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1. An analysis of the development of the policy-making process in relation to bidding for large scale sports events in the UK

Author

Salisbury, Paul J.

Subjects
796.0941, Sport, Policy, Mega-events, Bidding
Abstract

There is a growing field of literature concerning the staging, management and planning for large scale sports events; the evaluation of these events and the reasons why nations, but more recently cities, attempt to host these events, but few studies have attempted to provide a theoretically informed analysis of the processes by which these decisions are made. This study builds upon those existing studies in this area which outlined a method for exploring decisions to host, but furthers the analysis through the consideration of policy models, most notably the Multiple Streams Framework (Kingdon, 1984), in order to provide a sophisticated understanding of how such policy decisions are taken at the local level. Within the context of a critical realist epistemology, case studies of three United Kingdom bids (Sheffield s bid for the 1991 Universiade; Manchester s bid for the 2000 Olympic Games and Glasgow s bid for the 2014 Commonwealth Games) were undertaken. Content analysis of documents, triangulated with semi-structured interviews with the majority of key actors involved in, and excluded from, the processes were carried out in order for geographical, methodological and theoretical triangulation to be undertaken. The three bids were selected from across a twenty year period in order to test the hypothesis that the decision-making process for events would had become more and centrally-led over time. The results indicate that, while no analytical framework provides a perfect fit , the Multiple Streams Framework and its focus on policy entrepreneurialism is highly useful in explaining the elevation of these events onto local political agendas. Despite the increased centralisation of United Kingdom sport policy, local/regional actors were able to operate with surprising freedom and take advantage of apparent coincidences in order to achieve their objectives. The wider implications of these results include providing a stimulus for researchers to build upon the limited body of literature that applies policy theory to sports policy issues and also to stimulate research in the international context.

Published
2014

3. Fifa

Author

Bason, Tom, primary, Salisbury, Paul, additional, and Gerard, Simon, additional

Published
2018
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6. Building a brand portfolio: the case of English Football League (EFL) clubs.

Author

Pritchard, Adrian, Cook, David, Jones, Andrew, Bason, Tom, and Salisbury, Paul

Subjects
SOCCER, BRANDING (Marketing), ATHLETIC clubs, PROFESSIONAL sports, ARCHITECTURAL style, SPORTS marketing, SPORTS sponsorship
Abstract

Research question: Professional sports clubs (PSCs) may diversify by marketing a range of products that extend beyond sport. Using brand architecture as a framework, the research aims to examine: the brand names they adopt, markets they serve and the hierarchical relationship between the leagues and PSCs in the branding of the product ranges of both organizations. Research methods: Set within the context of the English Football League (EFL), club websites were reviewed to examine brand names that are used when marketing activities unrelated to sport. Semi-structured interviews were conducted with the commercial staff of 21 PSCs relating to their branding strategy. Results and findings: Leagues and PSCs may market a number of brands in addition to their core products of sporting competitions and teams. EFL clubs have developed brands independently of the league, primarily by branding their stadiums as a multi-purpose venue to stage events not related to matches. Within their venues they have also developed a category we term 'stadium sub-brands'. These include business clubs, comedy clubs and restaurants. Some of these services are co-branded with partner organizations. Implications: Devising a typology of the brand architecture of EFL clubs illustrates how sports organizations can diversify into markets other than football and add to their product portfolio by making use of their resources, in particular their stadium. [ABSTRACT FROM AUTHOR]

Published
2022
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8. Beasts of England

Author

Atter, David, Pratt, Ken, and Salisbury, Paul

Subjects
Literature/writing, Political science
Abstract

Jason Cowley's introduction to the new Macmillan Library edition of Animal Farm ('The road to revolution', 11 December) sent me back to George Orwell after 30 years. What I found [...]

Published
2021

9. Examining Legacies of Unsuccessful Olympic Bids: Evidence from a Cross-Case Analysis.

Author

Leopkey, Becca, Salisbury, Paul, and Tinaz, Cem

Subjects
OLYMPIC Games, ECONOMIC development, BRAND name products, URBAN planning
Abstract

Copyright of Journal of Global Sport Management is the property of the Global Alliance of Marketing & Management Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. (Copyright applies to all Abstracts.)

