Ponds and the importance of their history: an audit of pond numbers, turnover and the relationship between the origins of ponds and their contemporary plant communities in south-east Northumberland, UK

An increasing focus of interest in ponds over the last two decades arose largely because of concerns at the loss of ponds in intensively developed landscapes. In the UK, pond numbers declined from approximately 800,000 in the nineteenth century to 200,000 by the 1980s. Since then pond numbers have started to increase. The focus on overall pond numbers overlooks the importance of the history and origins of different pond types. This study combines a detailed map based audit of pond numbers in south-east Northumberland, UK, recorded at seven time intervals since the mid nineteenth century with a survey of contemporary plant communities in ponds with known and distinct histories to examine changes to numbers of ponds and communities associated with ponds with different origins. 222 ponds were recorded in the study area in the midnineteenth century, 257 in 2005/08. However, only 23 of the original ponds had survived with substantial losses and gains at all the map survey dates linked to changed land use from agriculture to coal mining then development of nature reserves and golf courses. Contemporary ponds on nature reserves, golf courses and subsidence ponds supported rather different plant communities to each other, with non-native invasives in golf and nature reserve sites, whilst individual reserves differed from one another perhaps due to intentional planting. Surviving old farm ponds were usually degraded. The results show that the history of ponds in a region can create an important cultural biodiversity which pond conservation strategies should incorporate

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

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