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

Natal philopatry in passerine birds: Genetic or ecological influences?

The degree of natal philopatry (the likelihood that individuals breed at or near their place of origin) can influenc

Long-term decline in a red-winged blackbird population: ecological causes and sexual selection consequences

Habitat loss and large-scale climate phenomena are widely implicated as causing decline in animal populations. I examined how both factors contributed to a precipitous decline in an Ontario red-winged blackbird (Agelaius phoeniceus) population using 16 years of data collected between 1974 and 1995. The decline was manifested as an almost 50% reduction in mean harem size, which reduced the opportunity for sexual selection threefold. Regional hay production, which should affect recruitment into the study population, also declined substantially. Correlation between blackbirds and hay may be coincidental, however, because annual changes in harem size were not associated with annual changes in hay production. This study coincided with an unprecedented positive phase of the North Atlantic Oscillation (NAO). Changes in harem size were correlated with winter NAO index values, suggesting that winter mortality contributed to the population decline. Positive correlation between harem size change and male return rates also supported the winter mortality hypothesis. Continued declines will cause this blackbird population to change from socially polygynous to socially monogamous. Study of red-winged blackbird winter ecology is needed to identify the proximate causes of mortality, whereas breeding studies can explore the consequences of relaxed sexual selection

Risk-taking by female ducks: intra- and interspecific tests of nest defense theory

We tested several predictions of nest defense theory by observing variation in flushing distance and probability of nest abandonment within and between six species of waterfowl. In these species, only the females incubate eggs and attend offspring. First, we examined whether flushing distance by females varied in relation to clutch size, stage of incubation, and time of season, after controlling for the number of visits made to nests by observers. Revisits by observers appeared to affect flushing distance by females for reasons unrelated to the relative value of the current clutch. We found that as incubation progressed, females allowed observers to approach more closely before flushing from the nest. In some species, females with larger clutches allowed closer approaches to nests before flushing which was also consistent with nest defense theory. In contrast, time of season (Julian date) did not relate to flushing distance for any species. When species were compared, we found that species with moderate to high yearly mortality and high reproductive output per breeding attempt (e.g., northern shoveler and blue-winged teal) were less likely to abandon nesting attempts and exhibited "riskier" behavior (remained at nests when approached closely by observers) than species that had lower yearly mortality (e.g., mallard). Our results show that flushing distance and patterns of nest abandonment by female ducks conform to several predictions of nest defense theory

Sex ratios, mating behavior and sexual size dimorphism of the northern water snake, Nerodia sipedon

Competition among males to mate is generally associated with male-biased size dimorphism. In this study we examine mating behavior in the northern water snake (Nerodia sipedon), a species in which males are much smaller than females despite substantial competition among males to mate. Competition among males was a consequence of a male-biased operational sex ratio due to slightly higher female mortality from a birth sex ratio of 1 : 1, and, in 1 year, more synchronous and longer mating activity by males. Approximately one-third of both males and females appeared not to mate in a given year. Larger males were generally more likely to attempt mating, but size did not explain the variance in the number of aggregations in which individual males participated. Within aggregations, males that were successful at achieving intromission were larger than unsuccessful males in 1 of 2 years. Variation in condition (mass relative to length) and relative tail length were not generally useful predictors of either mating effort or success in males. Because large size was often advantageous to males, sexual size dimorphism appeared not to be a consequence of sexual selection favoring smaller males. Because sexual dimorphism was evident at birth, and both males and females matured sexually at about 4 years, sexual dimorphism was not simply a consequence of one sex growing at the maximum rate for longer. Female fecundity increased with size, and sex differences in size-fecundity relations may underly the pattern of sexual size dimorphism. However, because multiple mating by females is common, sperm competition is likely to be important in determining male reproductive success. Therefore, allocation of energy to sperm rather than growth may also prove to be an important influence on male growth rates and sexual size dimorphism

How bad is to be slow-reacting?

87.23.Cc Population dynamics and ecological pattern formation, 87.18.Tt Noise in biological systems, 87.10.Rt Monte Carlo simulations,