Published
2021
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11. KAYBEDERKEN KAZANABİLDİK Mİ? İSTANBUL’UN BAŞARISIZLIKLA SONUÇLANAN OLİMPİYAT ADAYLIKLARININ ÇIKTILARININ İNCELENMESİ

Author

TINAZ, Cem, Leopkey, Becca, and Salisbury, Paul

Subjects
Bidding Legacy,Impact,Mega Sport Events, Adaylık Mirası,Etki,Devasa Spor Etkinlikleri
Abstract

The Olympic Games Bid is one of the critical issuesthat has recently occupied sport societies in many countries and citiesconsidering becoming candidates to host the games. Istanbul is one of thecities that has been regularly nominated to host the games since the 1990s. Ourresearch aims to examine and identify the positive and negative outcomes of thesummer Olympic Games Bids in Istanbul between 1993 and 2013. Whereas current researchin the literature focuses on the legacies of hosting sporting events, thisstudy concentrates mainly on the outcomes of the biddings. The increase in thenumber of cities withdrawing their candidacy while the process continues andthe decrease in the number of candidate cities make this research relevant.Within the scope of the research, semi-structured interviews were conductedwith nine senior officials in charge of past Istanbul's Olympic candidacies,and written reports and bidding documents were examined. Findings from thestudy indicate the existence of many tangible and intangible outputs as aresult of Istanbul's Olympic candidacies. However, many of these outcomes haveremained "impacts", only a limited part of which could be transformedinto legacies. The study concludes that a variety of outcomes such ascontribution to the promotion of the city and the country, acceleration oftransportation and infrastructure development, an increase in capacity to hostsporting events, the formation of inter-organizational cooperation, and thedevelopment of sports networks have been determined. On the other hand,negative outputs have also been identified, such as increased frustration insociety and a decreased public trust in the evaluation process. Findings fromthe research are predicted to contribute to possible future bidding in Istanbuland the process of legacy-planning of sports organizations preparing to bid forlarge-scale sports events., Olimpiyat Oyunları adaylığı, son dönemde birçokülkede spor kamuoyunu ve de oyunlara aday olmayı düşünen şehirlerdeki yerelhalkı meşgul eden önemli konulardan biridir. İstanbul da 1990’lı yıllardan buyana düzenli olarak oyunlara ev sahipliği yapmak için aday olan şehirlerarasındayer almıştır. Bu araştırmanın amacı İstanbul’un 1993-2013 yılları arasındagerçekleşen Olimpiyat Oyunları adaylıkları neticesinde ortaya çıkan olumlu veolumsuz çıktıların incelenmesi ve tanımlanmasıdır. Literatürde yer alan güncelbilimsel araştırmalar, ağırlıklı olarak, spor etkinliklerine ev sahipliğiyapılması neticesinde ortaya çıkan mirasa odaklanırken, bu araştırmada adaylıkneticesinde ortaya çıkan etkilere odaklanılmıştır. Son dönemde Olimpiyat Oyunlarıadaylığı süreci devam ederken adaylıktan çekilen şehirlerin sayısının artmasıve aday olan ülke sayısının düşmesi bu araştırmayı önemli kılmaktadır. Araştırmakapsamında İstanbul’un Olimpiyat Oyunları adaylıkları sürecinde görev almışdokuz üst düzey yetkili ile yarı yapılandırılmış mülakatlar gerçekleştirilmiş,bu konuda hazırlanmış yazılı raporlar ve başvuru dokümanları incelenmiştir. Araştırmadanelde edilen bulgular, İstanbul’un Olimpiyat Oyunları adaylıkları neticesindebirçok somut ve soyut çıktının varlığına işaret etmektedir. Ancak bu çıktılarınbirçoğu “etki” olarak kalmış, yalnızca kısıtlı bir kısmı ise mirasadönüşebilmiştir. Araştırma sonucunda şehrin ve ülkenin tanıtımına katkısağlanması, ulaşım ve altyapı gelişiminin ivme kazanması, spor etkinliklerineev sahipliği yapma kapasitesinin artması, örgütler arası iş birliklerininoluşması, spor şebekelerinin gelişmesi gibi birtakım çıktılar tespit edilmiştir.Öte yandan, toplumda yaşanan hayal kırıklığı, halkın değerlendirme sürecine olaninancının azalması gibi olumsuz çıktılar da mevcuttur. Araştırmadan elde edilenbulguların İstanbul’un gelecekte gerçekleşmesi muhtemel yeni bir adaylıksürecine ve büyük boyutlu spor etkinliklerine aday olmayı planlayan Türk sporörgütlerinin miras planlama sürecine katkısı olacağı öngörülmektedir.

