33 research outputs found

    Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

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    Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ā‰„18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5Ā·0 months (IQR 4Ā·2ā€“6Ā·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0Ā·0001) and independently associated with COVID-19 status (odds ratio [OR] 2Ā·9 [95% CI 1Ā·5ā€“5Ā·8]; padjusted=0Ā·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0Ā·0001; parenchymal abnormalities), brain abnormalities (p<0Ā·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0Ā·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4ā€“10]; mean age of 59Ā·8 years [SD 11Ā·7] with multiorgan abnormalities vs mean age of 52Ā·8 years [11Ā·9] without multiorgan abnormalities; p<0Ā·0001), more likely to have three or more comorbidities (OR 2Ā·47 [1Ā·32ā€“4Ā·82]; padjusted=0Ā·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3Ā·55 [1Ā·23ā€“11Ā·88]; padjusted=0Ā·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification

    Increasing Community College Graduation Rates with a Proven Model: Three-Year Results from the Accelerated Study in Associate Programs (ASAP) Ohio Demonstration

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    The nation's community colleges play a central role in producing a more educated workforce and promoting social mobility. They serve about 40 percent of all college students and, not surprisingly, they serve a disproportionate number of low-income and underrepresented students. But most students who enter these colleges do not graduate ā€” only about a third of entering students earn a degree or certificate within six years.Ā Among the many programs that have attempted to increase graduation rates, one program stands out. Developed by the City University of New York (CUNY), the Accelerated Study in Associate Programs (ASAP) is a comprehensive program that provides students with up to three years of financial and academic support and other support services. Along with those services and other forms of support comes an obligation to attend full time and participate in essential program services. An experimental evaluation of CUNY ASAP found that the program nearly doubled graduation rates after three years.Ā This report presents findings through three years from a replication of the ASAP model at three community colleges in Ohio. Low-income students were randomly assigned either to a program group, who could participate in their colleges' new programs based closely on ASAP (called the Ohio Programs), or to a control group, who could receive the usual college services. Comparing the two groups' outcomes provides an estimate of the Ohio Programs' effects.

    Getting the price right

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