turtle, the flatback turtle (Natator depressus) and a tiger shark (Galeocerdo cuvier). This interaction occurred at Roebuck Bay, Western Australia, where we are studying the foraging ecology of flatback turtles. Given that tiger sharks are a major predator of sea turtles (Witzell 1987), this interaction was not entirely unforeseen. However, here the shark’s predatory attempt was countered by the turtle lunging multiple times toward the shark attempting to bite its attacker (Fig. 1 and video linked in Data Availability). Our unique vantage point from the perspective of the study animal led to this novel observation of behavior that might have otherwise been missed