Published
2018

16. Three Ways of Assessing Newspaper Readership Demographics.

Author

Gollin, Albert E. and Salisbury, Paul A.

Abstract

Compares the uses of multiple regression, the Automatic Interaction Detector (AID) multivariate program, and cross-tabular analysis in identifying variables associated with newspaper readership. (RL)

Published
1980

22. Desquamative gingivitis: Clinical findings and diseases.

Author

Maderal, Andrea D, Lee Salisbury, Paul 3rd, and Jorizzo, Joseph L

Abstract

Desquamative gingivitis is a clinical finding with several potential etiologies. Among the most common are oral lichen planus, cicatricial pemphigoid, and pemphigus vulgaris, though various other differential diagnoses exist. The presence of desquamative gingivitis often results in poor oral hygiene, which can have downstream consequences, including periodontitis and tooth loss. Though certain mucosal findings may be suggestive of a particular diagnosis, a thorough history, physical examination, and appropriate dermato- and immunopathologic assessment is necessary for narrowing this broad differential diagnosis. This article offers a comprehensive review on the subject, including how to differentiate between the different underlying causes and the best methods for diagnosis (eg, how best to obtain mucosal biopsy specimens). In addition, there is minimal information in the dermatology literature on evaluation of oral hygiene and the consequences of poor oral hygiene not only on disease activity but also overall health. Knowledge on appropriate oral cavity inspection and evaluation of dental hygiene is lacking, and this continuing medical education series discusses methods to evaluate for these consequences so that the dermatologist can be better equipped in managing these patients and recognizing complications early on. [ABSTRACT FROM AUTHOR]

Published
2018
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23. Desquamative gingivitis: Diagnosis and treatment.

Author

Maderal, Andrea D, Lee Salisbury, Paul 3rd, and Jorizzo, Joseph L

Abstract

Desquamative gingivitis is a clinical finding with several potential etiologies, and therefore histologic examination should be performed to confirm the diagnosis before the implementation of systemic therapy. The best methods for obtaining a mucosal biopsy specimen are discussed to aid the dermatologist in approaching these patients, and indications for additional testing, such as immunofluorescence studies, are reviewed. Desquamative gingivitis is uncommon, and there are no systematic guidelines to assist the physician in treatment, producing a practice gap in management. As such, this article focuses on treatment for individual conditions, with emphasis on levels of evidence. An emphasis is also placed on the role of dental care in disease control and the best methods for achieving good oral hygiene. [ABSTRACT FROM AUTHOR]

Published
2018
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24. An analysis of Glasgow’s decision to bid for the 2014 Commonwealth Games.

Author

Salisbury, Paul

Subjects
COMMONWEALTH Games, SPORTS events management
Abstract

There is a growing body of literature concerning the staging, management and planning for large-scale sports events; the evaluation of these events and the reasonswhynations and cities attempt to host them, but few studies have provided a theoretically informed analysis of hosting policy decisions. This study builds upon existing studies which outlined a method for exploring decisions to host, but furthers the analysis through the consideration of a policy model, the Multiple Streams Framework (MSF), in order to provide a sophisticated understanding ofhowpolicy decisions are taken at the local level. A case study of Glasgow’s bid for the 2014 Commonwealth Games was undertaken using semi-structured interviews with the majority of key actors involved in, and excluded from, the policy-making process. The results indicate that, while it does not provide a perfect ‘fit’, the MSF and its focus on policy entrepreneurialism is useful in explaining the elevation of these events onto local political agendas. The implications of these results include providing a stimulus for researchers to build upon the limited body of literature that applies policy theory to sport policy issues and also to stimulate research in the international context. [ABSTRACT FROM PUBLISHER]

Published
2017
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25. Letters to the Editor.

