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

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 ≥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 5·0 months (IQR 4·2–6·3) 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<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; 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 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) 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

Learning letters, not language: The nature and quality of language and literacy apps used during remote learning with preschool children in the United States

During the COVID-19 pandemic, early childhood educators (ECEs) made a rapid pivot to remote instruction. Much of this instruction was facilitated by digital learning resources, but the nature and quality of these resources for children’s language and literacy learning is an open question. This paper draws on a national U.S. survey of ECEs during the second pandemic school year (2020–2021), which asked them to report on the apps and websites they asked children to use during remote learning. We then engaged in a content analysis of the apps/websites used most frequently, evaluating their quality along several dimensions, including support for a full range of literacy competencies, equity, and accessibility. Survey results indicated that preschool children were asked to use a wide range of apps, but six were used most frequently: YouTube, Seesaw, Starfall, Epic, Boom Cards, and ABC Mouse. The content analysis indicated that most apps supported code-focused literacy skills, but had less capacity to foster oral language and comprehension. Apps also presented few opportunities to approximate the active, hands-on learning characteristic of in-person preschool. Our analysis points to the pressing need for teacher guidance in the selection and use of apps that provide comprehensive support for language and literacy. Prior State of Knowledge: Prior studies have investigated the quality of apps for young children’s literacy learning, and several studies have investigated the nature and frequency of remote instruction for children attending preschool during COVID-19. Novel Contributions: The present study reports valuable information about which language and literacy apps early childhood educators asked children to use during remote learning and provides a comprehensive evaluation of those apps, including dimensions such as equity and accessibility that have been previously under-researched. Practical Implications: One important implication for administrators is that teachers need support in finding and learning to use apps that align more closely with early learning standards. Teachers can use the QuELLA rubric in this paper as a tool for evaluating apps.</p

Effects of Teacher-Delivered Book Reading and Play on Vocabulary Learning and Self-Regulation among Low-Income Preschool Children

<p>There is a need for empirically based educational practices shown to support learning, yet validation tends to require a high degree of experimental control that can limit ecological validity and translation to classrooms. We describe our iterative intervention design to support preschoolers’ vocabulary through book reading coupled with playful learning, including the process of translating research-based methods to an authentic teacher-delivered intervention. Effectiveness of the teacher-implemented intervention was examined by comparing book reading alone versus book reading plus play in supporting vocabulary development in preschoolers (<i>N </i>= 227) from low-income families with diverse backgrounds. Teachers used definitions, gestures, and pictures to teach vocabulary. During play, teachers led play with story-related figurines while using target vocabulary. Ten teachers read books and engaged children in play (read + play [R + P]), and 6 used only book reading (read-only [RO]). For children in both the R + P and RO conditions, within-subjects analyses of gains on taught versus control words revealed large effects on receptive (R + P, <i>d </i>= 1.08; RO, <i>d </i>= 0.92) and expressive vocabulary (R + P, <i>d </i>= 1.41; RO, <i>d =</i>1.23). Read-only had a statistically significant effect (<i>d =</i> 0.20) on a standardized measure of receptive vocabulary, but there were no statistically significant differences between conditions. Moderate to large effects were found using an expressive task when words were tested 4 months after they were taught. Implications for curriculum design and the potential benefits of enhancing children’s vocabulary through book reading and playful learning are discussed.</p