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

A ‘strange...absurd...and somewhat injurious influence’? Cricket, professional Coaching in the Public Schools and the “Gentleman Amateur” Ethos

This paper offers an insight into the changing social and economic relations in cricket between 1860 and 1914, by examining the role of professionals who were employed to coach the game in public schools. It highlights how professionals were widely respected before this period and pioneered the development of playing technique and its dissemination through coaching in a manner that ensured the game was played in a way which benefited their interests. The decline in their status which followed the rise of the ‘Gentleman Amateur’ to a position of control in cricket during the 1860s is then discussed and related to the growth of an influential body of rhetoric that underscored the new structure. Finally, the re-evaluation of coaching’s contribution to cricket in private education which formed part of this discourse is set against the continued employment of professionals in such institutions and their influence upon amateur players of the game’s ‘Golden Age’

Cricket in the Eighteenth Century

The chapter places the formative development of cricket during the eighteenth century within it's contemporary social and cultural context

‘In a Yorkshire Like Way’: Cricket and the Construction of Regional Identity in Nineteenth-century Yorkshire

This paper examines how by 1900 cricket had come to be seen as an important representation of Yorkshire identity. It places the start of this process in the game's popular pre-modern context, as professional-centred, competitive, commercial cricket dominated its formative development across the region. The way these values led to local rivalries which became focused on the concept of a representative team building Yorkshire's status within the national context of cricket is then explored. Finally these events are set against the formation of the ‘Gentleman Amateur’ controlled county club in 1863, to show how a distinctive concept of county cricket developed in Yorkshire which offers a different perspective on the English county game during its formative decade and beyond

‘Ten Drunks and a Parson’?: The Victorian Professional Cricketer Reconsidered

By focusing largely upon the West Riding of Yorkshire and its contemporary local press, this paper examines the role of the professional player in nineteenth century cricket. It examines how they developed careers in cricket, as the sport's popularity grew on a local, national and international basis. These broadening opportunities are related to the predominance of professionals before the 1870s, when they contributed much to the way the sport was to subsequently develop. The paper then discusses why cricket's historiography has commonly viewed early professionals only as self-interested and ill disciplined individuals. This is related to the predominance of amateur values in cricket, which meant that, although tolerated, the sport's professionals were subjugated by a set of restrictive regulations between the 1870s and the 1960s. Finally, it is suggested that by looking beyond cricket's mainstream nineteenth century source material, a more accurate assessment of the game's development can be made

The 'Up and Under' rugby league oral history project website.

By recording and then disseminating the oral reminiscences of the Rugby League community in West Yorkshire - players, officials and spectators - this project will preserve, celebrate and broaden recognition of the sport's rich social and cultural history in the region

‘Ordinary Working Men’: Professional Rugby League Players and Full Time Employment Outside the Game.

Using interviews from the University of Huddersfield’s ‘Up and Under’ rugby league oral history project, this paper explores the role played by the working life of professional players in shaping general perceptions of the sport. A diverse range of testimonies from supporters and the players themselves are examined to discuss ways in which oral history can be used to both complement wider contemporary and historical commentaries and offer new perspectives on the sport and the cultural relationships it engenders