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.

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Purpose -The purpose of this paper is to focus on disadvantaged tweens' (ages 11 through 13) strategies for making predictive and evaluative judgments of the credibility of health information online. More specifically, this paper identifies the features of Google search results pages and web sites that signal credibility (or lack thereof) to this population and the reasons behind their perceptions. Design/methodology/approach -The authors employed an ethnographic approach (using various types of data collection methods) targeted to generate in-depth descriptions of tweens making predictive and evaluative judgments of credibility, focussing on the ways in which these tweens naturally assess the credibility of online information. Findings -The research has yielded novel findings concerning the types of factors that influence disadvantaged tweens' credibility assessment strategies, such as limited English-language vocabularies, lack of familiarity with perhaps otherwise well-known sources, and forced reliance on (and/or general preference for) non-textual modalities, such as audio and video. Practical implications -The findings indicate a need for implementing digital literacy programs in a naturalized setting, building on tweens' existing heuristics and thereby resulting in strategies that are simultaneously compatible with their natural inclinations within the online environment and likely to consistently lead them to accurate credibility-related judgments. Originality/value -This study provides novel insights into how disadvantaged tweens interact with online health information in a natural context, and offers invaluable information regarding the ways in which credibility assessment processes should be facilitated within formal or informal digital literacy programs.

School librarians play a pivotal role in facilitating learning of all subjects in primary and secondary schools in the United States, but their potential contributions to science have not been explored. In this paper, we show how school librarian practices can directly enhance aspects of science education by providing concrete examples from a study where we engaged school librarians to co-design and co-implement a science-infused after-school program. We found that librarians are a strong asset in science learning, as they foster youth engagement in authentic inquiry practices and engage young people’s everyday life interests in science learning. This study contributes new insight into how librarians can use their expertise to enhance science education efforts in schools.

Background Although a low health literacy level has been found to be among the most powerful predictors of poor health outcomes, there is very little research focused on assessing and improving the health literacy skills of adolescents, particularly those from socioeconomically disadvantaged backgrounds. The vast majority of existing research focuses solely on reading comprehension, despite the fact that health literacy is actually a multifaceted concept, which entails many different types of skills. Objective The aim of this paper is to first mine existing literature to identify the many different skills that have been posited to constitute health literacy, and then, using this collection of skills as an overarching structure, to highlight the challenges that disadvantaged youth participating in our HackHealth after-school program encounter as they identify and articulate their health-related information needs, search for health-related information online, assess the relevance and credibility of this information, and manage and make use of it. Methods We utilized the design-based research method to design, implement, and revise our HackHealth program. To collect data regarding HackHealth participants’ health literacy skills and associated challenges, we used a variety of methods, including participant observation, surveys, interviews, focus groups, and logging of Web browser activities. We also collected data through specialized instructional activities and data collection forms that we developed for this purpose. Quantitative and qualitative techniques were used to analyze this data, as well as all of the artifacts that each student produced, including their final projects. Results We identified the various challenges that the 30 HackHealth participants faced in completing various health-related information activities during the course of the program. Based on these findings, we describe important implications for working with youth from socioeconomically disadvantaged backgrounds, how to assess and improve their health literacy skills, and offer specific recommendations for health literacy instruction aimed at this population. Conclusions With an increased societal focus on health and a shift from viewing patients as passive recipients of medical care to viewing them as active arbiters of their own health, today’s youth need to possess an array of health literacy skills to ensure that they can live long and healthy lives. Working with adolescents to help them develop and practice these skills will also help to break the cycle between poor health literacy and poor health outcomes, thereby reducing health disparities and improving the long-term outlook for the health of our nation.