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

Authority in Space?: Creating a Digital Web-based Map Archive

The paper discusses the creation between 1999 and 2002 of a collaborative Web-based digital image and map catalogue archive, “Charting the Nation,” coordinated by the Department of Geography, University of Edinburgh, and Edinburgh University Library. The creation of the archive, based on the maps, cataloguing information and associated manuscript sources in the holdings of numerous collaborating institutions, is examined in relation to questions concerning the nature of archives generally and to this archive in particular as a “space” of authority. Issues posed by the electronic archive as a “virtual space” and in the creation and practical management of this digital Web-based map archive are addressed in relation to debates on postmodernism and the archive and to geographical and other literature on the situated nature of knowledge. RÉSUMÉCe texte examine la création entre 1999 et 2002 de « Charting the Nation », une collection d’archives Web en commun qui comprend des images numérisées et un catalogue cartographique, qui ont été coordonnés par le Département de géographie de l’Université d’Édimbourg et la Bibliothèque de l’Université d’Édimbourg. La création de ces archives, basée sur des documents cartographiques, de l’information de catalogage et des sources manuscrites associées provenant de plusieurs institutions en collaboration, est examinée en relation aux questions entourant la nature même des archives de façon générale et la nature de ces archives spécifiques comme un « espace » d’autorité. Les questions posées par les archives électroniques comme un « espace virtuel » aussi bien que celles suscitées par la création et la gestion pratique de cette collection d’archives spécifique sont examinées. Pour ce faire, le texte fait un lien entres ces questions et les débats sur le postmodernisme et les archives, et sur la littérature – géographique et autre – sur la nature du savoir situé (« situated knowledge »)

Historical records and geomorphological events: The 1771 ‘eruption’ of Solway Moss

A number of authors have pointed to the value of historical evidence in understanding change in the physical environment. This paper examines historical evidence for the 1771 ‘eruption’ or bog burst of Solway Moss in north-west England. A range of contemporary evidence is examined to recreate this high-magnitude/low-frequency extreme geomorphological event. In conclusion, the paper calls for the circumspect treatment of historical evidence in reconstructing such events. © 1989 The Scottish Geographical Society

\u3ci\u3eGeographers: Biobibliographical Studies, Volume 33\u3c/i\u3e

Editor: Hayden Lorimer and Charles W. J. Withers Chapter, Hull House Geography, by Christina E. Dando, UNO faculty member. Volume 33 of Geographers Biobibliographical Studies adds significantly to the corpus of scholarship on geography\u27s multiple histories and biographies with six essays on individuals who have made major contributions to the development of geography in the twentieth century. This volume focuses on European geographers, including essays on individuals from Britain, France and Hungary. These are individuals who have made important and distinctive contributions to a diverse range of fields, including cartography, physical geography, oceanography and urban theory. As with previous volumes, these biographical essays demonstrate the importance of geographers\u27 lives in terms of the lived experience of geography in practise.https://digitalcommons.unomaha.edu/facultybooks/1275/thumbnail.jp

Historical geographies of provincial science: themes in the setting and reception of the British Association for the Advancement of Science in Britain and Ireland, 1831-c.1939

The British Association for the Advancement of Science sought to promote the understanding of science in various ways, principally by having annual meetings in different towns and cities throughout Britain and Ireland (and, from 1884, in Canada, South Africa and Australia). This paper considers how far the location of its meetings in different urban settings influenced the nature and reception of the association's activities in promoting science, from its foundation in 1831 to the later 1930s. Several themes concerning the production and reception of science – promoting, practising, writing and receiving – are examined in different urban contexts. We consider the ways in which towns were promoted as venues for and centres of science. We consider the role of local field sites, leading local practitioners and provincial institutions for science in attracting the association to different urban locations. The paper pays attention to excursions and to the evolution and content of the BAAS meeting handbook as a ‘geographical’ guide to the significance of the regional setting and to appropriate scientific venues. The paper considers the reception of BAAS meetings and explores how far the association's intentions for the promotion of science varied by location and by section within the BAAS. In examining these themes – the geographical setting of the association's meetings, the reception of association science in local civic and intellectual context and the importance of place to an understanding of what the BAAS did and how it was received – the paper extends existing knowledge of the association and contributes to recent work within the history of science which has emphasized the ‘local’ nature of science's making and reception and the mobility of scientific knowledge

Introduction

This collection of essays offers an interpretation of human geography and its significance as a diverse body of intellectual enquiry for imagining, thinking about, living in and changing the world. The book examines the ways in which human geography as a discipline – the intellectual concerns of a specialised yet richly varied field of knowledge – shapes the lived and experienced geographies of the human world and so is vital to its wider analysis, understanding and transformation. The book may, therefore, be described as a dynamic grammar, rather than a strict syntax or vocabulary, of human geography. And this grammar extends well beyond human geography. Our concern is to disclose human geography as a vibrant enterprise of vital significance in informing, framing and shaping social and environmental practices and understandings