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.

The brain is capable of producing coordinated fast changing neural dynamics across multiple brain regions in order to adapt to rapidly changing environments. However, it is non-trivial to identify multiregion dynamics at fast sub-second time-scales in electrophysiological data. We propose a method that, with no knowledge of any task timings, can simultaneously identify and describe fast transient multiregion dynamics in terms of their temporal, spectral and spatial properties. The approach models brain activity using a discrete set of sequential states, with each state distinguished by its own multiregion spectral properties. This can identify potentially very short-lived visits to a brain state, at the same time as inferring the state's properties, by pooling over many repeated visits to that state. We show how this can be used to compute state-specific measures such as power spectra and coherence. We demonstrate that this can be used to identify short-lived transient brain states with distinct power and functional connectivity (e.g., coherence) properties in an MEG data set collected during a volitional motor task.

Frequency-specific oscillations and phase-coupling of neuronal populations are essential mechanisms for the coordination of activity between brain areas during cognitive tasks. Therefore, the ongoing activity ascribed to the different functional brain networks should also be able to reorganise and coordinate via similar mechanisms. We develop a novel method for identifying large-scale phase-coupled network dynamics and show that resting networks in magnetoencephalography are well characterised by visits to short-lived transient brain states, with spatially distinct patterns of oscillatory power and coherence in specific frequency bands. Brain states are identified for sensory, motor networks and higher-order cognitive networks. The cognitive networks include a posterior alpha (8–12 Hz) and an anterior delta/theta range (1–7 Hz) network, both exhibiting high power and coherence in areas that correspond to posterior and anterior subdivisions of the default mode network. Our results show that large-scale cortical phase-coupling networks have characteristic signatures in very specific frequency bands, possibly reflecting functional specialisation at different intrinsic timescales.

MEG offers dynamic and spectral resolution for resting-state connectivity which is unavailable in fMRI. However, there are a wide range of available network estimation methods for MEG, and little in the way of existing guidance on which ones to employ. In this technical note, we investigate the extent to which many popular measures of stationary connectivity are suitable for use in resting-state MEG, localising magnetic sources with a scalar beamformer. We use as empirical criteria that network measures for individual subjects should be repeatable, and that group-level connectivity estimation shows good reproducibility. Using publically-available data from the Human Connectome Project, we test the reliability of 12 network estimation techniques against these criteria. We find that the impact of magnetic field spread or spatial leakage artefact is profound, creates a major confound for many connectivity measures, and can artificially inflate measures of consistency. Among those robust to this effect, we find poor test-retest reliability in phase- or coherence-based metrics such as the phase lag index or the imaginary part of coherency. The most consistent methods for stationary connectivity estimation over all of our tests are simple amplitude envelope correlation and partial correlation measures.

Brain activity is a dynamic combination of the responses to sensory inputs and its own spontaneous processing. Consequently, such brain activity is continuously changing whether or not one is focusing on an externally imposed task. Previously, we have introduced an analysis method that allows us, using Hidden Markov Models (HMM), to model task or rest brain activity as a dynamic sequence of distinct brain networks, overcoming many of the limitations posed by sliding window approaches. Here, we present an advance that enables the HMM to handle very large amounts of data, making possible the inference of very reproducible and interpretable dynamic brain networks in a range of different datasets, including task, rest, MEG and fMRI, with potentially thousands of subjects. We anticipate that the generation of large and publicly available datasets from initiatives such as the Human Connectome Project and UK Biobank, in combination with computational methods that can work at this scale, will bring a breakthrough in our understanding of brain function in both health and disease.

Complex thought and behavior arise through dynamic recruitment of large-scale brain networks. The signatures of this process may be observable in electrophysiological data; yet robust modeling of rapidly changing functional network structure on rapid cognitive timescales remains a considerable challenge. Here, we present one potential solution using Hidden Markov Models (HMMs), which are able to identify brain states characterized by engaging distinct functional networks that reoccur over time. We show how the HMM can be inferred on continuous, parcellated source-space Magnetoencephalography (MEG) task data in an unsupervised manner, without any knowledge of the task timings. We apply this to a freely available MEG dataset in which participants completed a face perception task, and reveal task-dependent HMM states that represent whole-brain dynamic networks transiently bursting at millisecond time scales as cognition unfolds. The analysis pipeline demonstrates a general way in which the HMM can be used to do a statistically valid whole-brain, group-level task analysis on MEG task data, which could be readily adapted to a wide range of task-based studies.

Frequency-specific patterns of neural activity are increasingly interpreted as transient bursts of isolated events rather than as rhythmically sustained oscillations. This has potentially far-reaching implications for theories of how such oscillations originate and how they shape neural computations. As this debate unfolds, we explore alternative interpretations and ask how best to distinguish between them.

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