Urban coral reefs: Degradation and resilience of hard coral assemblages in coastal cities of East and Southeast Asia

© 2018 The Author(s) Given predicted increases in urbanization in tropical and subtropical regions, understanding the processes shaping urban coral reefs may be essential for anticipating future conservation challenges. We used a case study approach to identify unifying patterns of urban coral reefs and clarify the effects of urbanization on hard coral assemblages. Data were compiled from 11 cities throughout East and Southeast Asia, with particular focus on Singapore, Jakarta, Hong Kong, and Naha (Okinawa). Our review highlights several key characteristics of urban coral reefs, including “reef compression” (a decline in bathymetric range with increasing turbidity and decreasing water clarity over time and relative to shore), dominance by domed coral growth forms and low reef complexity, variable city-specific inshore-offshore gradients, early declines in coral cover with recent fluctuating periods of acute impacts and rapid recovery, and colonization of urban infrastructure by hard corals. We present hypotheses for urban reef community dynamics and discuss potential of ecological engineering for corals in urban areas

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

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

Outcome of cardiopulmonary resuscitation in hospitalized African children.

The outcome of cardiopulmonary resuscitation at the research ward of the Kenya Medical Research Institute is reviewed. The outcome for respiratory arrest was 15 per cent (95 per cent CI 6.6-27) to discharge, and worse for cardiorespiratory arrest with no survival. The illnesses leading to cardiopulmonary arrest and causes for the disappointing outcome are discussed

An examination of resilience and coping in the oldest old using life narrative method

We aimed to identify aspects of late-life resilience and sense of self-identity and locate them within a life narrative to provide insights into methods of coping with the challenges of aging. To do this, in-depth interviews were conducted with 20 oldest-old adults (aged 88-98 years) recruited from the Australian Longitudinal Study of Ageing. Design, analysis, and interpretation of the study were informed by McAdams' life narrative theory, using concepts of redemption and contamination. Participants discussed their autobiographies and recounted significant life events. Interviews drew on McAdams' approach to elicit positive, negative, vivid, and turning point experiences. Analysis involved coding transcripts of the emergent personal narratives specifically to understand a "resilience story." This included data immersion and review of interview transcripts. Emergent codes were identified and discussed among the researchers. Although no contamination events were narrated, we identified the following themes: Adapting to aging-related physical challenges; Changing social networks; Continuity in sense of identity to maintain unity and life's purpose; and Redemptive capacity to cope positively with life challenges. This study fills a gap in knowledge on resilience from a personal perspective by the oldest old. Older people may benefit from interventions that harness positive coping strategies and foster social connections and meaningful activities, especially at times of loss or grief.Kathryn Browne-Yung, Ruth B. Walker and Mary A. Luszc

Applying a critical approach to investigate barriers to digital inclusion and online social networking among young people with disabilities

Despite the seeming ubiquity of young people’s Internet use, there are still many for whom access to the Internet and online social networking remains inequitable and patterned by disadvantage. The connection between information technology and young people with disabilities is particularly under-researched. This article contributes to the field of critical information systems research by exposing significant barriers and facilitators to Internet accessibility for young people with disabilities. It uses Bourdieu’s critical theory to explore how the unequal distribution of resources shapes processes of digital inclusion for young people with disabilities. It highlights access needs and experiences that are both disability and non-disability related. The article draws on interviews in South Australia with 18 young people aged 10–18 years with a physical disability (such as cerebral palsy) or acquired brain injury and with 17 of their family members. Interviews evaluated participants’ and parents’ reflections on the benefits of a home-based, goaloriented intervention to increase the young person’s Internet use for social participation purposes. The Bourdieuian analysis demonstrated how varying levels of accrued individual and family offline capital resources are related to digital/online resources and disability-specific online resources. This revealed how unequal resources of capital can influence technology use and hence digital inclusion for young people with disabilities. Our study demonstrates that young people with particular types of disabilities require intensive, personalised and long-term support from within and beyond the family to ‘get online’. We conclude that Internet studies need to more frequently adopt critical approaches to investigate the needs of users and barriers to information technology use within sub-groups, such as young people with disabilities