Author

Staats, Elmer B., Hamilton, Charles E., Goldin, Harrison J., Inberg, Carol, Proxmire, William, Holder, William W., Morice, James L., Moore, Perry Glen, Adalbert, Leo J., Wood, G. Christopher, Clipp III, E. Paul, Manners Jr., George E., Bulger, Brian W., Matthei, Wesley G., Foster, Jonathan F., Bader, Max, Gross, Clifford M., Bowsher, Charles A., Anthony, Robert N., and Salisbury, Paul Allen

Subjects
LETTERS to the editor, GOVERNMENT accountants, MEDICAL care cost shifting, PERSONNEL management, LABOR
Abstract

Multiple letters to the editor are presented on articles in previous issues. Titles include "Games Government Accountants Play," by Robert Anthony from the September-October 1985 issue, "How Companies Tackle Health Care Costs: Part I," by Regina E. Herzlinger and Jeffrey Schwartz from the July-August 1985 issue, and "Do We Really Want Labor on the Ropes?," by Jack Barbash from the July-August 1985 issue.

Published
1985

27. The future of engineering

Author

Thomas, Rick, Kiteman, S. A., Tallar, Craig, Salisbury, Paul, and Fermi, John

Subjects
Clothing industry, Textile industry, Engineers, Business, Engineering and manufacturing industries, Metals, metalworking and machinery industries
Abstract

As usual, your editorial ('Engineering students who don't go into engineering,' May 6) is right on target. However, the lack of money is not the only compelling reason to get [...]

Published
2010

30. Smokeless tobacco: Epidemiology, health effects and cessation strategies.

Author

Spangler, John G. and Salisbury, Paul Lee

Subjects
SMOKELESS tobacco, HEALTH
Abstract

Reports on the epidemiology of smokeless tobacco use and its adverse health consequences. Dental and periodontal effects such as gingival recession and marked staining; Leukoplakia; Oral cancer; Systemic nicotine effects; Smokeless tobacco cessation.

Published
1995

31. Gimme A Break!

Author

Salisbury, Paul Allen and Beer, Rose Salisbury

Abstract

No abstract available for this article. [ABSTRACT FROM PUBLISHER]

Published
1986
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32. Old Money.

Author

Salisbury, Paul Allen

Abstract

No abstract available for this article. [ABSTRACT FROM PUBLISHER]

Published
1986
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33. The occlusal wafer: simple technique for construction and its use in maxillofacial surgery.

Author

Irving, Steven P., Costa, Louis E., Salisbury, Paul Lee, Irving, S P, Costa, L E 3rd, and Salisbury, P L 3rd

Abstract

The acrylic occlusal wafer is a thin piece of plastic which fits between and indexes the occlusal surfaces of the maxillary and mandibular teeth. This appliance has three functions: it positions the jaws relative to one another; it prevents sliding movement during intermaxillary fixation; and it prevents unwanted orthodontic movement during intermaxillary fixation from the pressure of intermaxillary wires or rubber bands on unsupported teeth. The role of the occlusal wafer is well established in orthognathic surgery where it is used as a key for setting the jaws when osteotomies are performed. It has been underutilized in trauma due to the time and technical expertise required for fabrication. This paper describes a technique which can result in occlusal wafers of surgical quality in about 20 minutes, requires minimal laboratory equipment, and can be mastered by clinical personnel. Four cases are presented which illustrate the use of occlusal wafers and the indications for the device are discussed. [ABSTRACT FROM AUTHOR]

Published
1984
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35. Mandibular Fractures: Their Effect on Growth and Dentition

