Defense Monitor: Where is America Going? Five Years After Sept. 11

This special issue of the Defense Monitor is a collection of articles released on the fifth anniversary of September 11th. The collection includes: Where is America Going? Five Years After Sept. 11; In the Name of Fighting Terrorism: The United States is Still Arming the World; The War on Terrorism: Winning the Un-Winnable; Defense Budget Tutorial: So, You Think You Know the Costs of the Wars

Dietary Supplements and Sports Performance: Herbals

This is the fourth in a series of six articles to discuss the major classes of dietary supplements (vitamins; minerals; amino acids; herbs or botanicals; metabolites, constituents/extracts, or combinations). The major focus is on efficacy of such dietary supplements to enhance exercise or sport performance

Effect of thermal comfort on occupant productivity in office buildings : response surface analysis

Thermal environment is one of the main factors that influence occupants' comfort and their productivity in office buildings. There is ample research that outlines this relationship between thermal comfort and occupant productivity. However, there is a lack of literature that presents mathematical relationship between them. This paper presents a research experimental study that investigates effects of indoor environmental quality factors on thermal comfort and occupant productivity. This study was conducted by collecting indoor environmental quality parameters using sensors and online survey for twelve months. Data analysis was done using Response Surface Analysis to outline any mathematical relationship between indoor environmental quality and occupant productivity. The outlined relationships confirmed dependencies of occupant thermal comfort and productivity on various indoor environmental factors. These dependencies include the effect of CO2 concentration, VOC concentration. These relationships were analysed to rank nine indoor environmental parameters as per the degree of effect on occupant thermal comfort and productivity. These findings would help design professionals to design better office design that would improve occupants’ comfort and their productivity. Study results have different implications for professionals working in design, construction and operation of office buildings. It is recommended that design guidelines for office buildings should consider occupant productivity and incorporate recommended range for indoor environmental quality parameters in respective categories and criteria

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

The 2007 Defense Budget May Not Be What You Think

Fiscal year 2007 (FY 07) started on Oct. 1, and Congress managed to pass the Department of Defense Appropriations Act FY 07 just in time. However, despite what the press has reported, the legislation is not what the title implies and the numbers are very different from what the responsible congressional committees are advertising. Straus Military Report Project Director Winslow Wheeler explains in a new "tutorial.

Video-Based Approach to Engaging Parents into a Preventive Parenting Intervention for Divorcing Families: Results of a Randomized Controlled Trial

The public health impact of evidence-based, preventive parenting interventions has been severely constrained by low rates of participation when interventions are delivered under natural conditions. It is critical that prevention scientists develop effective and feasible parent engagement methods. This study tested video-based methods for engaging parents into an evidence-based program for divorcing parents. Three alternative versions of a video were created to test the incremental effectiveness of different theory-based engagement strategies based on social influence and health behavior models. A randomized controlled trial was conducted to compare the three experimental videos versus two control conditions, an information-only brochure and an information-only video. Participants were attendees at brief, court-mandated parent information programs (PIPs) for divorcing or never married, litigating parents. Of the 1123 eligible parents, 61% were female and 13% were never married to the child’s other parent. Randomization to one of five conditions was conducted at the PIP class level, blocking on facilitator. All participants completed a 15-item, empirically validated risk index and an invitation form. Results of regression analyses indicated that the most streamlined version, the core principles video, significantly increased parents’ interest in participating in the parenting intervention, enrollment during a follow-up call, and initiation (i.e., attending at least one session) compared to one or the other control conditions. Findings suggest that videos based on social influence and health behavior theories could provide an effective and feasible method for increasing parent engagement, which would help maximize the public health benefits of evidence-based parenting interventions