Author

McGuirt, W. Frederick and Salisbury, Paul Lee

Abstract

• Findings in 28 subjects having had childhood mandible fractures with long-term follow-up document asymmetric facial growth and dental abnormality in a high proportion. Facial growth abnormalities, five of which were moderate to severe, were detected by trained medical-dental examiners in 13 of the subjects (47%). Cephalometric abnormalities were detected in 18 (67%) of the 27 subjects so analyzed, with five (18%) meeting multiple roentgenographic criteria for abnormality. Frontal and lateral cephalometric abnormalities were found in nearly equal percentages among condylar-only, condylar-body, and noncondylar fracture groups, but abnormalities were most severe in association with the condylar injuries. The single best screening tool for facial abnormality was clinical examination. Frontal cephalometric roentgenograms correlated with clinical findings better than lateral cephalometric roentgenograms. However, roentgenograms alone had a 35% false-positive incidence of abnormality when correlated with the clinical-dental examination. Abnormalities of occlusion and dentition were seen in ten (36%) of the 28 subjects. Pterygoid muscle exercises following prolonged intermittent, nocturnal, intermaxillary fixation are discussed as a possible means to reduce the incidence of these abnormalities as the child matures.(Arch Otolaryngol Head Neck Surg 1987;113:257-261)

Published
1987
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42. Processual evolution of meta-organisations in sport : a lifecycle approach

Author

Farajpour Bakhtiari, Nima, Salisbury, Paul, Wong, Donna, and Senaux, Benoit

Subjects
796.06
Abstract

Within organisational fields, organisations may seek collective action in order to influence their environment. Formalisation of such process may entail the emergence of 'meta-organisations', which are organisations that have other organisations as members. The majority of the organisational literature has mostly addressed these organisational settings using theoretical constructs that, either explicitly or implicitly, assume that members of organisations are individuals. Ahrne and Brunsson (2005) pioneered a theory for meta-organisations that offsets some of the shortcomings of classic organisational theories. This study applies the theory of meta-organisations to the empirical context of sport in order to add depth to the current understanding of the evolution of meta-organisations across various stages of their organisational lifecycle. This qualitative inquiry is informed by the concept of Processual Analysis (Pettigrew 1997) and focuses on Global Association of International Sport Federations (GAISF) as a single embedded case-study. The study takes a longitudinal approach by collecting data across two phases of retrospective and real-time. Using semi-structured interviews and open-ended questionnaires, primary data was collected from Presidents and Secretary Generals of international sport federations. Also, secondary data was collected from the archives of the Olympic Library. Additional secondary data sources included press archives, organisational documents and historical books. This research showcases the usefulness of meta-organisation theory for the empirical context of sports. Also, it highlights the applicability of the organisational lifecycle model as a valuable analytical tool for conducting processual research. The findings of the study show that meta-organisations can be the result of transformation of loose networks into formalised entities. It is also learnt that heterogeneity in terms of interests and resources is critical in both the process of emergence as well as stability of the meta-organisation. Furthermore, the impact of outer and inner context on the evolution of the meta-organisation is remarked. Finally, it is shown that active non-members can have a significant impact on the trajectory path of the meta-organisation. Through inserting agency as well as creating implicit hierarchies, active non-members may restore the organisational boundaries to the environmental settings prior to the emergence of the meta-organisation.

Published
2021

43. Appliance to Protect Maxillary Teeth and Palate During Endoscopy

Author

Salisbury, Paul Lee, Curtis, James W., and Kohut, Robert I.

Abstract

• To avoid traumatizing maxillary teeth and edentulous ridges during endoscopy, a device or appliance must be used to prevent direct contact of the teeth and mucosa with endoscopic instruments. Because previous appliances have been minimally protective, easily dislodged, or obstructive to the endoscopist, none have been widely accepted at our institution. Consequently, we developed an easily fabricated protective appliance, using conventional dental technology, that has adequate strength to prevent fracture and displacement of teeth during routine endoscopy. The appliance is retentive, unobstructive, reusable, and reasonably priced for the patient. In an initial group of approximately 25 patients undergoing endoscopy, this appliance was well accepted by the otolaryngology and anesthesia staff, and there were no injuries to the teeth or oral mucosa. To verify further the usefulness of this type of appliance, a prospective study is planned.(Arch Otolaryngol 1984;110:106-107)

Published
1984
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44. Effect of hydrocortisone on mortality and organ support in patients with severe COVID-19

Author

Angus, Derek, Derde, Lennie, Al-Beidh, Farah, Annane, Djillali, Arabi, Yaseen, Beane, Abigail, van Bentum-Puijk, Wilma, Berry, Lindsay, Bhimani, Zahra, Bonten, Marc, Bradbury, Charlotte, Brunkhorst, Frank, Buxton, Meredith, Buzgau, Adrian, Cheng, Allen, de Jong, Menno, Detry, Michelle, Estcourt, Lise, Fitzgerald, Mark, Goossens, Herman, Green, Cameron, Haniffa, Rashan, Higgins, Alisa, Horvat, Christopher, Hullegie, Sebastiaan, Kruger, Peter, Lamontagne, Francois, Lawler, Patrick, Linstrum, Kelsey, Litton, Edward, Lorenzi, Elizabeth, Marshall, John, Mcauley, Daniel, Mcglothin, Anna, Mcguinness, Shay, Mcverry, Bryan, Montgomery, Stephanie, Mouncey, Paul, Murthy, Srinivas, Nichol, Alistair, Parke, Rachael, Parker, Jane, Rowan, Kathryn, Sanil, Ashish, Santos, Marlene, Saunders, Christina, Seymour, Christopher, Turner, Anne, van de Veerdonk, Frank, Venkatesh, Balasubramanian, Zarychanski, Ryan, Berry, Scott, Lewis, Roger, Mcarthur, Colin, Webb, Steven, Gordon, Anthony, NIHR, Hôpital Raymond Poincaré [AP-HP], Writing Committee for the REMAP-CAP Investigators, Farah Al-Beidh, Derek Angus, Djillali Annane, Yaseen Arabi, Wilma van Bentum-Puijk, Scott Berry, Abigail Beane, Zahra Bhimani, Marc Bonten, Charlotte Bradbury, Frank Brunkhorst, Meredith Buxton, Allen Cheng, Menno De Jong, Lennie Derde, Lise Estcourt, Herman Goossens, Anthony Gordon, Cameron Green, Rashan Haniffa, Francois Lamontagne, Patrick Lawler, Edward Litton, John Marshall, Colin McArthur, Daniel McAuley, Shay McGuinness, Bryan McVerry, Stephanie Montgomery, Paul Mouncey, Srinivas Murthy, Alistair Nichol, Rachael Parke, Kathryn Rowan, Christopher Seymour, Anne Turner, Frank van de Veerdonk, Steve Webb, Ryan Zarychanski, Lewis Campbell, Andrew Forbes, David Gattas, Stephane Heritier, Lisa Higgins, Peter Kruger, Sandra Peake, Jeffrey Presneill, Ian Seppelt, Tony Trapani, Paul Young, Sean Bagshaw, Nick Daneman, Niall Ferguson, Cheryl Misak, Marlene Santos, Sebastiaan Hullegie, Mathias Pletz, Gernot Rohde, Kathy Rowan, Brian Alexander, Kim Basile, Timothy Girard, Christopher Horvat, David Huang, Kelsey Linstrum, Jennifer Vates, Richard Beasley, Robert Fowler, Steve McGloughlin, Susan Morpeth, David Paterson, Bala Venkatesh, Tim Uyeki, Kenneth Baillie, Eamon Duffy, Rob Fowler, Thomas Hills, Katrina Orr, Asad Patanwala, Steve Tong, Mihai Netea, Shilesh Bihari, Marc Carrier, Dean Fergusson, Ewan Goligher, Ghady Haidar, Beverley Hunt, Anand Kumar, Mike Laffan, Patrick Lawless, Sylvain Lother, Peter McCallum, Saskia Middeldopr, Zoe McQuilten, Matthew Neal, John Pasi, Roger Schutgens, Simon Stanworth, Alexis Turgeon, Alexandra Weissman, Neill Adhikari, Matthew Anstey, Emily Brant, Angelique de Man, Francois Lamonagne, Marie-Helene Masse, Andrew Udy, Donald Arnold, Phillipe Begin, Richard Charlewood, Michael Chasse, Mark Coyne, Jamie Cooper, James Daly, Iain Gosbell, Heli Harvala-Simmonds, Tom Hills, Sheila MacLennan, David Menon, John McDyer, Nicole Pridee, David Roberts, Manu Shankar-Hari, Helen Thomas, Alan Tinmouth, Darrell Triulzi, Tim Walsh, Erica Wood, Carolyn Calfee, Cecilia O’Kane, Murali Shyamsundar, Pratik Sinha, Taylor Thompson, Ian Young, Shailesh Bihari, Carol Hodgson, John Laffey, Danny McAuley, Neil Orford, Ary Neto, Michelle Detry, Mark Fitzgerald, Roger Lewis, Anna McGlothlin, Ashish Sanil, Christina Saunders, Lindsay Berry, Elizabeth Lorenzi, Eliza Miller, Vanessa Singh, Claire Zammit, Wilma van Bentum Puijk, Wietske Bouwman, Yara Mangindaan, Lorraine Parker, Svenja Peters, Ilse Rietveld, Kik Raymakers, Radhika Ganpat, Nicole Brillinger, Rene Markgraf, Kate Ainscough, Kathy Brickell, Aisha Anjum, Janis-Best Lane, Alvin Richards-Belle, Michelle Saull, Daisy Wiley, Julian Bion, Jason Connor, Simon Gates, Victoria Manax, Tom van der Poll, John Reynolds, Marloes van Beurden, Evelien Effelaar, Joost Schotsman, Craig Boyd, Cain Harland, Audrey Shearer, Jess Wren, Giles Clermont, William Garrard, Kyle Kalchthaler, Andrew King, Daniel Ricketts, Salim Malakoutis, Oscar Marroquin, Edvin Music, Kevin Quinn, Heidi Cate, Karen Pearson, Joanne Collins, Jane Hanson, Penny Williams, Shane Jackson, Adeeba Asghar, Sarah Dyas, Mihaela Sutu, Sheenagh Murphy, Dawn Williamson, Nhlanhla Mguni, Alison Potter, David Porter, Jayne Goodwin, Clare Rook, Susie Harrison, Hannah Williams, Hilary Campbell, Kaatje Lomme, James Williamson, Jonathan Sheffield, Willian van’t Hoff, Phobe McCracken, Meredith Young, Jasmin Board, Emma Mart, Cameron Knott, Julie Smith, Catherine Boschert, Julia Affleck, Mahesh Ramanan, Ramsy D’Souza, Kelsey Pateman, Arif Shakih, Winston Cheung, Mark Kol, Helen Wong, Asim Shah, Atul Wagh, Joanne Simpson, Graeme Duke, Peter Chan, Brittney Cartner, Stephanie Hunter, Russell Laver, Tapaswi Shrestha, Adrian Regli, Annamaria Pellicano, James McCullough, Mandy Tallott, Nikhil Kumar, Rakshit Panwar, Gail Brinkerhoff, Cassandra Koppen, Federica Cazzola, Matthew Brain, Sarah Mineall, Roy Fischer, Vishwanath Biradar, Natalie Soar, Hayden White, Kristen Estensen, Lynette Morrison, Joanne Smith, Melanie Cooper, Monash Health, Yahya Shehabi, Wisam Al-Bassam, Amanda Hulley, Christina Whitehead, Julie Lowrey, Rebecca Gresha, James Walsham, Jason Meyer, Meg Harward, Ellen Venz, Patricia Williams, Catherine Kurenda, Kirsy Smith, Margaret Smith, Rebecca Garcia, Deborah Barge, Deborah Byrne, Kathleen Byrne, Alana Driscoll, Louise Fortune, Pierre Janin, Elizabeth Yarad, Naomi Hammond, Frances Bass, Angela Ashelford, Sharon Waterson, Steve Wedd, Robert McNamara, Heidi Buhr, Jennifer Coles, Sacha Schweikert, Bradley Wibrow, Rashmi Rauniyar, Erina Myers, Ed Fysh, Ashlish Dawda, Bhaumik Mevavala, Ed Litton, Janet Ferrier, Priya Nair, Hergen Buscher, Claire Reynolds, John Santamaria, Leanne Barbazza, Jennifer Homes, Roger Smith, Lauren Murray, Jane Brailsford, Loretta Forbes, Teena Maguire, Vasanth Mariappa, Judith Smith, Scott Simpson, Matthew Maiden, Allsion Bone, Michelle Horton, Tania Salerno, Martin Sterba, Wenli Geng, Pieter Depuydt, Jan De Waele, Liesbet De Bus, Jan Fierens, Stephanie Bracke, Brenda Reeve, William Dechert, Michaël Chassé, François Martin Carrier, Dounia Boumahni, Fatna Benettaib, Ali Ghamraoui, David Bellemare, Ève Cloutier, Charles Francoeur, François Lamontagne, Frédérick D’Aragon, Elaine Carbonneau, Julie Leblond, Gloria Vazquez-Grande, Nicole Marten, Maggie Wilson, Martin Albert, Karim Serri, Alexandros Cavayas, Mathilde Duplaix, Virginie Williams, Bram Rochwerg, Tim Karachi, Simon Oczkowski, John Centofanti, Tina Millen, Erick Duan, Jennifer Tsang, Lisa Patterson, Shane English, Irene Watpool, Rebecca Porteous, Sydney Miezitis, Lauralyn McIntyre, Laurent Brochard, Karen Burns, Gyan Sandhu, Imrana Khalid, Alexandra Binnie, Elizabeth Powell, Alexandra McMillan, Tracy Luk, Noah Aref, Zdravko Andric, Sabina Cviljevic, Renata Đimoti, Marija Zapalac, Gordan Mirković, Bruno Baršić, Marko Kutleša, Viktor Kotarski, Ana Vujaklija Brajković, Jakša Babel, Helena Sever, Lidija Dragija, Ira Kušan, Suvi Vaara, Leena Pettilä, Jonna Heinonen, Anne Kuitunen, Sari Karlsson, Annukka Vahtera, Heikki Kiiski, Sanna Ristimäki, Amine Azaiz, Cyril Charron, Mathieu Godement, Guillaume Geri, Antoine Vieillard-Baron, Franck Pourcine, Mehran Monchi, David Luis, Romain Mercier, Anne Sagnier, Nathalie Verrier, Cecile Caplin, Shidasp Siami, Christelle Aparicio, Sarah Vautier, Asma Jeblaoui, Muriel Fartoukh, Laura Courtin, Vincent Labbe, Cécile Leparco, Grégoire Muller, Mai-Anh Nay, Toufik Kamel, Dalila Benzekri, Sophie Jacquier, Emmanuelle Mercier, Delphine Chartier, Charlotte Salmon, PierreFrançois Dequin, Francis Schneider, Guillaume Morel, Sylvie L’Hotellier, Julio Badie, Fernando Daniel Berdaguer, Sylvain Malfroy, Chaouki Mezher, Charlotte Bourgoin, Bruno Megarbane, Sebastian Voicu, Nicolas Deye, Isabelle Malissin, Laetitia Sutterlin, Christophe Guitton, Cédric Darreau, Mickaël Landais, Nicolas Chudeau, Alain Robert, Pierre Moine, Nicholas Heming, Virginie Maxime, Isabelle Bossard, Tiphaine Barbarin 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Ferguson, Katharine Sellers, Joanne Bradley-Potts, David Yates, Isobel Birkinshaw, Kay Kell, Nicola Marshall, Lisa Carr-Knott, Charlotte Summers, and Mégarbane, Bruno

Subjects
[SDV.MHEP.ME] Life Sciences [q-bio]/Human health and pathology/Emerging diseases, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, General Medicine, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, Writing Committee for the REMAP-CAP Investigators, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, [SDV.TOX] Life Sciences [q-bio]/Toxicology, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, [SDV.TOX]Life Sciences [q-bio]/Toxicology, General & Internal Medicine, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, [SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, 11 Medical and Health Sciences
Abstract

Importance Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures The primary end point was organ support–free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned –1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support–free days were 0 (IQR, –1 to 15), 0 (IQR, –1 to 13), and 0 (–1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support–free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support–free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions.

Published
2020

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